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May 5, 2010

Under The Knife

Blue Moon Rising

by Will Carroll

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Jorge Posada (strained calf, ERD TBD)
If you read what I told you about—or actually, passed on from Ben Wolf—on Friday, then the calf strain for Jorge Posada shouldn't come as much of a surprise. Posada's injury to the back of his right knee was in a bad spot and this kind of cascade is very predictable. The bigger cascade worry would be a knee injury, but a calf strain would be a close second. Wolf's insight doesn't help the Yankees, who now have to go with Francisco Cervelli in the meantime while hoping that Posada can heal up. The Yankees are anticipating that Posada will be ready by the end of the week, but a Grade I strain might not heal up enough for catching. They'll wait until the end of the week to make a decision on the DL, since they'll get the off-day on Thursday, but I get the sense that they don't want to go into the Boston series short-handed

Mariano Rivera (strained oblique, ERD 5/6)
People often misunderstand why Mariano Rivera shows up as a red, year in and year out, when I do the Yankees' Team Health Report. Rivera is one of those players that often has a minor injury, misses a bit of time, perhaps even going on the DL for a short stint, and then comes back, as if he missed no time at all. It's not a bad thing, though it's certainly not a good thing. In fact, it's just a thing—a reasonable expectation that raises his risk. The threshold event in the THR is a DL stint, not a major injury. Rivera has had one of those minor injuries, a strained oblique, for the past couple days and the team is letting Joba Chamberlain try on the ninth inning for size while Rivera heals up. As long as there's a good option, there's no need to rush Rivera back. While it doesn't appear that he'll go on the DL, especially after throwing a good side session before Tuesday's game, it's this kind of event that keeps Rivera red. Risk or not, he's perhaps the most dominant pitcher in the history of the game. His return could come any time this week, with the Yankees likely to err on the side of caution.

Joe Mauer (bruised heel, ERD 5/10)
The Twins had an MRI done on Joe Mauer to see exactly what was going on with the heel. While everyone expected a bruise, most expected a bone bruise given the pain and discoloration. Instead, the MRI showed that the bruising was limited to the soft tissue. That doesn't make it any less painful for Mauer, but it does mean that it should heal up more quickly. Soft tissue heals better because of a number of factors and is much easier to take the weight off over bone, which can be stressed by more than just simple weight bearing. With the progress Mauer has already made, it's possible that he could be back by the weekend, though the Twins are definitely going to err on the side of caution. There's been some talk of using Mauer at DH for a couple days, giving him some additional healing time without the rigors of catching and giving the team a couple more looks at Wilson Ramos. Ramos' play is said to have the Twins brass excited enough to actually discuss moving Mauer from behind the plate on a full-time basis.

Ryan Madson (fractured big toe, ERD 7/10)
That must have been some kick. Ryan Madson did more than just fracture his big toe. He really fractured it. Madson needed surgery to fixate the toe and to repair some soft tissue damage. That can be a number of things, but usually involves tendons. The toe is significant to so many things and is the reason why something that seems so simple, like turf toe, can linger and disable NFL players for weeks. As a right-handed pitcher, his right big toe is a big part of the delivery. He'll need to be able to "lock the foot," which necessitates heavy flexion (toes curling down). Most think that a pitcher comes over the foot, coming up on his toes (toe extension). Instead, as you can see in the picture of Tim Lincecum I linked to above, the toes actually flex to keep the pitcher more upright and transfer the force into the arm. With a broken, damaged, or weak toe, Madson isn't going to be able to do that. The Phillies will have to watch him closely to make sure that the toe isn't forcing changes in his motion as he comes back, putting his arm at risk. This one's going to take two months, minimum, and could linger for a while. 

Rafael Furcal (strained hamstring, ERD 5/13)
This is how we get news these days: A tweet from TrueBlueLA that reads "Rafael Furcal to the DL. Nick Green the likely replacement." It doesn't say anything about the Dodgers, our pals at TrueBlueLA, or even Rafael Furcal that we learn of his DL move in a tweet rather than a press release or a spot on MLB Network. It's the speed of information. Then again—and again, no offense to TrueBlueLA—one of the solid Dodgers sites out there—there's not much information here. We'd known that Furcal had a strained hamstring. We knew that the Dodgers were going to make a decision on him yesterday as long ago as Saturday. I'm no Nostradamus, but my Monday UTK told where this was going for the most part. The Dodgers weren't willing to take on the uncertainty, and knowing that Manny Ramirez would be back and a move would be necessary there, this makes some sense. Our world comes in 140 character bites it seems, but there's no room for subtlety there (as I've learned the hard way). The story of baseball and baseball injuries isn't one that can be told only in tweets. It can't be handled in a quick chat and a blog post once a week. Baseball and injuries are inexorably intertwined, and that's why I'm obsessed with documenting this as best I can as often as I can. Twitter is a tool, sure, but the best one is right here: words, and lots of them. Furcal should be back at the retro minimum with no real lingering effects.

