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August 6, 2010

Under The Knife

28 Hours to Texarkana

by Will Carroll

Russell Martin (torn acetabular labrum, ERD 10/4)
Some injuries are traumatic, while some are insidious. With Martin, it's pretty clear exactly when and how his hip was injured. In virtually every other case in baseball, the mechanism is a bit different. Martin basically had his hip stuffed back into the fossa, the cup where the head of the femur connects to the pelvis. Because of this and his position, it's harder to compare this injury and the treatment to similar cases like Chase Utley and Alex Rodriguez. There are just no really good comparables here. There are going to be some that take a look at Martin's declining steals and workload and say that this did have some insidious nature. There's simply no way for us on the outside to know that and unless Stan Conte or Martin decide to share, we're left with what we do know. As a former Super-Two player, Martin is headed back to arbitration this year (or signing out of it, as he's done twice), but this complicates things. If Martin needs the FAIL surgery, he could be playing winter ball in time to get a good look at him prior to an arbitration hearing. While he's done for this season and there are no good comps, it's unlikely that Martin is done, period. The idea that Martin is a non-tender is a non-starter too; the Dodgers have nobody close in the minors after trading Lucas May to the Royals in the Scott Podsednik trade last week. In the meantime, the Dodgers will have to hope that Brad Ausmus is smart enough to handle this team for a couple months.

Rafael Furcal (strained back, ERD 8/11)
It's mostly good news, which the Dodgers could use. Furcal is having pain in the same area where he had surgery two years ago, but an MRI showed no new structural issues. (There were issues that were made asymptomatic last time they had him open.) Recurrence of back issues is never good, but this could have been much worse. The Dodgers can work to get Furcal back now, rather than worrying about whether he was headed for the DL or even more surgery. Beyond this, the Dodgers said that Furcal wouldn't be available until at least next week. There's some question as to whether that meant that Furcal had a contrast MRI, an imaging technique that uses a dye that must clear the system before strenuous activity, or if they just needed time to let rest and treatment hold. Either way, even next week is an iffy timeline, as it always is with recurrent back problems. (Note that "strained back" isn't an exact diagnosis here, but more of a placeholder for a non-structural recurrence.)

Kevin Youkilis (strained thumb, ERD 10/4)
They're importing a little trouble into Cleveland now, I guess. Youkilis had his second opinion with Dr. Tom Graham and it came back as expected. He will need surgery to repair the damaged muscle in his thumb. It's a relatively delicate surgery, but one that's also relatively simple. Youkilis is done for the season, but should be able to come back from this without any long-term consequences. The question now is how this happened. What we saw—the jam shot and Youkilis waving his hand in pain—was the 'straw that broke the camel's back,' but it's not the right mechanism for this kind of tear. This is much more along the lines of what Utley is dealing with, though with the problem in the muscle instead of the tendon, there's a possibility that this was more of a "wear down" than a "it just popped." (I wondered earlier why Youkilis would be heading to Cleveland rather than Baltimore. It's because Dr. Graham recently moved.)

Carlos Santana (sprained knee, ERD 10/4)
The Indians announced that Santana will need surgery to repair his injured knee, saying that he would need four to six months to recover, putting him on track for spring training. This comes as a shock to some. Santana escaped the worst-case scenarios—broken leg, blown ACL—but four to six months for an LCL and perhaps other associated damage seems long after thinking that he'd escaped. It's relatively routine to repair the ligament damage, so I don't think there should be much issue there for him getting behind the plate. What the Indians are hoping is that there's little cartliage damage. If some has to be taken out or even just shaved down, it sets him up for problems down the line. If you think back to the start of the year, Lance Berkman was having issues with his knee because cartilage had been removed in 1999. That's the kind of "down the line" that the Indians are hoping for. It's tougher as a catcher, of course, and the nature of the injury—LCLs aren't often torn alone in baseball—there's a bit more uncertainty. It's still much better than it looked and Santana's future is still bright.

Mark Reynolds (head injury, ERD TBD)
We all saw Reynolds get hit in the head. We saw him walk off under his own power. We saw him leave with symptoms that match up with post-concussion syndrome on Wednesday. Those are facts. So what does it mean when Reynolds says that concussion was ruled out after tests Thursday? The easy answer would be "Don't trust him! He's got a concussion!" I wish it were easy. If this were football, my guess would be that they were doing a bit of semantic dancing. In rugby, where concussions carry a 30-day recovery period, there was a huge decrease in reported concussions and a series of "inner ear," "neck," and "dental" injuries. I don't think that's it, either; there's no incentive here. Nick Piecoro of the Arizona Republic told me that Reynolds passed his ImPACT test and was told it would take time for "the cobwebs to clear." How that's different from post-concussive symptoms, I just don't know.

