PA-S | Ortho bro here to explain how injuries actually work and to share other health knowledge | Mechanisms, anatomy, timelines, never an official diagnosis
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Jack Hughes⬇️
Chipped teeth are practically a hockey rite of passage as Jack Hughes here would say 🏒🦷
But here’s the anatomy + physiology behind how they get fixed.
🦷 What Happens When a Tooth Chips?
Teeth have layers:
1.Enamel – Hard, mineralized outer shell (no nerves, no blood supply)
2.Dentin – Softer layer underneath, contains microscopic tubules connected to nerves
3.Pulp – Central core with blood vessels and nerves
If the chip is:
•Enamel only → cosmetic issue, usually painless
•Into dentin → sensitivity to air/cold (fluid shifts in dentinal tubules stimulate pulp nerves)
•Into pulp → bleeding, significant pain, infection risk
🏒 How Does It Get Fixed?
1️⃣ Evaluation
Team dentist checks depth of fracture and maybe an X-ray to assess pulp involvement.
2️⃣ Enamel/Dentin Chip
Most common in hockey.
•Smoothed or rebuilt with composite resin bonding
•Resin chemically bonds to enamel via acid etching
•Light-cured to harden
Function restored immediately.
3️⃣ If Pulp Is Exposed
•Root canal: Remove inflamed pulp, disinfect canal, fill with gutta-percha
•Crown may be placed later for structural strength
🧠 Physiology Pearl
Dentin hypersensitivity happens because exposed dentinal tubules allow fluid movement which triggers mechanoreceptors in the pulp (hydrodynamic theory).
Ah shit here we go again
Chipped teeth are practically a hockey rite of passage as Jack Hughes here would say 🏒🦷
But here’s the anatomy + physiology behind how they get fixed.
🦷 What Happens When a Tooth Chips?
Teeth have layers:
1.Enamel – Hard, mineralized outer shell (no nerves, no blood supply)
2.Dentin – Softer layer underneath, contains microscopic tubules connected to nerves
3.Pulp – Central core with blood vessels and nerves
If the chip is:
•Enamel only → cosmetic issue, usually painless
•Into dentin → sensitivity to air/cold (fluid shifts in dentinal tubules stimulate pulp nerves)
•Into pulp → bleeding, significant pain, infection risk
🏒 How Does It Get Fixed?
1️⃣ Evaluation
Team dentist checks depth of fracture and maybe an X-ray to assess pulp involvement.
2️⃣ Enamel/Dentin Chip
Most common in hockey.
•Smoothed or rebuilt with composite resin bonding
•Resin chemically bonds to enamel via acid etching
•Light-cured to harden
Function restored immediately.
3️⃣ If Pulp Is Exposed
•Root canal: Remove inflamed pulp, disinfect canal, fill with gutta-percha
•Crown may be placed later for structural strength
🧠 Physiology Pearl
Dentin hypersensitivity happens because exposed dentinal tubules allow fluid movement which triggers mechanoreceptors in the pulp (hydrodynamic theory).
Here we go again
Chipped teeth are practically a hockey rite of passage as Jack Hughes here would say 🏒🦷
But here’s the anatomy + physiology behind how they get fixed.
🦷 What Happens When a Tooth Chips?
Teeth have layers:
1.Enamel – Hard, mineralized outer shell (no nerves, no blood supply)
2.Dentin – Softer layer underneath, contains microscopic tubules connected to nerves
3.Pulp – Central core with blood vessels and nerves
If the chip is:
•Enamel only → cosmetic issue, usually painless
•Into dentin → sensitivity to air/cold (fluid shifts in dentinal tubules stimulate pulp nerves)
•Into pulp → bleeding, significant pain, infection risk
🏒 How Does It Get Fixed?
1️⃣ Evaluation
Team dentist checks depth of fracture and maybe an X-ray to assess pulp involvement.
2️⃣ Enamel/Dentin Chip
Most common in hockey.
•Smoothed or rebuilt with composite resin bonding
•Resin chemically bonds to enamel via acid etching
•Light-cured to harden
Function restored immediately.
3️⃣ If Pulp Is Exposed
•Root canal: Remove inflamed pulp, disinfect canal, fill with gutta-percha
•Crown may be placed later for structural strength
🧠 Physiology Pearl
Dentin hypersensitivity happens because exposed dentinal tubules allow fluid movement which triggers mechanoreceptors in the pulp (hydrodynamic theory).
