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July 18, 2011

Collateral Damage

The Hidden Pain

by Corey Dawkins and Ben Lindbergh

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Nick Punto, STL (Right elbow pain) [AGL: 2 (26DL), ATD: +.017(-.019DL)] (Explanation)
Punto’s painful elbow will likely send him to the disabled list, with a real possibility of season-ending surgery, accordingto Joe Strauss. Back in May, Punto was on the disabled list because of a strained forearm, but during the recuperative process, ligament damage was also found in his elbow, and it was a source of discomfort during his rehabilitation assignment. Punto has been battling intermittent pain since being activated on June 27th, but the pain has been significantly worsening over the last 10 days to two weeks.

The extent to which the pain is affecting him became apparent when he short-armed a throw on Friday, causing Albert Pujols to lament his lack of go-go gadget arms. Further tests are going to be performed over the next few days, and a determination will be made regarding surgery. There’s a good chance that this will end up as a lost season for Punto.

Ryan Braun, MIL (Left calf strain) [AGL: 3 (29DL), ATD: +.002(+.005DL)]
Just when I thought I was out, they pull me back in.”  Much like Michael Corleone’s attempts to reform, recoveries from minor strains often appear to be going well until old ills rear their heads and reveal some weakness within. After returning on Thursday from his strained left calf, Braun seemed to hold his own for the first few days, but the calf pulled him back to reality on Saturday, when he left early with a recurrence of tightness in his calf and hamstring and missed most of yesterday’s game.

With no measurable sign that clearly indicates when Braun is 100 percent healed, he and the Brewers will have to be cautious while determining how much he can push himself and when he needs to hold himself back. He’s going to continue to be day-to-day, but he may end up needing a trip to the disabled list to take care of this once and for all.

Pat Burrell, SFN (Right foot bone spur) [AGL: 13, ATD: -.004]
Burrell has had his fair share of injuries—including previous bone spurs in his right foot in 2005—and his right foot has been increasingly painful for several weeks. Spurs can form as the result of repeated traction force being placed where the ligaments or tendons attach and blend into the bone. Commonly found at the insertion of the Achilles tendon and the bottom of the heel, bone spurs in the feet can cause significant pain with each step. Calcaneal bone spurs on the bottom of the heel often form where the toe flexors begin despite being commonly thought to be inside the plantar fascia.

Grady Sizemore, CLE (Right knee contusion) [AGL: 1 (40DL), ATD: -.009(-.019DL)]



Sizemore had to leave Sunday’s game with a diagnosis of a right-knee contusion, and Manny Acta said more tests would be performed today to determine the proper treatment plan. Looking at the video, we are much more concerned about meniscus or articular cartilage damage, because the mechanism of injury doesn’t quite match up.

Sizemore was coming around first and stumbled slightly, resulting in a twisting injury to the knee, which would cause a shearing force of the meniscus and cartilage. Given his ability to keep running, the likelihood of a major injury to the ACL is low, but it is possible to continue running with a meniscal tear. The diagnosis of a contusion could still be accurate, because the force produced by the twisting could cause a bruise of the bone as well. The AGL and ATD numbers above are for a knee contusion but would be significantly higher for a meniscal tear.

Vladimir Guerrero, BAL (Right hand fracture) [AGL: 32, ATD: +.004]
As we get further into the season, it’s becoming more evident that initial diagnoses of bruises can often disguise more serious problems. Guerrero was plunked last Sunday, and his symptoms continued despite rest and therapy. Further testing revealed a small fracture in his right hand, and he was placed on the disabled list after being unable to make it through batting practice on Friday.

The general trend of team announcements is that initial diagnoses of a bruise give way to several days of waiting to see where the player stands. This is standard unless there is malalignment or a clear step off, which would indicate a fracture. If the bone “bruise” keeps a player out for more than four days, then we would be very concerned for a small break. We have seen more cases similar to Guerrero’s this year than that of Carlos Gonzalez, so that’s something to keep in mind going forward.

