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Analyzing Chiefs linebacker Nick Bolton’s wrist injury

Reports indicate that Kansas City’s star linebacker will be out for two months.

Los Angeles Chargers v Kansas City Chiefs Photo by David Eulitt/Getty Images

After a 2022 season in which MIKE linebacker Nick Bolton led the Kansas City Chiefs in tackles — setting a franchise record — he has had an unlucky beginning to his 2023 campaign.

It began with an ankle sprain that caused Bolton to miss three games. Then during the fourth quarter of Sunday’s game against the Los Angeles Chargers — only his second game back — he suffered a dislocated wrist when his left forearm was pinned underneath Los Angeles wide receiver Keenan Allen and another Kansas City defender. Following the incident, Bolton appeared to be experiencing significant pain.

According to initial reports, Bolton is expected to have surgery that will keep him out for about two months.

Analyzing the injury

A week ago, we discussed wide receiver Justin Watson’s elbow dislocation, which is expected to keep him out for a much shorter time — perhaps two to four weeks. While both injuries require a significant amount of force to occur, the biggest difference between them is the sheer complexity of the hand and wrist. This is why Bolton’s timeline for return is so much longer.

A dorsal (posterior) view of wrist joint including the eight carpal bones and ligamentous attachments in a perilunate dislocation.

The wrist joint consists of 15 bones (radius and ulna comprising the forearm, eight carpal bones, and the bases of the five metacarpals). Intertwined with these bones is a highly complex network of muscles, ligaments and nerves. This is what gives the wrist and hand the capacity for essential fine motor skills like gripping, pinching and so on.

While we don’t have precise details for Bolton’s injury, the fact that it requires surgery indicates that damage to ligaments is likely. Bone fractures and nerve damage are also possible.

Wrist dislocations most commonly involve the lunate bone — one of the eight carpal bones — rotating upon impact while the other carpal bones remain in place. A perilunate dislocation — in which the three ligaments surrounding the lunate bone are either completely torn or significantly strained — is also possible.

If the lunate bone is displaced in a palmar or anterior direction, we also sometimes see an injury to the median nerve. This occurs when it is compressed within the carpal tunnel, which is anterior to the lunate bone. Median nerve compression can result in numbness, tingling or pain in the distribution of the median nerve, which is the palmar aspect of the hand — including the thumb and first two fingers.

Again, the precise nature of the injury is unknown; these are some of the possible scenarios.

As with any dislocation injury, post-surgery rehabilitation goals include reducing pain and inflammation, as well as stabilizing the joint(s) by strengthening the surrounding muscles for dynamic stability — which is defined as stability during movement in various positions and different levels of force. Early in rehab, Bolton will also have to work at simple tasks to improve his grip strength and fine motor skills.

It is likely that when he returns to play, he will have a hard cast to protect his injured hand and wrist.

Impact on week 8 and beyond

The Chiefs will have to replace Bolton and his high level of production. This will largely fall upon linebacker Drue Tranquill, who filled in (and played well) during Bolton’s previous absence. The team will surely place Bolton on its Reserve/Injured (injured reserve) list this week — and make a corresponding roster callup.

If Bolton does miss a full two months, he would miss matchups against the Denver Broncos, Miami Dolphins, Philadelphia Eagles, Las Vegas Raiders, Green Bay Packers, Buffalo Bills and New England Patriots, returning in Week 16 against the Raiders on Christmas Day.

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