Somewhat overshadowed by the Kentucky Derby, Manny Pacquiao’s boxing title defense, the Lakers being swept out of the NBA playoffs, and Justin Verlander’s second no-hitter was one of the most gruesome injuries since Joe Theismann’s tibia fracture on Monday Night Football over 25 years ago. Boston Celtics’ point guard Rajon Rondo fell to the floor in Game 3 against the Miami Heat after getting tangled up with Dwyane Wade. His elbow immediately buckled, and the obvious deformity caused the stadium crowd and national audience to hold its collective breath.

After the game, Rondo told ABC’s Lisa Salters that his elbow was “still broken.” Actually, his elbow wasn’t broken but instead was dislocated. Whatever the injury was, NBA fans couldn’t believe any player could return after such a horrible injury.

The disbelief of fans comes partly from the fact that it is an uncommon injury, especially in sports. In fact, the only other elbow dislocation I can remember in college or professional sports was the 1999 Peach Bowl, when Clemson running back Travis Zachery dislocated his elbow early in the game.

An elbow dislocation is a fairly straightforward, albeit uncommon, injury. Typically an athlete lands on his outstretched hand with the elbow flexed, driving the ulna (one of the forearm bones) backward and popping it out from under the humerus. It’s uncommon because the elbow is a very stable joint.

While it might be easy to explain what Rondo did to his arm, explaining how he could come back to play is more difficult. I assume that the TD Garden has x-ray capability in the building because the team doctor would need to know immediately what the nature of the injury was. If x-rays had indeed shown a fracture of any of the bones around the elbow, almost certainly the doctor would have held him out. In this case, x-rays must have shown that Rondo did not break any bones when the elbow dislocated.

The team doctor then had to somehow put Rondo’s elbow back in place. While reducing an elbow dislocation can be straightforward, it is a painful procedure usually done in emergency rooms under sedation because, honestly, it hurts. A lot. The doctor couldn’t have given Rondo any narcotics if he had any realistic chance of returning in that game. And injecting an elbow to eliminate all pain is not as easy as fans might think. There are a number of nerves travelling around the elbow, and injecting all of them would be difficult and unlikely to make the elbow completely numb. I can imagine the doctor pushing the elbow quickly and firmly while Rondo screamed or bit on a towel.

Lastly the doctor had to decide if it was safe to allow Rondo to return to the game. I’ve mentioned previously in this column my two criteria for return to play after an injury. First, can the player protect himself from doing further damage? Rondo came back in what looked like a bulky elbow sleeve. While providing compression, that sleeve or brace probably did little to provide any real stability. Fortunately the natural stability of the elbow made a recurrent dislocation unlikely without damage to the stabilizing ligaments around the elbow, as an MRI confirmed the next day.

The second question I ask is how effective the player will actually be if he returns. Can he do his job on the court? Fortunately this was not Rondo’s shooting arm or main dribbling and passing hand. He barely used his left arm, often letting it dangle at his side while playing with his one good arm. And Miami tried to exploit the injury by frequently driving toward Rondo’s injured side and playing physically against him.

I’m writing this column as Miami defeated Boston in overtime of Game 4. And while there will be much second guessing after the team’s Game 4 performance, Rondo’s game tonight won’t draw their fans’ criticism. From my perspective, Rondo’s play the last two games after his horrific fall was one of the gutsiest performances I’ve seen in years – and almost as gutsy as was the decision by the Celtics’ doctor to let him play at all.

What do you think? Was it one of the most graphic injuries you’ve seen? Was it a risky decision on the part of Rondo? Or his doctor? Let me know what you think!

Note: The following post will appear as a column in the May 11, 2011 edition of The Post and Courier.