The curious case of Tyrod Taylor

The curious case of Tyrod Taylor
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Wow, what a week. When one of our editors suggested doing this column, never did I imagine that we’d have a week like week 2 of the 2020 NFL season. Whilst watching RedZone on Sunday it felt like there was a new injury concern every 5 minutes. Saquon Barkley, Nick Bosa, Jimmy G, the list was endless. This week, however I am going to focus on the curious case of Tyrod Taylor

HERBERT STARTS!!!

Image:Oregonlive.com

Without any fanfare or warning, Justin Herbert lined up under centre for the LA Chargers in their narrow defeat to the reigning Super Bowl Champs, the Kansas City Chiefs. Something seemed amiss, everyone had expected Tyrod Taylor to start. Usually when a rookie first rounder is about to start at QB, we know about it.

Reports emerged that Taylor had a chest injury just before the game and was unable to suit up. As more information came to light, it was then known that Taylor had been taken to a local hospital following complications from a rib injection.

Then on Wednesday afternoon there came the revelation that the Chargers QB had suffered a ‘punctured lung’ during the procedure.

Queue memes and GIFs galore on Twitter. But what actually happened? And how was this possible?

Intercostal Nerve Block

Tyrod Taylor apparently had fractured a rib and was to have a ‘painkilling injection’ to allow him to play on Sunday. The procedure, although I cannot know for sure, is most likely to have been an intercostal nerve block.

Image: Dr Vittoria Repetto

The intercostal nerves, shown above in yellow, supply the ribs and surrounding area. An intercostal nerve block is a regional anaesthetic technique in which the nerves are temporarily ‘frozen’, similar to the type of techniques used in dental treatments. This type of block can be used to treat conditions affecting the chest wall such as shingles or surgical incisions. In Tyrod’s case it was being used to treat a fractured rib to allow him to play as pain free as possible.

So how did this end up ‘puncturing his lung’, or to use the proper terminology, a pneumothorax?

Iatrogenic Pneumothorax

A pneumothorax occurs when air, for whatever reason, fills the space between your chest wall and you lung known as the pleural cavity. This can be caused by various traumas, surgeries or occasionally spontaneously and will cause all, or part, of the lung on the affected side to collapse.

Image: Saintlukeskc.org

These can also be caused iatrogenically, as in Tyrod’s case – iatrogenic meaning caused by diagnostic or therapeutic medical interventions.

So how easy is it to cause a pneumothorax such as that suffered by the Chargers Quarterback during this procedure? It’s difficult to say really and its certainly not as bad as been made out on twitter. The most recent study I could find on PubMed, which looked at Pneumothorax after this procedure for rib fractures (which is the reason Tyrod was getting this done) showed than for every nerve blocked (and we don’t know how many ribs were affected here) was approximately 1.4% of the time

So there you have it. Just over 1 time every 100 procedures might this occur.

Treatment and Comeback

The treatment that Tyrod Taylor will receive is very much dependent on the size of the Pneumothorax. Smaller incidence can be left to heal spontaneously, where in larger or very symptomatic incidence a chest drain tube is inserted into the pleural space to drain all the air out and reinflate the lung.

Flying is out of the question for at least 2 weeks after complete resolution and I suspect it will be at least 4-6 weeks before Tyrod is back on the practice field in contact drills.

As always, I’m keen to hear any feedback you may have on these articles – either @stuie17 or @NinetynineYards on Twitter

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