49ers’ Brock Purdy tears UCL: What are his medical options and how long will he be out?

San Francisco 49ers quarterback Brock Purdy has a complete tear in the UCL in his throwing elbow and will get further opinions on surgery, a league source confirmed to The Athletic on Monday. Purdy suffered the injury in Sunday’s 31-7 loss to the Philadelphia Eagles. Here’s what you need to know:

Purdy exited the NFC Championship Game in the first quarter after taking a shot to the arm by Philadelphia pass rusher Haason Reddick. He returned in the third quarter after backup Josh Johnson entered concussion protocol, but only attempted two passes — for 4 yards — the rest of the game.
Shanahan said Purdy simply couldn’t throw through the injury: “When he (went back) in we had to decide what he could throw and there weren’t too many options.”
The rookie, the final pick in last year’s NFL Draft, was 7-0 as a starter entering Sunday’s game.

Reddick has Philly going wild. #SFvsPHI on FOX
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— NFL (@NFL) January 29, 2023

Background

Purdy was 2-of-2 for 19 yards on San Francisco’s opening drive, but the hit to the arm by Reddick — which forced a fumble that Philadelphia recovered — knocked him out of the game.

“He didn’t lobby much because he went and kept throwing and realized he couldn’t, and so there was no discussion after that,” Shanahan said.

Purdy said after the game he couldn’t throw the ball much more than 5 yards and called the elbow injury “extremely painful.”

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Johnson, the 36-year-old journeyman backup, replaced Purdy and was 7-of-13 passing for 74 yards when he took a hard hit in the third quarter and left the game. With Purdy limited, the 49ers ran the ball on 13 of their final 16 plays, with running back Christian McCaffrey throwing an incomplete pass in addition to Purdy’s two attempts.

The team’s 97 passing yards were its fewest in a game since 2017.

Purdy, 23, ended his rookie season by passing for 1,943 yards, 16 touchdowns and four interceptions in the regular season and postseason combined. The 49ers used four quarterbacks over the course of this season; Jimmy Garoppolo was inactive Sunday while still nursing a foot injury and Trey Lance missed nearly all of the season because of an ankle injury.

What are Purdy’s medical options, when can he expect to return?

Purdy has two options after rupturing the UCL (ulnar collateral ligament) in his right elbow. The first option is a complete reconstruction, aka Tommy John surgery. While his recovery wouldn’t extend as long as it typically does for an MLB pitcher, it could still sideline him for around seven to nine months. During this procedure, the old UCL is replaced with a graft, typically a tendon from elsewhere in the athlete’s body. Tommy John surgery is incredibly rare for NFL quarterbacks.

The second option is an internal brace procedure, where the native UCL is repaired and reinforced with a strong tape-like suture. It is then attached to the humerus (upper arm bone) and ulna (one of two bones in the forearm) with anchors. If the UCL can be repaired, this is a much better scenario with a shorter recovery. Six months is a realistic timeline to return if the ligament can be salvaged.

The decision between a repair or total reconstruction will depend on the location and severity of the tear. Purdy should be able to return next season with a strong and stable elbow, but lingering soreness is common. If the UCL is repaired he has a shot at being ready to play in Week 1. This is less likely to happen with Tommy John surgery, although he should be ready in the first half of the season. — Zakas

49ers’ bad luck at quarterback

The 49ers’ quarterback injury nightmare only worsens. Although the team hopes that Purdy will be able to avoid the dreaded Tommy John surgery, the full UCL tear and six-month recovery prognosis is still exponentially worse than the hope on Sunday night.

At the very least, Purdy will now miss the entirety of an offseason program that was slated to be critical for him — and possibly even a chance for him to solidify a hold on the QB1 job.

Now, San Francisco has only one quarterback under contract for 2023 who has a shot at being healthy for the offseason program, and that’s Trey Lance. But even Lance is still in a walking boot, as he underwent a second surgery to remove a device from his previously fractured ankle last month.

The 49ers will certainly have to add a quarterback this offseason, even if their plan is to put Lance back into the top quarterback spot (he began the 2022 season there). The possibility of yet another reunion with Jimmy Garoppolo, who’s scheduled to become a free agent in March, cannot be ruled out. And Tom Brady talk certainly won’t subside with this news — although acquiring any higher-profile veteran would push the 49ers into a zone of financial discomfort.

This latest wrench with Purdy adds yet another hairpin turn into the windy road that has been San Francisco’s quarterback saga of the past few years. – Lombardi

Offseason challenges to overcome

For the second straight year, the 49ers quarterback who started the NFC Championship game will need surgery and may require several months of recovery. That threw a wrench in the team’s offseason plans to trade Jimmy Garoppolo last year.

It likely means that the 49ers will need to sign at least one veteran passer in free agency — or trade for one — this year. If Purdy is indeed out for six months, he’ll miss all of the spring practices.

Trey Lance should be recovered enough from his second ankle surgery last month to take part in the spring session, but whether he’s fully cleared remains to be seen. He was wearing a walking boot on his right foot on Sunday. It could mean that none of the quarterbacks who started for the 49ers in 2022 — Garoppolo, Lance and Purdy — are running the first-team offense in team drills when OTAs commence in May. — Barrows

Required reading

(Photo: Bill Streicher / USA Today)