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July 8, 2011

Collateral Damage

Adding Averages

by Corey Dawkins and Ben Lindbergh

After a whirlwind of activity over the weekend, a brief respite between injury onslaughts allowed us to come up with a new feature that we hope will enhance your Collateral Damage experience. Starting today, we will be including the average number of games lost (AGL) and average TAv difference (ATD) for each injury that is discussed in detail. Each number is broken down in a couple of different ways: pitcher vs. position player, and day-to-day ailments vs. injuries that require stints on the disabled list. The TAv difference is based on the change between the previously injured players’ performance in the two weeks prior to their injuries and their performance in the two weeks after their injuries (small-sample-size caveats apply).

Finally, if a player is already on the DL or is certain to be placed on it, only one number is shown. If the injury is day-to-day but has a chance of sending the player to the disabled list, two numbers will be given. The first number will always be the calculation for the day-to-day time lost, while the number in parentheses pertain to DL stints only.

Evan Longoria, TBR (Left foot Morton's neuroma) [AGL: TBD ATD: TBD]
The TBD above indicates that this diagnosis is not common among baseball players. Longoria has been suffering from a neurological compression injury termed Morton's Neuroma, despite its not being a true neuroma. There are very small nerves that travel down the foot into the webspaces before branching off into the inside and outside part of each toe. A fibrosis (excessive connective tissue) can form around the nerves at the point where they branch, which can compress the nerves and cause pain. This most commonly occurs between the third and fourth toes but also occurs between the second and third toes. The interspace volume between the distal ends of the bones of the foot is decreased when compared to the spaces of the first/second toes and the fourth/fifth toes.

As the available volume decreases in the interspace, increased pressure is placed on the now-thickening Morton's neuroma. This causes pain, numbness, and/or tingling in the area, can also affect the involved toes, and is often aggravated by pushing off the foot, causing further compression of the nerve. Foot type, footwear, and activity level all play a role in the course of the condition. Shoes with a narrow toe box will force a compression in the area and cause pain.

Treatments include footwear changes, activity modification when possible, corticosteroid (cortisone) injections, and occasionally surgery. The problem with surgery for this condition is that the neuroma can reform despite a successful surgery, putting the patient back at square one. For this reason, unless the symptoms are completely debilitating, surgery is avoided.

There are no comps in the database—hence the TBD above—but this is very unlikely to cause Longoria to miss significant time, at least from his foot pain. He could alter his biomechanics as a result of the pain and be more prone to ankle injuries, but that’s unlikely as well.

Wade Davis, TBY (Right forearm strain) [AGL: 38 ATD: +.004]
When Davis went on the disabled list with a right forearm strain, we found out that it had been bothering him during his last several starts, limiting his ability to throw his slider effectively. Repeated forearm strains can be a harbinger of things to come, but an isolated strain is not a death sentence. However, they do tend to keep pitchers out for a while because of their impact on the mechanics of pitching (hence the AGL of 38).

Somewhat surprisingly, pitchers have tended to improve in the first two weeks after returning from forearm strains. Davis may continue that trend, since the injury may have been hampering his performance for a few weeks now. Reports coming out suggest that Davis could return around the minimum, which is certainly possible, but chances are his recovery will take at least three weeks.

Scott Baker, MIN (Right elbow flexor pronator strain) [AGL: 15 (40 DL) ATD: -.005 (+.057 DL)]
Baker has not yet been placed on the disabled list, but he has been scratched from his next start with a mild strain of the flexor pronator mass in his right elbow. The average number of team games missed for even a day-to-day injury of this type is 15, so even if Baker avoids a DL stint, he won’t be back immediately. If he has to be placed on the disabled list, then the average figure jumps up to 40 games missed.

However, the Twins could use Baker’s time on the shelf to focus on his mechanics, as well as his strength and conditioning. Baker had his troubles with the elbow last year and needed a cleanup surgery at the end of the season, so Minnesota will likely be cautious in proceeding.

Charlie Blackmon, COL (Left foot fracture) [AGL: 35 ATD: +.074]
As Blackmon was approaching third base and entering his slide yesterday afternoon, breaking a bone in his foot was likely the last thing he was thinking about, but the injury occurred nonetheless. The resulting fracture and possible surgery will probably keep him out for several weeks, based on the numbers above.

The injury itself looked fairly harmless; Blackmon wasn't obviously limping or rolling around in pain afterward. He did have a little hitch in his stride as he was approaching third base, so the impact of his foot on the bag may not have been responsible for the fracture. If he does require surgery to stabilize the area, he will likely miss the remainder of the season, but it sounds like he will certainly miss a good chunk of time regardless.

Flesh Wounds: Chris B. Young is playing through a sprained left thumb... The left wrist of Elvis Andrus is not quite at 100 percent, and he will use the All-Star break to give it some much-needed rest... Austin Jackson was removed from yesterday’s game as a precaution after suffering left wrist soreness... Lonnie Chisenhall left last night's game after being hit in the face by a pitch. He was diagnosed with a contusion and will be monitored for any signs of concussion overnight before being reevaluated tomorrow... Jason Kendall will undergo another surgery on his right shoulder next Wednesday for two new rotator cuff tears, which could put his career in jeopardy... Brandon Webb is also facing the possibility of retirement and another surgery on his troublesome right shoulder after another setback in his recovery.

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:  Surgery

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Premium Article Prospectus Hit and Run... (07/08)
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