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July 26, 2010

Under The Knife

An Injury Stack Strikes the Tigers

by Will Carroll

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Magglio Ordonez (fractured ankle, ERD 9/15)
The interesting part of the injury to Ordonez is less about the injury itself, but the ankle problems that he'd been dealing with in the week leading up to his traumatic fracture. Ordonez had a minor injury to the ankle, reported as a sprain, that was limiting him to DH. Could the two injuries be related? It's impossible to say, even now, but traumatic fractures are seldom a cascade's result. It's possible that Ordonez's ankle might have been weakened to the point where the fracture happened, when if he'd been completely healthy, it might have been more stable or the forces distributed in a different, possibly less damaging way. While it's a nice game of what if, the Tigers have to deal with what is. Ordonez's fracture has a wide recovery window based on what in fact is fractured. At a six-to-eight-week timeline, there's a couple possibilities, with the most likely being a distal fracture of the tibia or fibula. Assuming a normal healing period, Ordonez should be able to come back without significant consequences. If this slides towards the end of the timeline, Ordonez won't be able to get a rehab assignment in, which could be an issue. It's possible, even likely, that Ordonez returns this year, though the Tigers'status as a contender nearer that date will determine whether he'll be needed.

Carlos Guillen (strained calf, ERD 8/9)
The Tigers took a double whammy in a season where it might have only taken one whammy to make the difference between winning and losing a division. Guillen joins Ordonez on the DL with a strained calf. Guillen is an interesting case study, since he's been as available and more productive in a year where he was shifted second base after "protecting" him with the DH slot in '09. Now, with an injury that's tough to pin on a position shift, his availability and durability is now back in question. The strain isn't considered serious, with the team hoping that Guillen will be ready to go at the minimum. If you look down the page to the Scott Rolen section, you'll see more discussion on how teams come to this kind of decision.

Jamie Moyer (sprained elbow, ERD 10/1)
A reporter asked me for my thoughts about Moyer late last week. I explained a little bit and he came back with the question of whether this was the type of injury that leads to Tommy John surgery. I put it up on Twitter, to save me from typing it again and again:

“It’s a sprained UCL. Every Tommy John happens on a sprained UCL, but not every sprained UCL will need Tommy John. Like any sprain, it can be minor (Grade I) or massive (Grade III, rupture.) I’m assuming it’s not the latter, since everyone would just know at that stage. If it’s torn somewhere around 25%, it’s touch and go. A doctor might say he needs it or that he can try to rehab. It’s really all down to a) how torn and b) if he wants to go through either set of hard, painful rehabs.”

After I sent it, I remembered that Moyer has a strained flexor tendon as well. This is the same combo that Edinson Volquez had, so you can take that as a positive, a negative, or both. With his age added into the mix, I feel like this is really and totally going to come down to Moyer’s desire to continue playing the game. Moyer gave a statement through his foundation that he was starting a rehab program, which indicates that Moyer's sprained ligament is somewhere on the line where surgeons have to debate whether or not to reconstruct. With Moyer's age, it makes a lot of sense for him to try and rehab, if only to see if he can pitch through it. I'm not quite ready to say that Moyer is done for the season, but there's only a small chance that he will be able to return effectively. The ERD is more a reflection of that than an actual date. Interesting thing here is that if he goes out like this, with his arm breaking on the last pitch after a career that boggles the mind with its longevity, he would have a comp: Nolan Ryan. Ryan, you might remember, popped his elbow on his last pitch and walked off the mound and into the figurative sunset.

David DeJesus (sprained thumb, ERD 10/4)
The Royals had as much bad timing as bad luck when it came to DeJesus' thumb. Some knocked the Royals for not having dealt DeJesus, but I always feel good about agreeing with Rany Jazayerli. The fact is that injuries like this—hitting the wall in just the wrong way—can't be predicted. We've seen similar situations just after a trade—Mark DeRosa last season comes to mind—so why not just before? DeJesus' injury is very similar to what Chase Utley had in mechanism, with the real difference being what they hit. DeJesus will have surgery and end his season. That timing is making people wonder why DeJesus' injury is "worse" than Utley's, but it's a function of the time—there's less season in which to come back to—and the Royals'and Phillies' relative contention status. DeJesus should be ready for next season without any issue.

Ben Sheets (inflamed elbow, ERD TBD)
Speaking of bad timing, Sheets heads to the DL with an elbow issue. Susan Slusser of the San Francisco Chronicle reported that Sheets was seeing significant swelling after starting and  that he wasn't recovering well between starts. The Athletics aren't commenting on this as Sheets heads to get more opinions, likely including Dr. Keith Meister, who performed his previous elbow surgery. Early indications are that this is going to be more than just a quick recharge stay on the DL, with some reports intimating that Sheets might be done for the season. According to Eddie Bajek's free agent ratings, Sheets would not return any compensation. I asked Baseball Prospectus' Matt Swartz about the realized value that Sheets gave to the team in return for his $10 million contract. Matt said "realized, he had 0.8 WARP3 so its just 5 times WARP3, which is $40 million more than league minimum, so $4.4 million." That's a bit below the value that could be projected from his PECOTA weighted mean (1.4). Given that value, he would have had to get near his 80th percentile projection. That isn't to say that the A's front office made a bad gamble. I'm sure they realized the risk. Sometimes, you have to bet on a longshot to win. We'll know more once Sheets collects those other opinions.

