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August 4, 2010

Under The Knife

Win One, Lose One

by Will Carroll

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Kevin Youkilis (sprained thumb, ERD TBD)
Jacoby Ellsbury (fractured ribs, ERD 8/4)
If you'd asked me yesterday, I would have thought that Youkilis would be back in the lineup and that Carlos Santana would already have had surgery to repair his leg. Turns out, I was wrong on both. Youkilis is on the DL with a torn adductor muscle. This is one of the small muscles of the thumb that allows it to be such a useful digit. This particular muscle pulls the thumb in (adducts) toward the hand and is involved in the grip. When Youkilis got jammed and injured it, it was an unusual mechanism. Usually, this would be injured more in the way we saw with Chase Utley or David DeJesus, where there's a forced abduction (pulling away and back from the hand). In that case, the tendon is usually what goes, rather than the muscle itself. Because we don't know exactly where it happened and how, it's difficult to see exactly what happened that resulted in this injury... or is this the problem? Youkilis told NESN that this problem has been "going on for a while" so what we saw was the "last straw" rather than the real mechanism of injury. Youkilis is headed for tests that will determine if he needs surgery and how long he'll be out. 

Youkilis, who is hoping he doesn't become Dan Shaughnessy's next target, was immediately replaced on the roster by Mike Lowell, but Ellsbury is coming back tonight. Reports that had Ellsbury "refusing to be activated" this week are patently ridiculous; Ellsbury was not activated by a team that's been burned by players hiding injuries and severity of injuries, so they didn't want to put him back in a situation where he was just going to re-injure himself. Contrary to most expectations, it's been rotational activities—like swinging a bat or throwing from the outfield—that have caused Ellsbury the most pain. He's not yet back to 100 percent, but he's finally able to play. The question now for Ellsbury and too many other Red Sox is can they stay that way?

Carlos Santana (sprained knee, ERD TBD)
Travis Hafner (strained shoulder, ERD 8/15)
Watching the play again, I have no idea how Santana escaped more serious injury. It might be that he popped out of the shoe at just the right time. One doctor I spoke with said Santana must have very strong supporting muscles to only sprain the LCL. Writers I texted with who were on the scene were convinced his leg had snapped and watching, I agreed. The way that the trainers cut open his pants quickly and braced the leg makes me think they thought the same thing. The results of early tests are encouraging, but there's still reportedly a lot of swelling in and around the knee that is making a final diagnosis difficult. There's no clarity yet on if Santana will need surgery to repair the ligament, but that likely won't happen quickly anyway. The standard procedure for this would involve some "pre-hab" before surgery. The recovery period even with a delay would have him back for spring training, so this isn't a big concern for the long term. The fact that we're talking about a long-term or even medium-term return is pretty amazing. 

Lost in the Santana collision was another trip to the DL for Hafner. The medical staff has done all it can to keep him productive, but it looks like this is going to be the pattern for the rest of his career. He'll be at DH putting up an 800 OPS, which isn't bad, but while getting paid for a 1000 OPS, which makes people think about him differently. The shoulder is a chronic condition that is helped by rest and treatment, but not so much that he won't be back in this situation again. It's a retro move, so he won't be gone too long, but the Indians have two more seasons of Hafner left on this deal.

Ryan Howard (sprained ankle, ERD 8/16)
Dr. Michael Cicotti got a good look at Howard's sprained ankle, and Howard ended up on the DL. A lot of the focus on his ankle involved his weight, or lack thereof comparatively. While that does help somewhat, Howard's ankle sprain was severe enough that the team didn't think he could come back before the 15-day minimum. Howard isn't that mobile, and lateral movement is only going to be an issue at the plate, where it's his back leg. He could lose a bit of power, though this should heal up quickly and some bracing will help alleviate any residual weakness. Still, it's a bit of good news in what could end up being a tipping point for the Phillies. Injuries have really pulled them down, showing that the random element is something even the best medical staffs can't stave off.

Joey Votto (sprained wrist, ERD 8/6)
Publicly, the Reds aren't saying much about Votto and his wrist injury. Behind the scenes, the team is worried. What was described as a "tweak" appears to be a tendon problem, one that could sap power from a guy who's one of the top power hitters in the game. Between treatments, Votto is working with Brook Jacoby and Dusty Baker on adjustments to his swing to try and find a comfort point. Votto is hitting in the batting cage, so he's likely not going to go on the DL just yet. He pinch-hit last night and was intentionally walked, and there is a chance he returns to the starting lineup tonight, though with a day off tomorrow, the team might hold off just to get the extra day of rest. Wrist injuries linger, so be aware of this until he proves the wrist is healthy with a couple long flies into the Ohio night.

Mark Reynolds (concussion, ERD 8/5)
Reynolds is one of those players that stands astride the demarcation line between old-school and new-school fans. His strikeouts are most of it, but saying he's just a modern Dave Kingman downplays his other skills. Reynolds had a good news/bad news night on yesterday, launching a home run and then getting one off the helmet later in the game. Reynolds was able to walk off under his own power, but there's little doubt that he was knocked a bit goofy and had a small cut where the helmet was pushed down by the 95 mph pitch. Concussions come in many varieties and, given reports from after the game, this one looks to be on the mild end of the scale, but he'll need to be watched over the next few days by the Diamondbacks medical staff. Missing a game or two is likely, which is probably not the birthday present he was looking for.

Brandon Inge (broken hand, ERD 8/5)
Broken hand. Returns in less than a month. If that statement surprises you, you haven't been paying attention. One of the things that astounds me about this beat is that I often have to go back and re-set the "normal range" for injuries. Broken bones are one of them that's really changed. I can clearly remember talk of Mark Mulder back in... 2002? I guess it's not that clear... as the Athletics were doing everything they could to get him ready for the playoffs and news leaked about him taking one of the new osteoporosis drugs to speed up healing. That's old hat now, and Inge is proof. After breaking his hand in late July, he was back on the field at Single-A West Michigan last night. He hit a pair of doubles in five at-bats and showed no problems with the hand. He could be back as early as tonight, though I'm told the Tigers want to watch the hand and make sure it doesn't swell up or have any sort of post-game problems.

David Freese (strained ankle, ERD 10/4)
Derrick Goold's headline doesn't leave much room for doubt. Freese is done for the season and will need surgery for a torn tendon in his ankle. He was just beginning a rehab assignment, but something "popped" in the first game back while running. This is a tough one because no team likes to see a recurrence, let alone an exacerbation. Freese had done well up to the full-go, real-game action, which is impossible to replicate no matter how hard some teams try. The timing is bad as well, leaving the Cardinals without much chance of making a deal to stop-gap the position. Freese should be ready for spring training and shouldn't be too affected by that point.

Quick Cuts: Stephen Strasburg is scheduled to make his next start next Tuesday. Stunningly, it would be a home start. ... Justin Morneau had a "good day" in the batting cage and could be back in the Twins lineup later this week. .... Pressure from Todd Helton got him back to the Rockies' active roster. He was activated and played yesterday. ... Looks like Chris Sale will be up for the White Sox and in the pen. The Inverted W crowd is going to explode. ... Speaking of the Sox, wouldn't that team more than any other be helped by a shorter bullpen? ... Ian Kinsler will have an MRI next week. If things look good there, he could be back as soon as August 12. ... The Phillies will be going to something of a modified four-man rotation, using Kyle Kendrick and Joe Blanton as the fourth starter in some alternating fashion. It's their hope that they can catch the Braves with pitching. ... Jason Bay is reporting some progress with his concussion. There's still no timeline for a return to the Mets.

Related Content:  Back,  The Who,  Broken Wrist,  Fractured Ankle

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