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April 13, 2011

Collateral Damage

Hamilton's Poor Sense of Humerus

by Corey Dawkins and Marc Normandin

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A lot of ink and bandwith has been expended in discussing how small, proactive investments by teams can help keep injuries to a minimum. Events of the past week suggest one such measure: teams might be wise to hire baserunning coaches to teach their players how not to crash awkwardly into bases, the plate, or their opponents.

Josh Hamilton, TEX (Right proximal humerus fracture)
Hamilton might want to re-learn some baseball basics after suffering a proximal humerus fracture following a slide into home on Tuesday. In an odd play—one that he would later throw his third-base coach under the bus for—Hamilton tagged up on a foul ball near the on-deck circle and slid headfirst in an unsuccessful attempt to avoid the tag at the plate.

He did not exhibit any signs of severe pain as he was walking back to the dugout, but after trying a couple of quick swings, he let Ron Washington know that he could not continue. Initial X-rays reportedly showed no large displaced fractures or dislocations, but he was quickly sent for a MRI.

Usually MRIs are obtained to evaluate soft tissue injuries, but they do have some utility in looking for swelling in the bones—especially in the case of acute injuries. The Rangers used this to their benefit to quickly diagnose a non-displaced humeral fracture.

Humeral fractures have a low incidence in baseball, but they are seen much more often in pitchers than in positional players. The types of fractures the two groups tend to experience also differ: pitchers are more prone to suffering displaced fractures, which are far more serious and often require surgery. When Dave Dravecky, Tony Saunders (twice), and Tom Browning suffered displaced humeral fractures, their reactions left little doubt that something bad had happened.

Pitchers tend to suffer displaced fractures more often as a result of the humeral biomechanics involved in their throwing motions. A study in the American Journal of Sports Medicine in 2004 showed that humeral torque is at its maximum right at the end of the cocking phase. (That's what she said.) When the resultant force is simply too great for a player's humerus to withstand, a spiral fracture—which involves a greater portion of the bone—can occur, threatening to bring his season to an end depending on the date of injury.

Rangers fans can breathe easier knowing that Hamilton avoided both a displaced humeral fracture and a spiral fracture. While his fracture will still require several weeks to heal, the potential time lost is nothing compared to missing the rest of the year, and the prognosis for this particular type of fracture is not nearly as bad as that for the spiral fracture in pitchers. There are not many comps among the ranks of positional players, but one that is eerily similar is Phil Nevin back in 2002. Nevin dove for a ball and was initially diagnosed with a bruised rotator cuff before the non-displaced humeral fracture was discovered. He ended up missing 43 days, a number consistent with the timeline presented for Hamilton.

Rafael Furcal, LAN (Broken left thumb)
Since joining the Dodgers, Furcal has suffered too many injuries to count—okay, we're lying, he's now up to 16—and the latest one has forced yet another trip to the 15-day disabled list. In Monday’s game—the first he had played in since injuring his left wrist on a check swing on Friday—Furcal slid into third base and fractured his thumb. (Seriously, does anyone know how to slide anymore?)

Fractures of the thumb while sliding (or bracing oneself against falling) occur most commonly when the ulnar collateral ligament on the bottom knuckle of the thumb (closest to the palm) pulls off a small piece of the bone. This ligament protects the thumb from being pulled away from the hand, regardless of whether that force comes from the bat, ball, or a slide.

Furcal saw a specialist on Tuesday, and surgery is not thought to be needed. He will be out four to six weeks to allow for proper healing, numbers that jibe with similar injuries in our database: the quickest a player has returned from an injury like Furcal's is 12 days, but the average is 26, and the maximum time lost is 41 days. Prior to finding out that he wouldn't need surgery, Furcal briefly contemplated retirement, more out of frustration than anything else. We’re sure the Dodgers feel much the same way.

Ryan Zimmerman, WAS (Abdominal strain)
As we pointed out in Monday’s column, Zimmerman has already suffered two abdominal strains this year. The latest one will cost him at least two weeks, courtesy of a visit to the 15-day disabled list. Initial reports described him as day-to-day, but this recent injury was worse than the initial one from spring training. Our database informs us that strains like these can be all over the place in terms of time missed. The least amount of time missed for a similar strain is just one day, while the max is 104—including that huge outlier at the end, the average time lost is 22 days.

Depending on the exact location of Zimmerman's strain, it could behave more like an oblique injury. Regardless, it seems that CHIPPER has scored another point.

Flesh Wounds: Rajai Davis is headed to the 15-day disabled list after aggravating his right ankle again. … Evan Longoria and Corey Hart reportedly need roughly two more weeks to recover from their oblique injuries. ... Kendrys Morales ran in spikes yesterday, but not at 100 percent, which puts the rest of April in serious doubt. ... Luis Ayala was placed on the 15-day disabled list with a strained latissimus dorsi. ... Surgery revealed Adam Moore’s knee to be in much worse condition than originally thought—he will be out four to six months. ... Joel Zumaya is paying a visit to Dr. Andrews now that “discomfort” in his elbow has turned into radiating pain, according to Kevin Rand, the Tigers’ athletic trainer. ... Magglio Ordonez has an inflamed bursa sac in his right ankle, not a problem with the Achilles. ... Adam Dunn won the race to the lowest number of days lost due to an appendectomy, with seven. Displaced record-holder Matt Holliday can't even try to reclaim the top spot, as he had just one appendix to give.

