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April 13, 2011
Hamilton's Poor Sense of Humerus
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)
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)
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)
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.