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May 11, 2011

Collateral Damage

Elbowed Out and Shouldered Aside

by Corey Dawkins and Marc Normandin

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Jenrry Mejia, NYN (Right elbowTJS)
Chris Young, NYN (Right shoulder
re-tear of anterior capsule)
The Mets got two bits of news they didn't want: possible surgery for Chris Young and definite surgery for Jenrry Mejia. While we have a firm grasp of what Tommy John surgery entails, questions remain about how Mejia ended up at this point.

All injuries come down to one basic premise: can the tissue deal with the forces necessary for the act that is about to be performed? In most cases, the body creates force production and subsequent force dissipation without any difficulties (even when you fall down on your arm or back). Other times it is simply unable to dissipate the forces fast enough, which results in injury when a player is hit by on the hand by a pitch or dislocates a shoulder while diving.

In Mejia's case, fatigue may have set in differently as he was used in multiple roles last season. Obviously, starters become more fatigued as their games go along, but relievers may not feel any symptoms of fatigue from the time they warm up in the bullpen till they exit the game.

In today's specialized game, roles are usually defined much earlier in players' careers–Tim Wakefield notwithstanding–but if a change in role is going to occur there, there is often a set plan to go with it. It didn't seem that the Mets had a set plan for him last year under Omar Minaya, which may have hindered his development as well as potentially played a part in his current injury. We won't see Mejia back before next year, meaning it's possible that he lost two years of development to that bullpen stint.

Chris Young has a slightly better chance of returning this season, but his chances aren't good. This isn't the first time that Young has suffered a shoulder injury; it's not even the first time he has torn the shoulder capsule. Last year he suffered the same injury and missed most of the season in rehabilitation after choosing not to undergo surgery. His current teammate, Johan Santana, went a different route and decided to have the surgery done in September 2010. He is still rehabbing from that surgery, with the goal of returning in June.

This particular injury takes that long to rehab because the capsule is an important stabilizing structure in the shoulder, operating through a couple of different pathways. Several of the ligaments in the shoulder are thickenings in the capsule itself—a healthy capsule allows the body to keep negative pressure at the joint. If there is a tear in the capsule, then this negative pressure is lost. How many of your mother's stained glass ornaments or decorative pieces fell off the window once the suction cups let go? There is a similar principle at work here.

Once the capsule tears, it loses that negative pressure, placing the other structures in the shoulder at significantly higher risk. It needs to be fixed either surgically or nonsurgically before effective pitching can resume. Since Young already rehabilitated it once and suffered the tear again, he will likely need the surgery to truly fix it at this point. No one can force him onto the table, and as of Tuesday night, Young hadn't made a decision, but one should be coming shortly.

It's a real shame that Young is out with an injury yet again, as he had just signed on in a new city and in yet another park where his problems with the long ball could be hidden—one of the few places he could succeed for the first time in a few years. That seems odd to say about a pitcher who had an ERA of 0.90 in 2010, but his SIERA was 5.07—Young's 2010 was entirely the product of his home park and a defense that stole a handful of homers from the opposition in a 20-inning sample. He isn't and may never be the pitcher he was before he hurt his shoulder back in 2009, but not being able to remain on the mound for more than four starts a year is a worse fate than pitching poorly.

David Aardsma, SEA (Right elbowgrade II sprain UCL)
Aardsma was close to returning from hip surgery, but his elbow had other plans. The ulnar collateral ligament contributes about 50 percent of the stability for the medial elbow and is one of the main reasons why UCL injuries end up being corrected surgically.

The diagnosis of a grade II sprain doesn't really give us too much information, even though grade II is considered a partial tear of the ligament—any sprain/strain has some tearing, even the mildest of cases. Grade II sprains can have 20 percent or 90 percent tearing—both are accurately diagnosed as grade II sprains. The severity becomes a matter of how unstable the elbow is, i.e. how much looseness is causing the symptoms. If the elbow isn't very loose, then a conservative rehabilitation could have a reasonable chance of success. If the elbow is loose, then the likelihood of a successful outcome without surgical intervention decreases significantly.

Aardsma is going to visit Dr. Yocum for another opinion before making any decision. While possibly losing Aardsma for the season is a bit of a downer, the extra time off for his hip may be good for him—as we discussed before, some pitchers who have had the same procedure on their hips have struggled to regain their form immediately. Sure, we're just trying to make Mariners fans feel better now, but don't take that away from them.

Bruce Chen, KCA (Strained left latissimus)
Chen has remained healthy since his Tommy John surgery in 2008, aside from an oblique strain at the end of 2009, so he was considered a moderate risk to hit the DL heading into the year. Latissimus dorsi strains tend to last a little longer than strains to the quad or calf, so Chen will likely miss more than the minimum.

While on the surface it may look like losing Chen will be a problem for the Royals' rotation, it gives them time to try out some of their younger pitchers and keeps them from seeing Chen's true performance level—he had a 4.75 SIERA last year and is at 5.02 this year, well above his 3.79 Run Average. We wish Chen could tell us how he has turned illusions for money these past few years, but we would hate to see him kicked out of the Magicians Alliance.

Edward Mujica, FLA (Left knee strain)
Things didn't look too good when Mujica was carted off the field with what appeared to be a serious left knee injury on Tuesday. He was lucky, though, suffering a left knee strain, and was only a little gimpy walking around the clubhouse a little while later.

The problems with Mujica's left knee aren't new, as the back of his knee was bothering him in early April. There is no word yet on whether he aggravated the earlier injury or if he will end up on the disabled list. If he was already walking around, albeit gingerly, he may be able to avoid the disabled list.

Luke Scott, BAL (Right shoulderpartial tear of the labrum)
Continued soreness in Scott's right shoulder led to imaging, which showed a partial labral tear. He is going to try to play through it with serious modifications in his workout routines—this may be difficult for him, as he is a self-described gym rat. Throwing seems to bother him more than hitting, so Scott feels he can put off the surgery until after the season if he still needs it. The likelihood of it healing is pretty low—as he continues playing, it's possible that it could worsen and flare up severely.

Flesh Wounds: Rafael Soriano is set to have a MRI on his sore right elbow today, and Jason Heyward will have one on his sore right shoulder. Both should yield results later today… Tommy Hunter aggravated his right groin in a rehab start and is at least two to three weeks away now... Vernon Wells also suffered a right groin injury, worsening an already poor start to the season... Geovany Soto strained his left groin in Tuesday's game and is day-to-day, depending on the forthcoming MRI results… We told you there was a chance Clay Hensley had a fracture even though it didn't show up on plain X-rays. MRI confirmed a hairline fracture in his left shoulder blade. He stands a good chance of pitching again once the pain and swelling subside, even before the four to six weeks required for most fractures to heal.

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:  Surgery,  Shoulder,  Elbow,  Year Of The Injury,  Quad-a

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