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May 4, 2011

Collateral Damage

Loose Lips Lead to DL Trips?

by Corey Dawkins and Marc Normandin

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Athletes don't offer information about injuries to anyone, even their teams' medical staffs, unless they believe that their aches and pains are affecting their performance. Responsible medical staffs warn their young charges to inform them about any problems and not try to play through injuries, as they could easily damage themselves further and be forced to endure significantly longer recovery times.

Some athletes listen and start offering more information in hopes of avoiding significant downtime, but there are always others who try to push through the pain and end up in the clinic discussing surgical procedures with the doctors. Often the athletes who end up talking with the surgeons (reluctantly) do so not because their bodies are hurting, but because they have lost a few ticks on their fastball or slowed to 4.4 to first instead of 4.3. Unfortunately, this habit isn't automatically broken once a player turns 18.

Ryan Zimmerman, WAS (Abdominal surgery)
Discussion about this surgery has been going on for several days now, and the one thing that everyone agrees on is that it was for the rectus abdominis. The phrase "sports hernia" is being tossed about, as are reports that muscle tearing was involved instead.

While it is certainly true that tears of the rectus abdominis are one of the contributing factors to sports hernias, they can also cause other types of hernias. What's more, the muscle and tendon attachment can be injured in isolation without any herniations, similar to every other muscle in the body. Without knowing the exact location of Zimmerman's pain and tenderness–remember, his injury has been reported as an abdominal strain, not the groin strain commonly reported prior to sports hernia surgeries—it's impossible to rule out other injuries besides the sports hernia.

Regardless, while the surgery went well and there was less tearing than expected, six weeks would be on the extremely low end of the recovery range in our database for all hernia surgeries, whether they were specified as sports hernias or not. If the surgery was intended to correct tendon tearing without correction of a hernia, then scar tissue needs to build up and strengthen the area, which takes time to happen.

The tendon has to scar and remodel over time, similar in concept to an Achilles tendon repair (although certainly not on the same level of time missed before playing again). As we have said many times already this year, Zimmerman has suffered numerous injuries to his core and lower extremities over the last several years, so it may be a little too optimistic to have him back in the six-week time frame.

Phil Hughes, NYA (Shoulder fatigue/Dead arm)
If you read our in-depth discussion about Thoracic Outlet Syndrome (TOS) in Friday's column, store that knowledge for a time when you can use it, as it turns out none of that applies to Hughes, who came back from his check-up TOS free. (Of course, don't let us stop you from clicking the link above and reading the explanation, if you haven't yet done so.)

Further testing and evaluation by one of the leading TOS experts ruled out TOS as a cause for Hughes' continued loss of velocity and sensation of a dead arm. While it's appropriate to celebrate the lack of TOS, let's not forget that the Yankees don't have a definitive alternative diagnosis for Hughes yet, either. As usual with pitchers, numerous problems could be the source of his symptoms, and most of them are normally teased out by the multitude of tests he labored through over the last 10 days.

Still, not all of the tests are 100 percent sensitive—meaning that they correctly diagnose the injury/condition–even with newer technology and the use of contrast to improve the visualization of internal structures. Eventually a point is reached where the only way to definitively rule out injuries is to visualize them surgically, and that point isn't quite as far away for Hughes as it was just 10 days ago.

A dead-arm feeling doesn't just arise out of thin air; there is something that is causing it, even if it is at the microscopic level. Hughes will meet with team physician Christopher Ahmad soon to see what the next step in this journey without a clear destination is.

Zach Braddock, MIL (Sleeping disorder)
Those Brewers sure love making injury history, don't they? Last week, Erick Almonte became the first player to hit the 7-day DL for a concussion, and now Zach Braddock holds the distinction of being the lone player to be placed on the disabled list due to a sleeping disorder. And no, "sleeping disorder" isn't code for "stayed up too late drinking Red Bull and playing Portal 2 last week."

Tying in to what we spoke about above, professional athletes are not going to talk to you about an injury—let alone a medical condition that isn't readily apparent on the field–unless they believe it affects their performance. A wide range of sleeping disorders, from insomnia to sleep apnea, all end up depriving people of sleep that is sufficient to allow the body to rest and heal itself. One or two nights of tossing and turning might not affect a player, but long-term difficulty in sleeping can lead to many of the same symptoms as concussions, including lethargy, headaches, delayed reaction time, and cognitive difficulties, just to name a few.

Fortunately, for most sleeping disorders there are treatments that range from medication to behavior modification. Since there are no comps in the database, it is hard to tell how long Braddock will actually remain on the disabled list.

David Freese, SLN (Left hand surgery)
Updating previous reports, Freese underwent surgery for a broken left hand and will miss between two to three months, according to Cardinals general manager John Mozeliak. That is a bit longer than we estimated, but we also said that if the fracture was more severe, our estimate would change.

The hardware will likely be removed in roughly six weeks (give or take a week or two) once alignment and an appropriate amount of healing has been established both clinically and radiographically. Having metal hardware implanted is the easy part. The hard part is the necessary rehabilitation that follows to restore normal function by improving range of motion and grip strength. That's not only more difficult than "metal hardware implants" might have made things sound, but less exciting, too, as the phrase might have led you to believe that Freese would be coming back as a cyborg or a player straight out of Super Baseball 2020.

Sadly, Freese is not coming back as a cyborg, but he may want to consider doing so in the future, as this will be the third straight season in which he'll have missed a significant chunk of the season due to surgery. He underwent left heel surgery in the minors in 2009, right ankle surgery in 2010, and a debridement a few months later, in addition to this latest operation.

July is the earliest that Freese will be able to return, at which point we hope he will stick around for awhile before suffering his next injury. All he has done in his limited time on the field is hit—he has a career line of .313/.368/.427 in the majors, good for a .285 TAv that is well above the average at the hot corner. You can't hit if you can't suit up, though.

Flesh Wounds: Jenrry Mejia is expected to become the latest pitching prospect to fall prey to Tommy John surgery after meeting with Dr. Andrews later this week. One wonders if this is the final parting gift of deposed general manager Omar Minaya, as the Mets messed with Mejia's development last year... The exploratory surgery on Joe Thatcher's shoulder turned up fraying and inflammation, but no frank tears of the labrum or rotator cuff. He should start throwing in about six weeks... Jose Bautista was sent for an MRI after persistent neck spasms. It showed inflammation but no structural issues… Jim Thome was placed on the disabled list for his left oblique strain and will be eligible to come off on May 15th… Everth Cabrera broke the hamate bone in his right wrist to match the injury he suffered in his left one back in 2009… American League pitchers are going to be a little more worried about facing the Rays and Tigers, respectively, with Evan Longoria activated and Victor Martinez due to return prior to Wednesday's game... Meanwhile, National League pitchers will get to take a break from Ty Wigginton (left oblique) and Marcus Thames (right quad)—even the senior circuit's injured players are overshadowed by AL superiority… Scott Rolen was caught taking unauthorized practice swings in the batting cages outside of the Reds clubhouse. The swinging stopped when Dr. Tim Kremcek found Rolen out and told him that was a naughty thing for a player on the DL to do.

Life has a way of reminding everyone that baseball, for all of its intricacies and beauty, is just a game. We wish pitching prospect Paul Bargas only the best as he starts chemotherapy following a life-altering diagnosis of brain cancer. 

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

Related Content:  The Who,  Surgery,  Phil Hughes,  Year Of The Injury,  Quad-a

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