Jon Rauch (viral infection, ERD 8/11)
When you work "inside" baseball, you hear stories. Some of them are funny, like the first time I was in a locker room and Brian Giles came in with a t-shirt that said... oh wait, I can't use that word on BPro. Some of them can't be repeated, except to other people in the game. Too many—and almost every time I speak to a clubbie or trainer—I hear about what a filthy place the locker room is. A bunch of guys who have too much free time and not much concern for hygiene in too many cases, being in close proximity to each other for a long enough period to stop caring about niceties is a bad mix. Add a little heat, humidity, and share items like showers, tubs, and weight equipment and it's bad enough that people could die. It's not that bad for Rauch, but he does have a viral infection known as hand, foot, and mouth disease. Usually, this is seen in proximity to babies. I'm not sure if Rauch has one of those, but he will be quarantined until this clears. The best guesses are that he'll be out until early next week. The disease is very infectious, so there may be some more issues with the Twins. Pardon me while I go dunk myself in Purell.

Kris Medlen (sprained elbow, ERD 10/4)
Medlen has a torn UCL. Easy, right? No. Medlen has a partially-torn UCL. Easy, right? No. The problem is that we don't know how torn it is. After all, 99 percent is "partial," right? Most orthos in the game hover around the 25-30 percent mark as where a pitcher can actually rehab, avoiding surgery. It's different for everyone and in absence of information on joint loads, the lean has always been to go ahead and repair the elbow or, at the very least, open up the elbow and get a better look. Of course, the rule is also that a team always tries to avoid surgery. You can see where this is going—in circles. Medlen is likely done for the season with this, but as yet, it's impossible to say for sure that he's headed for Tommy John surgery. That will come in the days ahead.

Brandon Webb (strained shoulder, ERD 10/4)
Webb was scheduled for a throwing session Thursday. Some reports had it today. No reports I could find had him throwing Thursday, but I can't swear to that. The word I got was that at this date, if Webb had to wave off another throwing session, then he wouldn't have enough time in the minor-league season to build up his arm with a rehab assignment. In essence, the clock would have run out and Webb's 2010 would end much the way his 2009 did. The season was a calculated gamble by ex-GM Josh Byrnes that hasn't paid off. If Webb is unable to recover enough to pitch in a year, that's not going to make it easy for him to get a nice free-agent contract this offseason. Someone, somewhere will take a gamble on him, but it will be one of those two-year jobs with a low first year and a giant option.

John Buck (lacerated thumb, ERD 8/20)
Another thumb injury? This time, All-Star Buck was hit by a foul tip. Instead of his thumb breaking, like Victor Martinez's did on a similar play, Buck "just" had some skin torn away, necessitating stitches. Since J.P. Arrenciba was in the wings anyway, the Blue Jays didn't waste time in DLing Buck to allow the thumb to heal and to get their young catcher a cup of coffee in the interim. Overall, this isn't a long-term issue, though it had to be painful. One front-office type speculated that the Jays might try and sneak Buck through waivers while he's on the DL, especially with a couple of teams (like the Dodgers) in need of someone. We'll see, just as we'll see what kind of situation Buck returns to in about 15 days.

Notes on Rehabs
I get a lot of questions about players that are in the midst of rehabs. "What's going on with _____?" The problem is that most of the time, there's nothing to report. Much of rehab is routine and the rest is mind numbing. Unless something goes wrong, we need to assume things are on schedule because it's almost always the case. "No news is good news" truly holds here. I don't know the status of all players at all times and have to prioritize my time and efforts. Remember, I'm a reporter, not Melinda Gordon. While I will make estimates at times, I'll always clearly mark them as such and give you as much information as I can so you can work out your own estimates as well. I'm all for answering questions and having discussions, but please, don't pound me with this version of the WATG.

 Quick Cuts:There are so many "10/4" ERDs, I feel like Smokey and the Bandit. ... Stephen Strasburg threw a simulated game Thursday and had no issues. He'll start next Tuesday at home. ... That cry you hear is Christina Kahrl, pining over the news that Brian Moehler might be done for the season. He's heading for an MRI after his groin did not take well to a throwing session. Oh Scuffy! ... Manny Ramirez should start a rehab stint by the start of next week. ... Conor Jackson will start a rehab assignment Saturday. If all goes well, he could be back quickly. ... Jason Marquis returns to the Nationals rotation this weekend. The Nats hope he can absorb some innings over the next two months. ... I'm headed to Detroit (today), Cleveland (Saturday), Pittsburgh (Sunday), and Cincinnati (Monday). I'll be tweeting and Foursquaring, so if you're in the area, or better, at the game, say hi.   

Related Content:  Back,  Surgery,  Time,  Year Of The Injury

8 comments have been left for this article.

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