Ah shit here we go again
Chipped teeth are practically a hockey rite of passage as Jack Hughes here would say 🏒🦷
But here’s the anatomy + physiology behind how they get fixed.
🦷 What Happens When a Tooth Chips?
Teeth have layers:
1.Enamel – Hard, mineralized outer shell (no nerves, no blood supply)
2.Dentin – Softer layer underneath, contains microscopic tubules connected to nerves
3.Pulp – Central core with blood vessels and nerves
If the chip is:
•Enamel only → cosmetic issue, usually painless
•Into dentin → sensitivity to air/cold (fluid shifts in dentinal tubules stimulate pulp nerves)
•Into pulp → bleeding, significant pain, infection risk
🏒 How Does It Get Fixed?
1️⃣ Evaluation
Team dentist checks depth of fracture and maybe an X-ray to assess pulp involvement.
2️⃣ Enamel/Dentin Chip
Most common in hockey.
•Smoothed or rebuilt with composite resin bonding
•Resin chemically bonds to enamel via acid etching
•Light-cured to harden
Function restored immediately.
3️⃣ If Pulp Is Exposed
•Root canal: Remove inflamed pulp, disinfect canal, fill with gutta-percha
•Crown may be placed later for structural strength
🧠 Physiology Pearl
Dentin hypersensitivity happens because exposed dentinal tubules allow fluid movement which triggers mechanoreceptors in the pulp (hydrodynamic theory).
Likely some sort of grade 1 MCL sprain for Marchenko given the mechanism and timeline
Given at the time of injury his skate was not stuck in the ice could have prevented an ACL injury with it
Grade 1 injuries have returned to play in as little as 10 days but Kirill will probably wait till he is pain free and feels stable
🚨 A group of Leafs fans bumped into Kirill Marchenko at the Calgary airport today, where he told them he was “flying back home today” and will be back in “two weeks.”
As of now, no official confirmation has been made by the Leafs (should know more tomorrow)
📸: @Alwaysbardown1
#leafs
The Body Explained | Hockey Injuries retweeted
Sam Steel of the Stars received an “injection as part of his treatment”
What does that mean?
It could mean several things
Most often, this means a corticosteroid injection. Corticosteroid injections switches off inflammatory genes which reduces pain and swelling. The steroid takes effect over a few days, and a "steroid flare" (more pain for 24–48 hours) can happen first. I have been giving a ton of these on my current school rotation
The trade-off is that inflammation is part of normal healing, so suppressing it may in theory slow repair.
🚨The steroid also does not reverse structural damage! An injection does not repair tissue.
Other possibilities are platelet-rich plasma (PRP) or an anesthetic-only diagnostic injection.
Diagnostic anesthetic injection involves numbing a specific spot, such as the hip joint, helps identify the pain source. If pain goes away, the joint is the likely source.
PRP is when the player's own concentrated platelets are injected to try to stimulate healing. It has been tried for adductor injuries that don't respond to rehab, but evidence is limited (@DrJesseMorse is a good follow for this stuff)
What does this tell us in Steel’s case?
Steroid injection directly into a fresh muscle tear is controversial, so this injection 2 days after an injury points to something to more than a simple tear
Bursitis or tendon irritation respond well to injections, and can lead to a return of play in as little as a week
Reviews note that a midseason corticosteroid injection may be considered specifically to speed return to play for players with recurrent pain. Steele had a hip/groin issue this March, so this is very much in play
Overall, a quick return (days to about 2 weeks) suggests the injection was used to manage pain or inflammation in a minor or chronic problem so he can keep playing.
A longer absence suggests the injection was diagnostic or supportive alongside a real structural injury.
Ran across this as well and definitely something to look into
In mice, hypobaric exposure 3 hours after mild TBI increased neuronal injury markers and IL-6. Exposure at 24 hours did not.
The Body Explained | Hockey Injuries retweeted
Could oxygen availability be an overlooked factor in concussion recovery?
Interesting connection here to the emerging research on hyperbaric oxygen therapy (HBOT) for TBI.
Commercial flying reduces oxygen pressure, while HBOT increases oxygen delivery to tissues.
