On Sunday, quarterback Ryan Fitzpatrick suffered a hip subluxation after taking a hard hit early in the second quarter. Fitzpatrick was replaced by Taylor Heinicke and was later ruled out. Fitzpatrick had an MRI of his right hip which confirmed the initial diagnosis. He was later placed on the injured reserve and early reports are that he will be out 6-8 weeks.
What is a Hip Subluxation?
To understand what is fully happening in a hip subluxation it’s first important to understand the anatomy of the hip joint. The hip joint is a ball and socket joint. The head of the femur creates the round ball part of the joint and it rests snugly in the acetabulum or the hip socket on the pelvis.
Because this socket is so small, and the ball of the femur is so large (think golf ball on a tee), our hip joint also has the labrum which is a soft tissue that helps extend/widen the hip socket. The labrum also helps to create a better seal of the joint providing stability while allowing the two bones to move freely without rubbing against each other.
A hip subluxation is where the head of the femur is partially displaced from the socket vs a dislocation which is where the head of the femur is fully displaced from the hip socket. Often, hip subluxations reduce on their own, or in other words the ball returns to the socket on its own.
As you look at the picture, you see that not much of the head of the femur or the ball joint fits in the socket. This is where the ligaments of the hip come in as they help stabilize the hip joint preventing dislocation (see below). These are some of the strongest ligaments in the body.
To sublux or dislocate the hip, it requires massive force loads. In fact, over 90% of posterior hip dislocations are due to car accidents. I say this to better understand the force that Fitzpatrick took to sustain this type of injury. Even as violent as football is, these injuries are rare. The most recent example was Tua Tagovailoa. Although his injury was a full dislocation that required surgery.
The next question to ask is how did the hip get subluxated? Or in other words which direction was the hip joint partially dislocated. This is an important question as it determines which tissues were likely injured. Normally, the hip joint is only dislocated anteriorly or posteriorly and after quickly assessing the play in which Fitzpatrick was injured we can safely assume his hip was dislocated posteriorly or backward.
We can assume this given the position his right hip was in. Hip flexion and hip adduction (hip joint bent forward and towards his left leg) with his knee planted on the ground and the defender’s force and weight driving towards the ground. This created a situation where the head of the femur or the ball was being forced out of the socket backward.
Return to Play
Given the initial timeline of 6-8 and the fact that we know Ryan Fitzpatrick had radiograph/X-Ray and MRI imaging, it is safe to assume that he did not sustain a fracture to the acetabulum or socket joint as his season would be over if this were the case.
The most likely scenario is he has a tear to his labrum in his right hip as this is almost always a given with subluxation or dislocation injury. This was the best possible outcome given the rehab process we all witnessed as Tua recovered following a full dislocation.
Without seeing/assessing the player directly or seeing his imaging, it’s difficult to assess the extent of his injury. As of now, it appears that the team plans to rehab Fitzpatrick conservatively which makes me believe the tear may be minimal. If this is the case, a 6-8 week timeline is the typical return to sport for the conservative management of labral tears as long as his symptoms are managed.
If Fitzpatrick’s pain and mobility cannot be managed, he likely would require surgery which would warrant at least 12 weeks of rehab almost certainly ending his year.
Conservatively, I wouldn’t expect Fitzpatrick to return to play until at least week 8 and I believe there is still a significant chance he will elect for surgery within the next few weeks if his symptoms persist, ending his season.
Fantasy Outlook
I don’t believe Ryan Fitzpatrick warrants a roster spot in any format of fantasy football given he is a 38-year-old quarterback who will be returning from a severe to possibly season-ending injury.
In Superflex leagues, I would be looking to pick up Taylor Heinicke as he can be a match-up based start and I believe he will be the starter over Fitzpatrick the rest of the season. It’s possible the Football Team brings in another quarterback but given Washington’s roster, he may be able to do enough to hold onto this job.
He has limited experience playing in the NFL and isn’t a prolific passer but he provides a solid rushing baseline as he had 46 yards and 1 touchdown on the ground in his only start against the Tampa Bay Buccaneers in the postseason last year.
-Zach Pavlichek, PT, DPT
Feel free to reach out on Twitter @Zachpav42 with any injury questions or concerns.
