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March 9, 2010

Under The Knife

Spring Injury Roundup

by Will Carroll

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It's the first UTK of the season. Normally, I do these on Fridays during spring training, but there was just too much misinformation out there on a couple of these cases to wait for the end of the week. I'm excited about another season—my ninth!—of doing UTK, a run that will cross the 1,000-column mark sometime in May. As always, I'm trying to be better at it, to get you the information you want in a readable, understandable way. To help, I'm making a few changes. My continued quest for a quick way to put an expected return date shifts now to what you'll see below. After the player's name, you'll see the condition and the ERD. The ERD is a very, very, very rough guess, based on the best information at the time. It's designed to be more of a "quick look" than a definitive time frame, so it will change from day to day if the information has changed or if a team gives better guidance. I think having the condition readily available will help as well for those of you that just skim UTK.

You'll also see UTK comments shifting over to the player cards as part of the new format. That functionality is still being worked on, so don't count on it being 100 percent just yet. We're also rolling out ways to get the information I get out to you faster. Those aren't ready yet, but believe me, the work behind the scenes is happening and yes, we're listening. Finally, while I appreciate questions in comments, I'm going to tend to ignore them this year. Too often, it turned into "what about this guy?" I'm not going to cover every single injury. I'm going to focus on the ones where I can add to the discussion. If you want exhaustive coverage (rather than an exhausted Injury Guy), try our friends at Rotowire, who do that very well. This year I'm going to focus on explanation and education, something I hope you'll help me share. So, powered by the excitement of another season together, on to the injuries:
 

Jose Reyes (thyroid: 3/20)
Let's face it, this is the Mets, and after last year nothing is going to be taken at face value. Reyes was found to have a thyroid hormone imbalance during the course of normal tests in comparison to previous tests. He was already running and doing baseball activities, but because this was a condition that could affect him and because of that long shadow of medical dysfunction that still hangs over the team, they went conservative. Reyes was held out of activities and then sent back to New York for further testing and to determine a treatment. In most cases, the thyroid situation can be taken care of with medication. In extreme cases, surgery or a more aggressive medication is necessary. Reyes showed no symptoms of the condition, normally called Graves' disease, and seemed to have no problem through his rehab from hamstring problems. There's nothing here that seems to have any long-term consequences. Speaking with several doctors who have knowledge of both thyroid conditions and athletic performance, including some that worked with Florence Griffith-Joyner (who suffered from the condition), indicate that the only issue might be with adjusting to medication. Joyner often complained that her medication made her "feel slower" and early in her career, would go off her medication before competitions, according to several reports from the mid-'80s. While Joyner often faced the kind of PED accusations that Reyes is now hearing, she never failed a drug test, and her autopsy showed that a congenital brain defect caused her death, not drugs as many still think. What Reyes faces is an adjustment, not a problem.

Joe Nathan (torn UCL: unknown)
Nathan had chips removed from his elbow. If you've read my column before or heard me talking about Johan Santana recently, you'll know this is usually not a big deal. Honestly, the operation isn't that different from "Operation." You know, the game wherethe surgeon reaches in with his scope, grabs the chips, pulls it out, and hopefully the nose doesn't light up. (Actually, it's a bit more brutal than you'd expect: you can watch a typical procedure here.) Nathan's chips had actually lodged into the UCL, the "Tommy John" ligament, and were causing inflammation. Now, we have to wonder if the damage they were doing was already done. It's odd, since as the chips were being taken out, the ligament would be visualized and we assume was intact. That means the mere act of removing the chips changed something, and soon after a return, the ligament snapped. It recalls the case of A.J. Burnett, who had spurs removed and shortly afterwards had to have TJS. It's not a complete tear (or rupture), and the Twins will give Nathan a chance to try and rehab it, but in almost all cases, he'll end up with that iconic triangular scar on his elbow and a lost season on his record.

Alex Gordon (fractured thumb: 4/1)
Headfirst slides actually aren't more dangerous. Back in the initial days of UTK, we found out together1 that studies done on collegiate softball players indicated that while more people broke fingers on headfirst slides, the broken ankles of footfirst slides equalled things out. That said, Alex Gordon doesn't feel very good about his decision. As you'll hear Wednesday on BP Radio, there's a new glove technology that might have helped him avoid this. Gordon's fracture is at the tip of the thumb, above the joint but not under the nail. As breaks go, that's not a bad one. He'll be splinted to protect it, but can keep his cardio going and do many of the exercises he'd normally do. While the 3-4 week timeframe is solid, it's possible that Gordon is ready for opening day. The location of the fracture makes it less involved in the grip, meaning his bat control shouldn't be affected. Gordon has a lot of questions heading into 2010, so while this injury doesn't help, he should still get the chance to answer those questions in April.

Russell Martin (groin strain: 4/1)
The initial stories about Martin's injuries all went the same direction. Whether you were reading ESPN Los Angeles or the LA Times, whether you were reading MLB.com or the blogs, there was an underlying implication that Martin might be dealing with a hip problem rather than a groin. The femoral acetabular impingement problem often presents as groin pain, so it's understandable. What I don't get is how so many different places went the same direction. That means someone, somewhere pointed them in that direction. Fact is, Martin simply tried to play through what he thought was a minor problem and couldn't. It's a simple Grade I/II strain2, painful, but not a long-term problem. It does put the Dodgers in a tough situation, since Brad Ausmus would be exposed by extended playing time. Martin should be nearly ready by opening day since all indications are that he'll push for that and since this is on the lower end of the spectrum.

