That was close.
As has been discussed at length, Ben Roethlisberger suffered what ended up being an incredibly rare and dangerous rib injury during Pittsburgh's 16-13 overtime win over the Kansas City Chiefs Monday night.
How difficult is it to injure the first rib?
Consider this: On medical board exams, students and physicians are taught that unless the question describes someone in an unrestrained motor vehicle accident, a first rib injury is not the correct diagnosis.
That is the injury Big Ben suffered.
Not just a shoulder sprain.
Not just a "rib injury."
A, quite literally, potentially fatal first rib dislocation.
While the scene that unfolded in Pittsburgh Monday night looked like a run-of-the-mill injury to a quarterback, it could have been much, much worse.
How much worse?
The first rib is buried deep within the upper chest. In fact, it is so deep it is impossible to feel from the outside of the body, unlike the clavicle (collar bone) and second rib, both of which can be felt without difficulty.
That is the reason why the injury to Big Ben could have been catastrophic. If his rib dislocated further, Monday Night Football could have ended with Big Ben undergoing emergency life-saving surgery, or worse.
Because the first rib is so deep in the upper chest, it is located amongst a number of important structures.
Such as the lung.
And the esophagus.
Oh, and the aorta.
That's right, the aorta, or the single largest and most important blood vessel in the body that takes blood directly from the heart to not just one or two specific locations, but to the entire rest of the body.
A dislocated or fractured first rib, if displaced enough inwards, can press on or tear the aorta.
Pressure on the aorta compromises blood flow to the rest of the body.
Tears are even more frightening, as they result in massive internal bleeding.
Additionally, they are not just occasionally or sometimes fatal.
They are almost always fatal.
Kinda makes the idea of Big Ben trying to "tough it out" sound a little silly, right?
Fortunately for Roethlisberger, he "only" has a partially dislocated first rib. However, as with any dislocation, the tissues keeping the rib in place are weak.
That means that further injury is likelier, as well as all of the scary consequences that could result.
While the human body is beautifully designed to protect the first rib and the structures underneath, it would be foolish and, frankly, reckless, for Big Ben to return until the rib is healed and firmly back in its proper location.
How long will that take?
No one can really say.
The injury is so rare that a clear cut timetable to return is impossible to predict because there is no basis on which to compare, but for now, the Associated Press reports Byron Leftwich will be under center for the Steelers (h/t Fox Sports).
The AP reports Big Ben is still in extreme pain that is preventing him from sleeping (via NFL.com) and will not be returning any time soon.
No one will waver on that, either.
Given the severity of the situation, that is for good reason.
The author of this article is a soon-to-be Family Medicine resident physician with plans to eventually specialize in Primary Care (non-operative) Sports Medicine. The above injury information is based on the author's own anatomical and clinical knowledge. Additional input is welcomed and encouraged.
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