Given the mitochondrial dysfunction and altered energy metabolism that can follow brain injury, it’s worth asking how changes in oxygen availability influence recovery.
The research remains inconclusive, but I think this is an area deserving much greater attention.
This article was not peer reviewed so take it with a couple grains of salt, but I was able to find a 2012 conference abstract on NFL and NHL players found that those who flew commercially soon after brain injury missed more games.
The authors suggested postponing flights by 48–72 hours until early symptoms ease.
Kirich took a big blow to the head, so likely just a precaution and is what it says
Interesting find I thought I’d share!
This angle of the Hyman hit shows his head hitting the boards
Immediately looks dazed and needs to be helped off, concussion protocol is likely
I remember hearing as a kid that anytime someone is grabbing at their helmet like Hyman was it probably isn’t the best news
This article was not peer reviewed so take it with a couple grains of salt, but I was able to find a 2012 conference abstract on NFL and NHL players found that those who flew commercially soon after brain injury missed more games.
The authors suggested postponing flights by 48–72 hours until early symptoms ease.
Kirich took a big blow to the head, so likely just a precaution and is what it says
Interesting find I thought I’d share!
Per Lindy Ruff, forward Jiri Kulich “hasn’t cleared enough” in his protocol to fly west yet.
More info → bufsabres.co/3WNIHbn
Looks like a common mechanism for an MCL injury but does not look too severe
🦴In regards to Jaxson Dart's recent injury, here are some things to know about the MCL as the potential main injury....
🔹The MCL is the main restraint to valgus stress, which is what you can see is disrupted when he was hit
🔹The semimembranosus and pes anserinus tendon add to the stabilization
⚕️Injury wise...
🔹Typically a valgus force to the knee causes injury (as seen in the picture)
🔹Younger patients may see bone injuries or MCL avulsions, which may be seen in Dart given the recent update being worse than originally thought
Grade 1 - microscoping tearing
Grade 2 - partial disruption/tear
Grade 3 - full tear
Symptoms likely include inner knee pain and tenderness, bruising, and instability depending on the grade
🩺Management will depend on severity. Almost all isolated grade 1 and 2 injuries do not need surgery as it heals very well on its own.
Avulsions and full tears generally need surgery as well as when the injury is combined with ACL tears.
Pretty common mechanism for an MCL injury but didn’t look too severe
🦴In regards to Jaxson Dart's recent injury, here are some things to know about the MCL as the potential main injury....
🔹The MCL is the main restraint to valgus stress, which is what you can see is disrupted when he was hit
🔹The semimembranosus and pes anserinus tendon add to the stabilization
⚕️Injury wise...
🔹Typically a valgus force to the knee causes injury (as seen in the picture)
🔹Younger patients may see bone injuries or MCL avulsions, which may be seen in Dart given the recent update being worse than originally thought
Grade 1 - microscoping tearing
Grade 2 - partial disruption/tear
Grade 3 - full tear
Symptoms likely include inner knee pain and tenderness, bruising, and instability depending on the grade
🩺Management will depend on severity. Almost all isolated grade 1 and 2 injuries do not need surgery as it heals very well on its own.
Avulsions and full tears generally need surgery as well as when the injury is combined with ACL tears.
Doesn’t look too severe but looks like common mechanism of MCL injury
🦴In regards to Jaxson Dart's recent injury, here are some things to know about the MCL as the potential main injury....
🔹The MCL is the main restraint to valgus stress, which is what you can see is disrupted when he was hit
🔹The semimembranosus and pes anserinus tendon add to the stabilization
⚕️Injury wise...
🔹Typically a valgus force to the knee causes injury (as seen in the picture)
🔹Younger patients may see bone injuries or MCL avulsions, which may be seen in Dart given the recent update being worse than originally thought
Grade 1 - microscoping tearing
Grade 2 - partial disruption/tear
Grade 3 - full tear
Symptoms likely include inner knee pain and tenderness, bruising, and instability depending on the grade
🩺Management will depend on severity. Almost all isolated grade 1 and 2 injuries do not need surgery as it heals very well on its own.
Avulsions and full tears generally need surgery as well as when the injury is combined with ACL tears.
Potential MCL injury but doesn’t look too severe
🦴In regards to Jaxson Dart's recent injury, here are some things to know about the MCL as the potential main injury....