Angel Guzman (torn shoulder ligament, labrum: unknown)
Guzman is no stranger to surgery. Jim Andrews did both his elbow (TJS) and shoulder (labrum) previously, but there might not be anything that anyone can do this time. With a torn ligament and damaged capsule, Guzman is facing the end of his career. There's no guarantee that surgery could get him back, leaving him and the Cubs with a tough decision. Take the chance on surgery and an extended rehab or try to work through it. Since Guzman's going to be on  the Cubs' dime either way, there's every reason to think he'll work towards some kind of comeback. This is a problem that doesn't really have any known root cause, which makes it all the tougher to pinpoint. Guzman simply couldn't stay healthy, at any level, in any role. That's not his fault; it's just how the game works sometimes. While it's hard to just throw your hands up and say, "I don't know," that's all we can do. We don't have enough information to do any more, but perhaps that's the real issue.

Brian Roberts (herniated disc in lower back: 3/17)
Kidney stones are painful. I mean really painful, knee-bucklingly so. I'm sure at some level Roberts is glad that's not what he has, but a herniated disc isn't better. While the team can calm things down, this is something that can easily recur if it gets exacerbated. That's why the Orioles are being so conservative with him early in camp. Roberts is taking some swings and will progress slowly to game action. Any pain or setbacks will push them to be even more conservative. There's still plenty of time for him to get ready and opening day is certainly within reach for him. There's a bigger question about how this might affect his speed and range. I think the steals will be down early in the season as the conservatism is in place. The longer he goes without a recurrence the better and the more likely he'll begin running as normal. (On a cool note, former BP Idol contestant Brittany Ghiroli is following this situation in her new job as the Orioles' beat writer at MLB.com. She's an honorary medhead for the solid coverage and great questions she's asking.)

Emmanuel Burriss (broken foot: unknown)
It's not often that a team admits it's going to medicate a player. Sure, painkillers are used and appropriate medications like anti-inflammatories are well noted. Burriss is going to do something that hasn't been done ... or at least admitted. The Giants are "throwing the kitchen sink" at the problem, according to head ATC Dave Groeschner in this Chronicle article. Burriss will have injections of Forteo, a drug normally used for post-menopausal osteoporosis. (Go ahead, recycle those Manny Ramirez jokes from last summer.) Forteo was rumored to be used several years ago as the A's tried to get Mark Mulder back for the playoffs. This kind of approach tells you just how seriously the Giants are taking the task of keeping Burriss' foot together. It also shows just how close he is to having his career end because of the chronic problem.

Mark DeRosa (torn tendon sheath in wrist: 3/20)
While Rickie Weeks might be a bit ahead, more should be watching to see how DeRosa comes back from the same surgery. He had surgery last fall and was expected to miss much or even all of spring training. Instead, DeRosa is ahead of schedule and thinking he could make his Giantsdebut as early as next week. DeRosa has had no problems at all in his rehab and says he's feeling great. Observers who watched him hit said they saw nothing different in his swing and noted that he was not hesitant at all. This is all a good sign and if we get a look at him in spring games, the key will be to see if he's lost any power or has any residual inflammation after use. Watch out here becausethe story will be that he's ahead of schedule, but the important fact will be that he doesn't have pain and/or inflammation between outings.

Cameron Maybin (groin strain: 3/15)
Bases are dangerous. While breakaway bases have come into play in many youth leagues, it's still an issue for some major leaguers. We saw it with Gordon and the Marlins are worried a bit about Maybin. Maybin strained his groin—look, please don't say "tweak" about groins—when he stepped awkwardly on third as he rounded it. A speed player always worries about a muscle strain in his legs, but word is that this is minor and the Marlins are just being cautious with their presumed starting center fielder. I'm not overly concerned about this in the long term, but since so much of Maybin's value is in his legs, I do want to see him running before giving the green light. Expect him to be dialed back for about a week, then brought back conservatively.

Quick Cuts: Kelvim Escobar has shut things down and has no plans to throw again in the foreseeable future. Play my song. ... Brandon Lyon is "way off pace" after having a cyst drained in his pitching shoulder. He may have to start the season on the DL. ... The entire Rodriguez family has pink eye, but none of the Mets do. The way the team handled Francisco Rodriguez looks smart now. He's been throwing on his own. ... Joel Hanrahan's sore elbow matched up with Octavio Dotel's strained oblique means the Pirates' pen plans have already gone awry. Evan Meek could be the beneficiary if neither is back for the start of the season. ... Josh Hamilton is expected to start playing on Monday. The shoulder is said to be "no big deal", though everything's a big deal with Hamilton. ... Daisuke Matsuzaka threw "all his pitches" in a pen session and will move to game action next. Of course "all" just means four of them these days. ... Hearing that Xavier Nady will start the season on the DL as he continues to come back from TJS. ... Kevin Slowey is showing no problems with his surgically repaired wrist. ... Jair Jurrjens will make his spring debut on Thursday, well ahead of expectations after his early spring shoulder issue.

Notes
1 I always like to think that UTK is a learning journey that we're both on. Just let me believe that, ok?
2 I/II strain? Yes, this is slightly new terminology. It indicates a strain that grades in between a I and II. It's what used to be referred to as a I+. I feel like the new terminology is clearer and will standardize on it.

Related Content:  Back,  The Who,  Groin,  Year Of The Injury,  Headfirst

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