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July 8, 2010

Under The Knife

Peavy's Unique Injury

by Will Carroll

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Jake Peavy (strained lat, ERD 10/4)
Not just strained, but detached. That was the piece of info that took this from being bad news for Peavy and the White Sox to being the worst-case scenario. Peavy has pulled the muscle out at the insertion. That's the point where it connects to the upper arm, as seen here. It's not the best comparison, but if you've ever broken down a chicken, this is very similar, though obviously there's a size (and species) difference. It's the same kind of muscles and tendons that are pulled apart when taking the wings off before adding the delicious sauce. Peavy will in all likelihood need surgery to reattach the muscle. He'll get a second opinion, maybe more, but doctors and therapists I spoke with said a complete detachment of this type can't heal on its own. This detachment is what differentiates this strain (and yes, it's still a strain; a detachment is just a specific kind of rupture, which itself is a complete strain) from the ones suffered by other pitchers, such as Brad Penny, Josh Beckett, and Ben Sheets. They had strains in the "belly" of the large muscle rather than at the thinner, weaker point nearer the arm. The cause is unknown and probably always will be. SBNation quoted me early in saying this was Don Cooper's fault, but that's not what I meant at all. In changing anything about a pitcher's delivery, there can be consequences, just as if a pitcher instinctively changes something to compensate for an injury. That's why it's so tough to see a pitcher with terrible mechanics but good results; even a small change might change things for the worse. The pitcher has done this for such a long time that his body, even his bones, have adjusted to that specific motion. The question now becomes whether or not Peavy can come back at all. There are no comparables for this. Again, I went to my doctors and therapists, who think that he can come back. "It's not a cuff," said one ortho, "and putting the muscle back in place isn't difficult. It's an anchor. It's not like there's multiple structures or ways to do it really." A physical therapist put it more succinctly: "If a nail comes out of your wall, you hammer it back in place. That's all this is." We've seen players come back from detached muscles before. The one that immediately comes to mind for me is the dreadful image of Dean Palmer's biceps strain. The muscle retracted, visibly rolling up his arm as he screamed in pain. I'm glad that's not on YouTube. Peavy is looking at a significant rehab and most likely his season is done. When he might be back on a mound remains to be seen.

(Or you could check this video out if you want the two-minute quick take.)

Kevin Youkilis (strained ankle)
Josh Beckett (strained shoulder, ERD 7/22)
Youkilis left Tuesday's game with what the Red Sox called an "ankle cramp." I'll call it a strain, since that involves a muscle (and keeps me from having to add a category in the IDB.) Sources say that Youkilis was having trouble even before the fourth inning, showing some discomfort while he was at first base, something Youkilis later confirmed to the Boston Globe. Since the mechanism is unclear, even to Youkilis, it's tough to get much of a read on this. If it's just a cramp or something a bit more complex, like a tendon not "popping over"—the geometry of the ankle is very fluid—then it's a passing issue. That's not to say that there's not some underlying structural issue. Youkilis was back in the lineup Wednesday against the Rays so the Sox medical staff had to have some confidence in sending him back out there. There's also more good news with Beckett. He will make two rehab appearances in the minors after a solid simulated game. Sources tell me that Beckett is hoping to look so good in the first that the second won't be necessary. That's plausible given his rapid progress after he returned to the mound. It looks like the Sox field and medical staff made the right moves along the way with this one. 

Yovani Gallardo (strained oblique, ERD 8/10)
As expected, Gallardo was pushed to the DL. Some seemed to think that Gallardo's initial listing of "day to day" meant that the oblique strain wasn't as serious as originally thought. No, all that list does is reflect the current reality. Since Gallardo wasn't going to start for the next couple of days anyway, there's no rush. Why not see if Brewers athletic trainer Roger Caplinger and his staff can work a miracle, or if Gallardo wakes up healed. It's not likely, but things happen and there's no penalty for waiting. Gallardo is likely to be out the best part of a month with this as it heals and then he builds back up. The worry is recurrence first, then maintaining his stamina. 

Robinson Cano (strained back, ERD 7/8)
Cano and the Yankees "mutually" decided that he shouldn't be in the All-Star Home Run Derby. I love the idea that things were ever mutually decided on a Steinbrenner team. Yes, I have an imagined scene from Seinfeld in my head, with the back of Steinbrenner's head bobbling back and forth while yelling at Costanza for signing Cano up for the Derby. Cano was out of Wednesday's lineup, but no one seemed to know if it had anything to do with the minor back injury cited for pulling him out of the Derby. My guess is yes, but that in the longer term, this won't mean anything for the guy who would get my first-half MVP vote.

Matt LaPorta (concussion, TBD)
The good news here is that LaPorta isn't having post-concussion symptoms. He's not having headaches or any of the other various signs you look for when considering whether or not a player should be back on the field. MLB has done a pretty good job of taking concussions seriously since first having it forced upon them. Given the recent crushing news that Chris Henry, an NFL receiver not known to have had any concussions during his football career at any level, had severe brain damage in his mid-20s shows just how serious this is. Some even wondered if all the hits that Bob Probert took during his hockey career might have contributed to his early death. I hope MLB will realize that even though these kinds of hits aren't an issue, that traumatic brain injuries are a problem, not just in the bigs, but for the amateur and youth leagues for which they serve as a role model. Better helmets for everyone, Bud. Mandatory.