Jair Jurrjens (strained hamstring, ERD TBD)
Yunel Escobar (strained groin, ERD 5/18)
While I won't mention the Verducci Effect here, I will mention that fatigue manifests itself in various ways. It can be shoulder fatigue and weakness, which makes sense for a pitcher. It could be something like a muscle strain, say the hamstring. These are both injuries that have held back Jair Jurrjens this season, and while it's too early to say that his workload last year cost him something this year, it's precisely this kind of thing that keeps workloads for young pitchers at the front of my mind. Yes, I know it's anecdotal. Jurrjens' hamstring hasn't loosened up since his last start, and while the strain is not considered significant, the Braves aren't sure they will let him go out to the mound as scheduled on Saturday. Bobby Cox doesn't have to make a decision until then, though he'll likely have to make some sort of roster move unless he gives the ball back to Kris Medlen, as he did when Jurrjens went out. If the Braves do hold Jurrjens out, there's a chance they'll DL him retro to call up a starter, so be aware of that possibility. The ERD was almost set at 5/10. That's a bit of a split-the-baby date that renders it almost meaningless, so I'll just say "TBD" and leave it there. Over on the positional side of things, the Braves made the expected move and shifted Yunel Escobar to the DL with his strained groin. It's a retro move and the team expects him back at the minimum. However, there's been no progress since his initial injury late last week, making some worry that this one might linger a bit longer than the minimum. Some depends on the needs of the team and how the replacements play. Omar Infante will handle the shortstop duties while they shift the actual roster slot around among some other needs over the next couple weeks.

Mike Pelfrey (shoulder stiffness)
After an MRI that reportedly came up clean on Monday, the Mets altered Mike Pelfrey's between-game schedule. He'll skip the normal throw day and go to a Leo Mazzone-styled "touch and feel" session, according to pitching coach Dan Warthen. This kind of session, as used by Mazzone, amounts to a light game of catch with a crouching catcher. The pitcher is exerting very little effort, but still focused on hitting his spots. The Mets, as far as we know, haven't done this kind of alteration and are only doing this due to the shoulder stiffness with Pelfrey, so there's not much to go on here. Pelfrey was ineffective last time out, so even if he gets on the mound as planned on Friday, there's still a lot of risk here. Beyond that, we'll have to see if the Mets keep Pelfrey on the altered program or if he can shift back to a more normal between-start routine.

John Lannan (inflamed elbow, ERD 5/13)
The Nationals are trying to hold together their pitching staff. Losing John Lannan isn't that big a talent hit, but there's a point where the lack of depth in the organization is going to combine with a need to protect a couple of their young pitchers. One of those is, of course, Stephen Strasburg. One interesting thing that is out there, from both Peter Gammons and Jon Heyman, is that there is a handshake agreement to keep Strasburg at or under 100 innings. Strasburg has already gone are 22 innings in Double-A, but do the Nationals count those on his overall innings total? We can expect about the same as he shifts up to Triple-A, so does that mean he'll really have 60 or so innings—eight or nine good starts—or does the counter begin at the major-league level? A total of 140 innings at all levels isn't a big jump for him after his college workload. Oh yeah, we were talking about Lannan. He had a cortisone shot in his pitching elbow to calm down an inflamed flexor tendon. Images showed no strain, but tendons don't swell for no reason. They'll try to get him back out there, but the Nats are going to have to watch the waiver wire closely to find pitching to get them through this season, putting them in an odd position of being out of contention, but possible buyers of some innings eaters at the deadline.

Chris Dickerson (fractured wrist, ERD 7/10)
You don't have to look too hard at the Cincinnati team audit to see that outfield production is an issue early in the season. Right now, Mike Leake seems like a viable option out there. Only Jay Bruce has a positive value, with a TAv just above .280. The team doesn't have much depth to work with and less now that Chris Dickerson has had multiple surgical procedures on his right wrist. Dickerson had the hook of his fractured hamate removed, followed by a scope that and the rest of the joint cleaned out. I'm not sure why Dr. Tim Kremchek elected to do this as two separate procedures, but the hamate work does require a larger portal, though it may be in the wrong location for the rest of the work. The Reds are listing Dickerson as out for four to six weeks, but normal treatment is going to cost him nearly a month in a cast. It's more likely that he's out until the All-Star break and even then, he'll have the normal loss of power once he does return. There is a good rate of return to previous level, so he's got that going for him.

Quick Cuts: Rick Ankiel was pushed to the DL with his ankle sprain. Trey Hillman historically doesn't like to play a man down. ... Andrew McCutchen is not expected to miss much more time with his mild ankle sprain, but the Pirates will be conservative with him. ... Jimmy Rollins is having some specific functional issues that have held back his rehab from a calf strain, but lateral motion is not one. Anyone that tells you that isn't talking to the right people. ... Nelson Cruz is back running and doing some "baseball activities." He might have a short rehab assignment, likely in nearby Double-A Frisco, but is on track to return next Wednesday. ... One pitching guru I trust saw very bad signs in Clayton Kershaw's meltdown last night. He tells me that, "Kershaw completely lost his touch for the ball and looked baffled by it." ... Carlos Quentin was back in the starting lineup after what was described as a mild hamstring strain held him out. Observers continue to insist they see signs that the foot problem (plantar fasciitis) is still bothering him. ... Manny Ramirez went 1-for-3 on a rehab assignment at High-A Inland Empire. ... Let's use some un-advanced stats—15 IP, 2 R, 1 BB, 22 K—to demonstrate just how dominant James Shields has been in his last two (small sample size!) starts. ... Jake Westbrook was nearly scratched from his start with back spasms. This will obviously need to be watched. ... Kerry Wood got his work in during his first rehab outing, but that's about it. He got knocked around some at Double-A. He'll be more focused on results in the next two scheduled outings. ... Gerald Laird has a bruised left shin and could miss a couple games. It's unlikely he'll need to be pushed to the DL. ... The Phillies acknowledge that J.A. Happ won't be back before June, but sources say "early June" and that the setback was "not significant. Bad, but not real bad." ... Thanks to everyone that sent feedback on the interview with Dr. Neal ElAttrache. I hope to do more of that kind of thing, though we do a lot of it at BPR. If you're not checking that out, why the heck not? It's free!

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