Tom Gorzelanny, WAS (Right ankle sprain) [AGL: 2 (21DL), ATD: -.007(+.019DL)]
Ross Detwiler, WAS (Right ankle sprain)

Washington pitchers might need to focus on additional preventative strengthening exercises for their ankles after Gorzelanny and Detwiler both sprained their right ankles over the weekend. Gorzelanny collided with Brian McCann on a play at the plate and left the game favoring his right ankle. It did not appear to be a significant mechanism of injury on replay, and more information should be coming out soon, but Gorzelanny was clearly favoring it as he came back to the dugout. Detwiler’s injury was much less obvious, as he slipped on the mound twice during his last start, but he does not appear likely to miss any time.

Brandon Kintzler, MIL (Right elbow stress fracture) [AGL: 99, ATD: +.064]
Kintzler was experiencing continued pain and discomfort in his posterior elbow, and repeat imaging revealed a stress fracture in his elbow. Stress fractures of the posterior elbow usually occur in the olecranon process of the ulna and can be very difficult to heal properly in a pitcher.

If surgery is needed to stabilize the area, an approximate four to 4 ½ screws are inserted into the elbow and across the stress fracture to ensure proper healing. There have been pitchers who have undergone the surgery, but the list is not promising in terms of returns, with Cal Eldred and Adam Loewen coming to mind. Joel Zumaya may have been suffering from a stress injury prior to the fracture of his olecranon, but Zumaya’s surgery resulted from the acute nature of the fracture. Kintzler will be receiving a second opinion about the prospect of surgery.

Jake Peavy, CHA (Right arm fatigue) [AGL: 3 (20DL), ATD: +.024(-.011DL)]
Peavy had his start pushed back because of arm fatigue that partly stems from a 55-pitch relief effort on two-days’ rest on June 25th against the Nationals. It’s not unusual for a pitcher to come in for a relief appearance on one of his throw days, but it is rare for a pitcher with his injury history to do so having been on the disabled list twice already in 2011. Peavy’s start has been pushed back to tomorrow, and we’ll see if he can rebound from his last few disappointing starts with the extra rest.

Flesh Wounds: David Aardsma is not responding to conservative treatment, and the new recommendation is for him to undergo Tommy John surgery at this time... Carlos Guillen was activated from the 60-day disabled list following microfracture surgery on his left knee. He rejoins the Tigers along with teammate Al Alburquerque, who was also activated from the disabled list following right forearm inflammation... Carlos Beltran is-day-to-day as he battles flu-like symptoms while trying to figure out all the trade rumors involving his name. We’re not sure which one might be causing his head to spin more... Joey Devine left Friday’s game with right-side back spasms after landing awkwardly on a pitch to Mike Trout. He thinks he will be able to make his next start but was still feeling some soreness yesterday... Peter Bourjos was placed on the disabled list Friday after his right hamstring gave him problems during a workout late Thursday. The move was retroactive to July 8th, and he is unlikely to be activated when eligible on July 23rd... Scott Baker was placed on the disabled list retroactive to July 7th with a mild right elbow flexor strain, but he could end up returning by the end of the week... Bobby Jenks’ move to the disabled list—perhaps the third time in 2011 will be the charm—for left back tightness means that his previous back problems have not been resolved. There’s no timetable for his return, making us more concerned that he will need surgery due to the recurrent nature of his injuries... Chase Headley strained his right calf on Friday, but an MRI didn’t show anything significant. He’s day-to-day... Jose Arredondo was placed on the disabled list with a strained right forearm on Friday... Eduardo Sanchez is going to be prevented from throwing for six weeks because of recurrent—it’s the word of the day—inflammation in his shoulder. He’s been on the disabled list since June 13th with a rotator cuff strain. He’s likely to need several more weeks of throwing before considering a rehabilitation appearance, which puts the remainder of his 2011 season in jeopardy... The Tigers are not entertaining the idea of using Austin Jackson as a pinch-hitter or defensive replacement, in case they want to move him to the disabled list. Given this level of concern, odds are that he ends up on the disabled list relatively soon.

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

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