Carlos Quentin (sore knee, 7/11)
When healthy, Quentin is good. He's very lucky he's with the White Sox, where they were able to get him through plantar fasciitis and back into the lineup. Now a knee issue has cropped up that the Sox are being very closed-lipped about. It's not thought to be serious, with the team expecting him back by the weekend, but is there any sort of interrelation with the foot problems? We'll probably never know, but it bears watching if they've traded one problem for another. The delay is leading some to speculate that Quentin had a cortisone injection, but there's no evidence for that. Look to see how Quentin responds once he's back in the lineup or if he's limited to DH duty. If nothing else, Harold Baines is there as an object lesson.

Buster Posey (bruised knee)
Give Bruce Bochy a +1 here. After resisting Posey's presence for a while, now Bochy has seen enough to want to keep his bat in the lineup despite a sore knee. Posey took a pitch off the outside of his kneecap, a painful location that wouldn't enjoy the up and down of catching until it heals up. The Giants will shift Posey to  first base for the short term and allowing Eli Whiteside to take the spot behind the dish. This isn't expected to be a long-term thing, but since we've often discussed this with regard to Joe Mauer, maybe we should investigate the idea of moving Posey from behind the plate as well. Posey is not nearly the defensive catcher by reputation that Mauer is, having converted to the position late. He's more an athlete that can catch enough to make his bat a real advantage there, though many expect defensive improvement with experience. Posey also doesn't have the joint issues that Mauer or Matt Wieters does, being a more compact 6-foot-1. That's still historically tall for a catcher, though I have no idea what that means in context. What's easily understandable is that a catcher takes a lot of abuse crouched back there and if the value is in the bat, then giving that player a bit of extra rest at any position makes some level of sense. There's no DH in San Francisco, so first base—a position where no one is blocking Posey—is as good an option as any. Bochy can get another +1 if he gets what Ron Gardenhire hasn't.

Oliver Perez (patellar tendinitis, ERD 7/29)
Perez is working his way back from the controversial injury to his knee that put him on this rehab assignment. The move to Triple-A should be seen as a nice step, but there are whispers that it might not be structured that way. This is nothing more than speculation by several people not with the team, but two people from different teams suggested that the push up to Triple-A has something more to it than just a progression. "It's quick, but I don't think [the Mets] care if he fails. At worst, they call him up and sink or swim him and if he gets knocked around there, they can make the case of how much they need to go get Cliff Lee or Danny Haren," said one, essentially echoing the other. I think that's a bit conspiratorial. Despite the controversy surrounding Perez's initial shift, let's not forget he's less than a year out from having scar and necrotic tissue scraped away from his knee. While most of the discussion—and his SFD that put him on the DL—many of my advisors think that Perez is actually dealing with patellar tendonosis rather than the more common patellar tendinitis. Tendonosis is the long-term degeneration of a tendon. I spoke with a current MLB team physician who has not treated or examined Perez, but he suggested that all the symptoms match up with tendonosis and that he was not aware of anyone, let alone a pitcher, who had returned from it. The name he brought up: Mark McGwire, whose career was ended by patellar tendonosis. 

Travis Snider (sprained wrist, ERD 7/21)
Do I need to recount what happens when hitters come back from wrist injuries? Shouldn't I have a FAQ somewhere reminding people that a sprain is a tear and that wrist injuries sap power? There are new readers all the time—thankfully—so repeating myself should be a blessing. Snider started his Double-A stint with a decent night and a couple of doubles. That's good, very good. Doubles turn into home runs, scouts remind us, and for a player coming back from a wrist injury, doubles show us that the bat speed is coming. Snider is still at least 10 days away, unless things change rapidly. The Jays will let him get his swing back in order. Snider was hitting at pretty much the same levels as his first half-season prior to the injury, so if he puts up numbers like last year, giving back the extra power, that's very reasonable.

Quick Cuts: Jose Reyes was in the lineup on Wednesday. Back-to-back games is a good sign the oblique is really healthy. ... Justin Morneau took a knee to the head on a slide into second base Wednesday. No word on the severity, but he walked off on his own. ... Early reports have Delmon Young with a minor "strained wrist" after an outfield collision. We'll have to see what the correct diagnosis is and how serious. ... Geoff Blum had surgery to remove chips and spurs from his elbow. He'll be out around three weeks. Can we please quit saying he hurt himself with a shirt,too? ... Ryan Madson could be activated as soon as Thursday. Things have gone much better in his last few rehab appearances. ... Brandon Webb had another good side session. His rehab assignment could come before the end of July. ... Gil Meche will start a rehab assignment next week but Luke Hochevar hasn't even started throwing yet ... Stu Sternberg: day to day. ... Brian Moehler left Wednesday's game with a strained groin. ... For those interested in football—the NFL kind—I'll be writing at SI.com this year. More details soon.

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