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May 30, 2011

Collateral Damage

A Wing and a Prayer

by Corey Dawkins and Ben Lindbergh

Today marks Memorial Day in the United States, the occasion when we honor those brave souls who lost their lives serving our country. Do your part to honor those lost by thanking those still here. The next time you see a soldier, ask to shake their hand.

On to the injuries.

Joe Nathan, MIN (Right forearm and elbow inflammation)
It's not uncommon for players to end up back on the disabled list within a year or two of returning from Tommy John surgery. The surgery requires a long recovery, and there are often bumps in the road both during the rehabilitation process and even once the player is activated. In many instances, the newly-healed body isn't ready for the grind of the season. The typical throwing program accounts for fatigue and restores the body to its former strength, but it can't prepare every player for factors like travel and getting out of the ballpark after midnight.

Looking into the database, we see 173 players who have missed time at the major-league level due to Tommy John surgery. Within one year of returning, a little over 28 percent of the 173 players suffered some sort of injury that caused them to miss time. That figure does include all injuries, so you might think it sounds a little misleading, but almost 20 percent involved injuries to the upper extremities and torso. In fact, nine of the 173 players had another surgery on an elbow or shoulder within a year.

In light of those numbers, it's not too surprising that Nathan finds himself on the disabled list again. Inflammation such as his is very common because of the fatigue factor, but it does tend to resolve with rest and proper rehabilitation. It will likely keep him out for three to five weeks, depending on how long it takes to get the inflammation under control.

Wandy Rodriguez, HOU (Left elbow swelling)
The body doesn't swell without a reason. That reason may not be a major structural issue, but it’s always something. The swelling inside Rodriguez's elbow has been persistent to the point that it required a move to the disabled list. Earlier in his career he suffered from multiple oblique injuries, but this year it's been the shoulder and elbow that have given him problems.

A recent MRI revealed no major structural issues, but it must have missed something. Often there can be damage to the cartilage, which can certainly cause swelling inside the joint. Rodriguez hasn't had any major elbow injuries before, but the Astros would be smart not to push him back too early and risk causing a cascade-type injury.

Joe Beimel, PIT (Left elbow inflammation)
Tony Pena, CHW (Right elbow inflammation)
Tom Gorzelanny, WAS (Left elbow inflammation)

Continuing the trend of elbow injuries, Beimel, Pena, and Gorzelanny all ended up on the disabled list with elbow inflammation. All three have suffered from at least one injury to an arm before, so it's not surprising that we see them here again. We’re also reaching the point in the season where the grind is starting to takes its toll on the players’ bodies; starting around the second week of May, fewer off-days and longer road trips become the norm.

Beimel will undergo an MRI tomorrow, at which point we should find out more about his condition, but Gorzelanny expects to make only a short stay on the disabled list. Pena had an MRI a few weeks ago when his elbow first started acting up, and it came back showing no structural damage, so the length of his DL trip is still undetermined.

Matt Maloney, CIN (Broken rib)
What was first described as an oblique injury for Maloney ended up being a broken rib, conjuring memories of Sammy Sosa's sneezing injury. Small fractures of the ribs can be difficult to assess, especially without any evidence of trauma. In some instances, there isn’t much difference between a bad bone bruise and a small fracture, and in many cases they take about the same amount of time to heal. Maloney was placed on 60-day disabled list, which puts him on the shelf until mid- to late July.

Gordon Beckham, CHA (Left eye contusion)
Even though Beckham wasn't at the plate when a ball hit him in the eye—he was struck by a throw from the outfield that took a bad hop on the Toronto turf—he was still lucky that it didn't cause any fractures or serious damage, since there are several small bones around the eye that don't take a lot of force to fracture. Beckham's eye was swollen, not to mention about three different shades of black and blue, but his vision was normal. Once the swelling subsides enough for his peripheral vision to return, he should come back without any difficulties.

Bronson Arroyo, CIN (Low back pain)
Word came out that Arroyo had an epidural injection for his back pain, which tells us a lot about what’s going on. Epidural injections have many uses throughout medicine, but in sports medicine they tend to be used for disc injuries, such as bulging or degenerative discs, and stenosis, a narrowing of the spinal column.

These injections often contain an anti-inflammatory similar to cortisone as well as pain-relieving medication, and they can make all the difference when physical therapy has failed. They can be very effective at relieving pain and inflammation in both the short- and the long-term, but they don't heal the herniation or create more space in the spinal column. What's more, they're not guaranteed to work.

Flesh Wounds: Kenley Jansen became the Dodgers' 15th visitor to the disabled list in 2011 (three more than any other team) thanks to right shoulder inflammation... Reed Johnson was placed on the disabled list with back spasms, extending his long history of back problems... John McDonald strained his right hamstring a few days ago, and he hit the DL after it failed to improve... Steven Pearce will have an MRI on his right calf on Tuesday and is expected to move to the disabled list... A few days after Buster Posey's injury, Humberto Quintero was lucky to come away with just a high ankle sprain on a similar play... Speaking of Buster Posey, Giants head athletic trainer Dave Groeschner confirmed that he will be out for the season following his recent surgery. He will need at least one other surgery in two to three months to remove two screws.

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

Related Content:  Cascade Injuries,  Elbow

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

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dianagram

Hanley Ramirez ... his feet ... his back ... his not being worth (my) first round pick of him.

May 30, 2011 07:35 AM
rating: 0
 
BP staff member Michael Jong
BP staff

dianagram,

You're telling me. Hanley's production is currently polluting four of my six fantasy teams. Hasn't been worth my auction dollars and my rabid fandom.