🔹The MCL is the main restraint to valgus stress, which is what you can see is disrupted when he was hit
🔹The semimembranosus and pes anserinus tendon add to the stabilization
⚕️Injury wise...
🔹Typically a valgus force to the knee causes injury (as seen in the picture)
🔹Younger patients may see bone injuries or MCL avulsions, which may be seen in Dart given the recent update being worse than originally thought
Grade 1 - microscoping tearing
Grade 2 - partial disruption/tear
Grade 3 - full tear
Symptoms likely include inner knee pain and tenderness, bruising, and instability depending on the grade
🩺Management will depend on severity. Almost all isolated grade 1 and 2 injuries do not need surgery as it heals very well on its own.
Avulsions and full tears generally need surgery as well as when the injury is combined with ACL tears.
Sam Steel of the Stars received an “injection as part of his treatment”
What does that mean?
It could mean several things
Most often, this means a corticosteroid injection. Corticosteroid injections switches off inflammatory genes which reduces pain and swelling. The steroid takes effect over a few days, and a "steroid flare" (more pain for 24–48 hours) can happen first. I have been giving a ton of these on my current school rotation
The trade-off is that inflammation is part of normal healing, so suppressing it may in theory slow repair.
🚨The steroid also does not reverse structural damage! An injection does not repair tissue.
Other possibilities are platelet-rich plasma (PRP) or an anesthetic-only diagnostic injection.
Diagnostic anesthetic injection involves numbing a specific spot, such as the hip joint, helps identify the pain source. If pain goes away, the joint is the likely source.
PRP is when the player's own concentrated platelets are injected to try to stimulate healing. It has been tried for adductor injuries that don't respond to rehab, but evidence is limited (@DrJesseMorse is a good follow for this stuff)
What does this tell us in Steel’s case?
Steroid injection directly into a fresh muscle tear is controversial, so this injection 2 days after an injury points to something to more than a simple tear
Bursitis or tendon irritation respond well to injections, and can lead to a return of play in as little as a week
Reviews note that a midseason corticosteroid injection may be considered specifically to speed return to play for players with recurrent pain. Steele had a hip/groin issue this March, so this is very much in play
Overall, a quick return (days to about 2 weeks) suggests the injection was used to manage pain or inflammation in a minor or chronic problem so he can keep playing.
A longer absence suggests the injection was diagnostic or supportive alongside a real structural injury.
Rasmus Ristolainen suffered another injury of the same hand he hurt on 10/5 from being hit with a puck
He returned two days ago, so 19 days after the original injury which tells us it probably wasn’t a fracture as 19 days is too early to tolerate impact
He is now suspected to miss two weeks
Major concern could be a bone bruise that is now a fracture but the two weeks would still be too little, so it is likely just a reaggrevated contusion they want to fully heal
X-Rays were probably redone to confirm
"He really got it in an awkward spot and kind of re-aggravated it. Kind of a bad luck injury." nbcsportsphiladelphia.com/nh…
The Body Explained | Hockey Injuries retweeted
Logan Thompson's injury history raises some interesting questions about his latest setback.
In 2018 with Brandon (WHL), he suffered a leg injury, missed the final five regular-season games, returned for the playoffs and reinjured it in Game 2, ending his season.
In February 2023 with Vegas, he suffered an apparent left-leg injury, missing 18 games. He returned in March, only to suffer another lower-body injury in his first game back. His rehabilitation subsequently stalled, with Bruce Cassidy acknowledging he wasn't responding well to the workload. He never played again that season.
In April 2025, a collision forced him into the splits, leaving him unable to bear weight on his left leg.
Now, another lower-body injury with apparent left-leg discomfort.
We don't know whether these injuries involve the same structures, but the repeated setbacks following return to play are concerning.
Is there an underlying issue with force production, load tolerance or unresolved deficits from previous injuries?
Sometimes the injury isn't the entire problem. It's what remains after the athlete returns to play.
Logan Thompson left practice after 45 minutes today, which could mean nothing and just be load management
It does not really confirm any diagnosis, but given the speculation of an adductor strain it could’ve been under recovered and loaded too early
Pain usually goes away with these strains in a couple days but can be felt with higher level activities for a couple weeks
The worst fear is a higher grade strain or insertional injury
I wrote an article on adductor strains that will help below!
