Hopes for a 49ers Super Bowl trip were all but dashed when Brock Purdy injured his throwing elbow early on in the conference title game against Philadelphia. Though Purdy will need surgery to repair his ulnar collateral ligament, the 49ers are optimistic that the rookie will be able to return to action come training camp at the end of July.
Purdy is still getting second medical opinions, but the consistent feedback is that the 23-year-old will likely need a repair and not a more invasive replacement of his UCL, general manager John Lynch told reporters on Wednesday. However, a UCL replacement, also known as Tommy John surgery, can't be completely ruled out yet.
The ultimate decision will be made mid-operation when the surgeon can closely examine the ligament.
"The positive bit of news is that it seems to be consistent that the right approach is the one that takes us to the six-month mark," Lynch said. "Everyone will also say, you never know once you get in there. Every surgeon will tell you that on every surgery, you need to get in to see exactly."
Dr. Nirav Pandya, a pediatric orthopedic surgeon at UCSF, isn't surprised by this diagnosis. That Purdy was gingerly throwing the football on the sideline — and later able to throw a handful of wobbly emergency passes once backup Josh Johnson left the game with a concussion — is a good indication that Purdy's UCL is in decent shape despite the tear. Pandya said he would be shocked if surgeons determined that Purdy needed a UCL replacement.
"He has so much less mileage on his elbow, so that works in his favor," Pandya said. "He probably has good cartilage and muscles. It's never a good time for surgery, but the fact it's during his first year is a good sign."
If Purdy undergoes a repair, he will likely be able to start throwing a ball again after three months and return to action after six months.
"Most people, by a large amount of research, predictably get back after six months," Pandya said. "The benefits of repair is that you can throw after three months. So you have May to August to get back to your mechanics and iron out details."
Crisis averted
Surgery is never ideal, but the 49ers have to be relieved by what they're hearing.
Tommy John surgery would force Purdy out for 9-to-12 months, but it is common among athletes with far more wear and tear on their elbows.
Baseball pitchers, including the eponymous Tommy John himself, have typically needed the surgery because they use that ligament to get torque on their pitches, repeatedly thrown at high velocity. Jake Delhomme, formerly of the Panthers, is the only NFL quarterback known to have had Tommy John surgery, and he had a record of elbow pain and injuries.
A UCL repair is far less invasive and would give Purdy plenty of time to rehab his elbow in time for the 2023 season. He and Trey Lance will likely be competing for the starting quarterback job, coach Kyle Shanahan told reporters on Wednesday.
"I know we have two starters on our team right now that I believe we can win with," Shanahan said. "So when you have that situation, you're not that eager to go looking around."
Any post-surgery risks?
Though the recovery time following a repair isn't extensive, there are some concerns to watch for once Purdy returns. Will Purdy feel a little rushed in order to avoid contact on his surgically repaired elbow? Will any lingering soreness impact his play? Will he compensate for any soreness, leaving him vulnerable to injury?
Those are all risks to consider, but the odds that he will have recurring issues with his elbow are low, Pandya says.
"For a repair, because he won't be stressing it, there's a low likelihood he would have recurring issues," he said. "(It's a) better quality tissue — he's not throwing 100 mph fastballs, so all things are in his favor."
While an MLB pitcher is activating his UCL on almost every pitch, the quarterback does not use that part of his elbow when throwing. So chances that Purdy would aggravate the ligament injury are slim.
"The throwing motion is a little different (than a pitcher): You aren't straining the UCL as much," Pandya said. "The football is bigger and (there's) less torque across the elbow. You see muscle issues around the elbow with quarterbacks, but you don't see the ligament take a hit."
The bad luck of Purdy's injury was the timing and placement. It happened on the 49ers' first drive of the game when Eagles linebacker Haason Reddick hit Purdy in the arm as he was attempting to wind up and throw.
"People get hit all the time in the arm," Pandya said. "He's throwing at the right motion where if someone were to hit him, it will strain the UCL. If he hit him two seconds later, he probably would have been fine."
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