May 30, 2011 12:17 PM
 
dianagram

Now we read he's been feeling this back issue for a long time and trying to play through it .... had to STAND for the entire plane ride home and couldn't even tie his shoes.

Why why why do players NOT talk to their training staffs/managers?

May 30, 2011 16:05 PM
rating: 0
 
BP staff member Corey Dawkins
BP staff

Let's just say that I'm a little biased in this. I completely understand not letting everyone in the world know about the injury but at least tell the medical staff/manager about it.

May 30, 2011 16:55 PM
 
BP staff member Michael Jong
BP staff

Corey,

When I first read about this injury and the tingling in his leg / lower extremities, I first thought of a herniated disc. Could this be the case, and what would be the possible timetable on a return from it?

May 31, 2011 12:17 PM
 
flyingdutchman

Yep, a lot of elbow injuries. Seems like there have been a lot of pitcher injuries in general, and by a lot I mean the regular amount. Are there fewer injuries to pitchers now that everyone is being careful about pitch counts? I haven't noticed any difference.

May 30, 2011 11:39 AM
rating: 1
 
BP staff member Corey Dawkins
BP staff

Maybe slight but could also be from chance. Not enough pre-pitch count data in the database yet

May 30, 2011 11:48 AM
 
BP staff member Dan Turkenkopf
BP staff

There's also the confounding issue of better diagnosis and better medical staffs. So we're probably seeing more reports of injuries (as opposed to pitchers pitching through things, or just "dead arms") and we're seeing more pitchers come back from things that would knock them out of baseball pre-pitch count - which means you'll see fewer career-ending injuries, but possibly more overall injuries (and definitely more re-occurring injuries).

May 30, 2011 12:37 PM
 
carpoon

Any word on Homer?

May 30, 2011 12:49 PM
rating: 0
 
BP staff member Corey Dawkins
BP staff

None yet. They're going to have to be more careful given his impingement earlier this year.

May 30, 2011 14:29 PM
 
Jason Wojciechowski

"Within one year of returning, a little over 28 percent of the 173 players suffered some sort of injury that caused them to miss time."

For a sense of context, over the course of a year, what percentage of pitchers who aren't coming back from Tommy John surgery get hurt?

May 30, 2011 13:44 PM
rating: 1
 
BP staff member Corey Dawkins
BP staff

I know that over the course of the season roughly between 40 and 50% of the pitchers end up with something whether it's a flu or surgery.

I think the better question is how many missed time in 2 consecutive years, not just for Tommy John surgery. In 2009-2010 it's 27%, but again this includes everything.

I was trying to get more to the belief that once someone gets back from TJS everything is ok from a health point of view. It is common to have some issues after surgery and not just performance wise.

May 30, 2011 15:58 PM
 
Jason Wojciechowski

Oh, ok, got it.

Thanks for the numbers, too.

May 31, 2011 14:22 PM
rating: 0
 
chicoruiz

You could fill an entire column with the mishaps of the Reds pitching staff over the last week or so...

May 30, 2011 13:47 PM
rating: 0
 
dodgerken222

Why do so many players today wear those plates in their mouths like boxers? Were there that many teeth-related injuries before this, or is it just a fashion statement, like those idiotic necklaces all players wear?

May 30, 2011 14:15 PM
rating: 0
 
BP staff member Corey Dawkins
BP staff

Not quite sure what you mean. Mouthguards?

Most pitchers, if they wear a mouthguard, use one for grinding of the teeth during maximum effort pitching.

May 30, 2011 16:04 PM
 
dodgerken222

By the way, the real Tommy John had nine seasons after his ground-breaking surgery in which he topped 200 innings. He topped 230 frames four times. The reason you don't have enough info in the database for the pre-pitch count era is that it was a needless and unnecessary stat to keep. There are a lot of reasons why baseball is not nearly as great as it was, and pitch counts tops the list. It's an excuse for managers to pull pitchers so that they are not second guessed by the lemmings-like media if the pitch count should exceed 100. Every game is managed so that these so-called "closers" can pad their save totals.
I'm sick of hearing that a hitter had a great at-bat because he popped up after fouling off three pitches, so that he upped the hurler's pitch count. Pitch counts. Five-man rotations. One-inning closers. What nonsense.

May 30, 2011 14:30 PM
rating: -2
 
BP staff member Corey Dawkins
BP staff

Not sure where to go with this one. While I think some managers and others lean on pitch counts too much, the science behind pitch counts and injuries is sound.

The "100" number shouldn't be a hard and fast rule for everyone. Some can go more and some can't.

Also not all IP are equal. We don't have pitch count totals available for most historical data but we do have a way to estimate the pitch counts. This has been done by many different people over the years.

Based on those estimations Tommy John, even in his 230+ IP season, never really was much above 100 pitches per start himself.

May 30, 2011 16:48 PM
 
NL2003

With regard to the above discussion of mouthguards, I recently heard that mouthguards are thought to prevent or minimize the occurrence of concussions. It is a topic of debate however. I quickly found this article: http://dentistry.about.com/od/issuesandemergencies/f/concussion.htm although I'm sure there is more and better information available.

Jun 01, 2011 09:36 AM
rating: 0
 
BP staff member Corey Dawkins
BP staff

It was originally thought that they may help prevent concussions and there was a lot of emphasis put on everyone wearing one in the impact sports. This really was not even too long ago. Newer research shows that it has a minimal impact on concussions, if at all. The concussion is not caused by the impact of the teeth together or anything like that, it's more from the action of the head and how much you were expecting the force.

Mouthguards do help prevent oral injuries and should be worn for those sports where it is at risk though.

Jun 02, 2011 09:06 AM
 
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