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

16 comments have been left for this article. (Click to hide comments)

BP Comment Quick Links

dianagram

"Displaced record-holder Matt Holliday can't even try to reclaim the top spot, as he had just one appendix to give."

-----------------------

"In a show of his religious spirit of generosity, Albert Pujols has said he is willing to be an appendix transplant donor for Holliday, so that Holliday can try to beat Dunn's record of seven days"

Apr 13, 2011 06:47 AM
rating: 12
 
Luke in MN

"While his fracture will still require several weeks to heal, the potential time lost is nothing compared to missing the rest of the year"

This is nitpicky, but the potential time lost is a significant fraction of the rest of the year. Maybe one fifth to one third of the rest of the year, not "nothing" compared to it.

Apr 13, 2011 07:40 AM
rating: 0
 
BP staff member Corey Dawkins
BP staff

Compared to having you arm explode I consider that nothing. Point is well taken though that it is a significant chunk of time, even if not the entire year.

Apr 13, 2011 08:03 AM
 
Marc Normandin

Playing in 100-120 games this year as opposed to 10 fits the "nothing compared" bill, I think.

Apr 13, 2011 08:42 AM
rating: 0
 
Agent007

I know Hamilton's a competitor and that a run could have been scored but sometimes long-term considerations should be brought to bear. Like, maybe sliding head first is not the best idea, especially for one of your key players. It's just one run if it is successful (and worth nothing if it isn't). One swing of the bat and the sheet is balanced. Some teams have curtailed base stealing attempts because of the chance of injury (okay, some may have read the statistical analysis too). Maybe sliding to break up a double play is another thing teams should consider. The Twins lost Morneau for four months (and he's still not back to what he was) to possibly save one out last year. As fans we like to see players go all out but is bowling over a heavily-protected catcher to maybe score a run worth the injury potential?

Apr 13, 2011 08:00 AM
rating: 1
 
BP staff member Corey Dawkins
BP staff

I'll leave the necessity part of scoring to others but this just happens to be one of those things, a freak injury. He dove for the plate and didn't even really get tangled with him. The fracture likely happened as he hit the ground in the slide and not from the tag. He has probably dove or slide headfirst tens of thousands of times and never had this before.

Apr 13, 2011 08:37 AM
 
Edwincnelson

Phil Nevin was not particularly good after he came back in 2003 (about .200 points off his previous OPS). Does this type of fracture heal completely within 6-8 weeks, or can some pain/discomfort linger afterwards?

Apr 13, 2011 08:50 AM
rating: 1
 
BP staff member Corey Dawkins
BP staff

Yeah they absolutely can. The player and medical staff do the best they can but with major injuries there is only so much you can do short of playing. The bone can heal and they can go through all the requisite stages of rehab but it still doesn't replicate game conditions and fatigue during the same season.

It can also change the hitting mechanics for some time afterwards aswell.

Apr 13, 2011 11:12 AM
 
CRP13

"...showed that humeral torque is at its maximum right at the end of the cocking phase. (That's what she said.) "

So refreshing to have good baseball analysis that doesn't need to sound stuffy and serious. Thanks.

Apr 13, 2011 09:09 AM
rating: 4
 
jasemilw4

Does anyone think the Dodgers would consider calling up Dee Gordon to partially replace Furcal?

Apr 13, 2011 10:04 AM
rating: 0
 
asstarr1

Regarding Hamilton's injury, I can't seem to remember a coach being uniformly lambasted for a call. Had Hamilton been safe everyone would be saying how hard he plays. It seems the line between stupid and hustle is very small. PS - thank you for not including any links to exploding humerus injuries as I generally read your column during lunch.

Apr 13, 2011 10:21 AM
rating: 1
 
BP staff member Corey Dawkins
BP staff

Yeah they are nasty. Even I cringe.

Apr 13, 2011 11:06 AM
 
BP staff member Corey Dawkins
BP staff

Thanks

Apr 13, 2011 11:05 AM
 
adecker31

Loving these articles. Would love to see how approaches to injuries and subsequent effects of these injuries have changed since say 2000 or 1990. I mean, is there any significance to the fact that Nevins comparable injury was in 2002 while Hamilton's was in 2011? Or has treatment of this kind of injury not really changed?

As well, I'm curious about shoulder issues in regards to pitchers. Labrums seems much scarier than rotator cuffs, but is that kind of thinking becoming outmoded, or perhaps still true but not in degree?

I am really curious about where the biggest changes in sports medicine have occurred in the last decade (as well as being confused by the huge number, seemingly, of oblique injuries...).

Thanks again, you both do a tremendous job, not just of reporting, but of writing and providing scale and scope.

Apr 13, 2011 17:11 PM
rating: 1
 
morpheusq

I can honestly say: I don't miss Will Carrol one bit. Nice job guys!

Apr 13, 2011 18:13 PM
rating: 1
 
amazin_mess

I agree. This is just as good.

Apr 14, 2011 13:53 PM
rating: -1
 
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The Asian Equation (04/13)
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