Jacoby Ellsbury (fractured ribs, ERD 8/5)
Victor Martinez (fractured thumb, ERD 7/26)
The Red Sox are getting healthier. It will be interesting to look back at the end of the season and see how, if at all, the injury stacks that the Sox have dealt with have any sort of pattern or discernible effect on their season. It's very likely to require the full, hands-on injury accounting treatment. For now, things are looking up with Josh Beckett back and more help coming. Ellsbury's situation has been the most noted and dramatic, but he might have the least effect overall. Ellsbury has made progress since returning to the Sox complex and the team announced he'll start a rehab assignment today. It's no easier to tell a timeframe on Ellsbury than it was months ago, but since this is about pain management, if he's able to play without pain, he's not likely to be far from a return. There's rust to knock off his swing to be sure, but there's not really a way to test him besides letting him get out there and hoping that it works. If things go well, he could be back in Boston next week but that seems a bit aggressive. It's easier with Martinez. His thumb is doing well with everything they've tasked him with. Being able to catch Tim Wakefield is a real test, since it's hard to "web" all the catches. Sure, the velocity isn't what he's going to get with other pitchers, but really, that's the easy part for a catcher. Martinez will be back in the lineup tonight, filling one of the big holes in the Sox's lineup.

Scott Rolen (strained hamstring, ERD 7/28)
Last week, I talked about the equation that a team has to use in order to make a smart decision about whether or not to put a player on the DL. The crux of it is "will he be out 15 days or more?" If no, then it gets a bit tougher. We saw the Mets use that logic correctly with Jose Reyes, but are the Reds doing that with Rolen? It's never quite as simple as an equation, as was shown on Wednesday when Miguel Cairo missed a chance at a ball over his head at third base that many think was a play a taller Rolen might have made. Rolen is expected to be back during the next series, but that still puts him at 10 or more days missed. With a 0.120 difference in their MLVr, the Reds have played short a man during that period for a return that's at most half a run. I'm not sure if that's worth it or not. Rolen is making solid progress, but beyond the current issue, having hamstring problems isn't a good sign for a guy with chronic back issues.

Ross Detwiler (torn hip labrum)
Detwiler came off the DL for the Nationals on Sunday and while his first outing wasn't successful, he is back, just four months after major hip surgery. Detwiler had the labrum repaired, though it was not the full "FAIL" like Utley, Alex Rodriguez, or Brett Myers had done. It's still quite the thing to come back from, especially for a pitcher and even more for a pitcher who's had issues with repeating his delivery. It's that issue that extended his rehab and is keeping him from establishing himself. His stuff has never been the issue and if he can keep up the results he had during his rehab, it will certainly help. Like with Tommy John surgery, any rehab can allow a player to focus on things without having to deal with the day-to-day issues of pitching and recovery. Having Detwiler back helps take some of the pitching load off of Stephen Strasburg, but the Nationals are going to need Detwiler to do better and for a couple more rotation pieces to show up.

Brandon Webb (strained shoulder, ERD 9/1)
A lot of people are pinging, begging for updates on Webb. Problem is, there's nothing new to report. Webb is nearing the stage in the season where he might not be able to make it back. The Diamondbacks regularly said he'd need the full 30 days of a rehab assignment, which gives him about a week to start upsince the minor-league regular season ends on labor. That doesn't look to be the case, with Webb only throwing side sessions at this stage. Webb said earlier that he'd hoped to make "six-to-eight starts" this season, if only to showcase himself and prove that he's made it back from shoulder surgery. There's going to be an interesting balance between Webb's need and desire to get some work in, if possible, and a new front office needing to look at other players while making plans for future seasons. Webb heading into 2011, even without much of an audition, is a similar risk to Sheets, at least on the surface. The biggest difference is that teams are much, much more willing to take a chance on someone coming back from an elbow injury than they are one that has a shoulder problem. I'll continue monitoring the situation, but don't expect much movement over the next week.  That ERD is really more of a drop-dead date than a real return expectation.

Quick Cuts: I'd never seen a commercial for a knee replacement, but Smith and Nephew is doing so now. They've been one of the leading financiers of sports medicine research. ... Alex Rodriguez left Sunday's rain-delayed game after being hit in the forearm with a pitch. No word on severity, but it could delay home run No. 600. ... Orlando Hudson hit the DL with an oblique strain. No details on the severity at deadline. ... Shin-Soo Choo has shown no problems with his thumb since returning. Phillies fans should take note. ... Umm, what? ... Mark Teahen is expected to start a rehab assignment within 10 days. He's just starting baseball activities, but the White Sox are hoping to get a good idea of when and how he'll come back this week. ... Brett Anderson was pretty dominantin his rehab start for Triple-A Sacramento. Mike Curto reports that he looked ready and was in the low 90's with his fastball. He's expected back in the Oakland rotation on Friday. ... Scott Kazmir has been downplaying his shoulder injury, but if that's true, it means it's all his poor results lately are because of his pitching. ... In 2010, it's insane that I had to spend time explaining to a world-class athlete that this type of thing isn't a real solution. ... Jim Edmonds has an Achilles issue, but he's going to try to play through it. At this stage in his career, the worst that can happen is it pops, which is very fixable for someone that just wants to live life. ... Eugenio Velez heads to the DL (no pun intended) with a concussion. I can't say I've ever seen a play exactly like this. There's no helmet technologyin the world that helps in the dugout. ... Word is that Travis Snider will now be back with the Blue Jays on Friday. The delay is a roster thing, not a setback.

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