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February 28, 2011

Collateral Damage

Let the Games Begin

by Corey Dawkins and Marc Normandin

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We all look forward to the day when pitchers and catchers report, but the real fun of spring training begins with the games. Fans still living in winter conditions can look out their windows and see snow falling as they write their Monday columns (yes, this happened to both of us), but they can also start to look for box scores coming from the warm weather climates and know that soon they will be able to enjoy baseball that matters in their own backyard (and in more favorable conditions). Teams also begin looking ahead: they have to carefully balance getting players ready for the regular season from a health standpoint while also preparing them for their performance in games that matter. It is not an easy time for medical staffs—no time ever is—but it's an exciting one, nonetheless.

Chase Utley, PHI (Right knee tendinitis)

Utley is dealing with patellar tendinitis in his right knee. It has limited him for the last few days, but it is something he's dealt with previously and the Phillies are not considering surgery to treat it. The patellar tendon—tissue that runs from the bottom of your kneecap to the very top of your shin bone—experiences micro-tearing as the result of repetitive activities involving the quadriceps, tendons, and the tissue that are connected to them. Otherwise known as Jumper's knee, this condition most often results from repetitive jumping, as in basketball and volleyball. It can occur in any sport, though, and it is often associated with tight quads and muscular imbalance.

Patellar tendinitis is usually managed with rest, therapy, and bracing in certain situations. If chronic enough it can lead to degeneration of the patellar tendon, called patellar tendinosis: this condition puts the tendon at risk for rupture, and trust us, that's not pretty. A rupture is extremely unlikely; however it is possible, as Kiko Calero (2003) and John Valentin (2000) can attest. Before his patellar tendinitis ever reached that stage, Utley would likely undergo plasma rich protein (PRP) injections into the area of tendinosis. However, Utley's patellar tendinitis should improve without his resorting to that treatment, allowing him to return to full activities within a week, according to the team. That's good news, since the above scenario is a messy one.

Adrian Beltre, TEX (Right calf strain)

The Rangers are sticking to their assessment of Beltre missing 10-14 days despite reports of his missing a month with a strain of his right calf. He hasn't missed any significant time due to calf injuries in the past (although he has suffered numerous nagging muscular injuries to the thighs over the years). Lower body injuries can effect everything up the kinetic chain, so ensuring proper healing is key to long-term health and performance. Calf injuries can take a few weeks to a few months to heal, depending on the severity and location of the tear. Texas is going to be conservative with their major off-season acquisition to ensure that he's able to produce during the games that count.

Cla Meredith, WAS (Right elbow inflammation)

When a pitcher walks off the mound with the team’s athletic trainer and points to his elbow, it often means bad news. While the injury database has no record of ligament damage in Cla's past, he did have surgery this past offseason to remove bone chips in his right elbow. Bone chips for pitchers are often the result of small chips breaking off the thumb and back sides of the elbow, caused by the large compressive forces during acceleration and deceleration. If left inside the elbow, the bone chips may jeopardize the long-term health of the joint, especially if they are grinding on the joint’s surfaces. If large enough and caught in the right position, they can cause additional pieces of either joint cartilage or bone to chip off.

Meredith recently underwent a special MRI called an arthrogram, in which dye is injected directly into the joint and used to evaluate the joint as well as the ulnar collateral ligament (UCL) of Tommy John surgery (TJS) fame. Because the MRI arthrogram is an invasive procedure, it is not performed unless there is sufficient suspicion of intrarticular (inside the joint) or UCL injury and a plain MRI has not provided definitive evidence. This does not automatically mean that there is UCL damage, but an arthrogram is better-suited for evaluating the undersurface of the UCL than a regular MRI. As of this writing, there is no further news as to the results of the procedure.

Rich Harden, OAK (Right lat soreness)

With all the talk about lats over the last few years–Jake Peavy, Ben Sheets, and Harden have all recently been in the news due to them–an explanation is in order. The latissimus dorsi is a muscle that stretches from the front part of the shoulder all the way down to the hip. It is the strongest internal rotator of the shoulder, key to providing acceleration to the baseball. During the cocking phase of pitching, the latissimus dorsi stores energy as it is being stretched and releases it by contracting and accelerating to 90-plus mph. As you can imagine, it takes tremendous force and timing to propel a baseball at that speed, and this muscle is behind much of it. If the timing is off or the resultant force is too great as a result of fatigue or improper mechanics, the latissimus dorsi can be stretched too far before contracting. Either frank or micro-tearing can occur in this situation. Harden has had his fair share of injuries, so Oakland is taking their time and will make sure that his mechanics are sound when he does return to throwing.

Ian Stewart, COL (Knee MCL sprain)

Both Rockies management and fans held their breath after witnessing newly-extended Carlos Gonzalez and Stewart collide on Saturday. Both players walked away and appeared unharmed, but Stewart woke up Sunday morning with soreness in his knee. He was later diagnosed with a medial collateral ligament (MCL) sprain. He will be getting treatment and resting for a few days before resuming baseball activities.

The MCL lies outside the knee joint itself, so it doesn't cause isolated swelling like the ACL does. When the MCL is injured the swelling and any bruising will spread diffusely throughout the lower extremity. Stewart's sprain does not appear to be too severe, and the MCL heals very well on its own due to its excellent blood supply, which means it rarely requires surgical intervention when injured in isolation.

Adam Wainwright, STL (Right elbow Tommy John surgery)

Wainwright appears again, for the purpose of clearing up a mistake in last week’s piece. While it was true that he suffered from elbow problems in high school in 1998, there was no confirmed surgery at that time. Instead, he was treated similarly (as best as we can tell) to 2004, when he suffered a partial tear in his elbow. It doesn't change his prognosis at all, but it does make his rise to prominence even more impressive—he basically put off major elbow surgery for 12 years and become one of the top pitchers in the majors in the process. There is still time for him to get that second Tommy John surgery, but let’s hope it doesn’t come to that.

Flesh Wounds: Shin-Soo Choo underwent an MRI on his left elbow—it showed no structural damage, and he likely hyper-extended the elbow during his throwing program. This was the elbow he had TJS on in late 2007, but the current pain is located in a completely different area... Henry Barrera had an MRI on his right elbow that showed a strained flexor tendon and a bone bruise. He's expected to be shut down for a few weeks… Corey Hart suffered a slight strain to his side after slipping while making a throw from the outfield on Saturday… Michael Cuddyer is dealing with a plantar wart on his left foot that he’s had since the winter. He's not planning on having it surgically removed at this point, and is instead using topical cream… Mike Stanton was diagnosed with a right quadriceps strain and after walking off the field was eventually taken to the clubhouse on a golf cart. Reports are that he was in obvious pain, but we will have to wait for an update on his condition in the next 24-48 hours.

Corey Dawkins is an author of Baseball Prospectus. 
Click here to see Corey's other articles. You can contact Corey by clicking here

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