September 6, 2011
The Season-Ending Injury Edition
Hanley Ramirez, FLO (Left shoulder surgery—instability) [AGL: 94, ATD: +.065] (Explanation)
Arthroscopic procedures are minimally invasive and generally have a shorter recovery time. Small incisions are made in the shoulder to allow the instruments to be passed into the shoulder. Before addressing any repair of the capsule itself, the surgeon will take a look at the labrum, rotator cuff, and articular cartilage on the end of the humerus. If any of these is injured, repair of that structure will ensue.
Two of the most common injuries resulting from instability are a specific tear of the labrum called a Bankart lesion or a second lesion called a humeral avulsion of the glenohumeral ligaments, aka HAGL. The Bankart lesion occurs when the bottom front part of the labrum pulls away from the main ligament in the area. In order to repair the lesion, the torn labrum has to be anchored into the very edges of the bone. To repair the HAGL lesion, the ligaments must be reattached where they came off the humeral head or risk remaining unstable.
After all of the structures are evaluated and repaired inside the shoulder joint itself, attention turns to repairing the capsule itself. The inferior part of the capsule is then pinched and lifted up, tightening the bottom front of the capsule. The capsule is then sutured to permanently keep it in the tightened position before all the other subcutaneous tissue and skin is closed.
For the open reconstruction, a procedure called an arthrotomy occurs when the incision is made into the shoulder joint itself. All of the same structures are then evaluated in a manner similar to arthroscopy, except that they can be better visualized. After all the structures inside are addressed, the capsular repair begins. In open procedures, the capsule is split and left with flaps, which are then sutured in an overlapping fashion in order to tighten the capsule. The rest of the tissue is then closed and the incision is sutured shut.
Results of research studies are somewhat varied in terms of long-term redislocation rates, but generally an open procedure is still considered the gold standard despite its lengthier rehabilitation time. Improvements in arthroscopic techniques are closing this gap, especially in the hands of skilled surgeons. If Ramirez chooses surgery, he will miss anywhere from four to eight months, depending on what exactly needs to be repaired and what procedure he chooses.
Brennan Boesch, DET (Right thumb surgery—torn ligament) [AGL: 14(60DL), ATD: TBD(-.041DL)]
Franklin Gutierrez, SEA (Left oblique strain) [AGL: 6(23DL), ATD: -.010(+.009DL)]
Mike Stanton, FLO (Right hamstring strain) [AGL: 4(27DL), ATD: -.018(-.005DL)]
Conor Jackson, BOS (Right knee contusion) [AGL: 1(40DL), ATD: -.011(-.019DL)]
Flesh Wounds: Pat Burrell's foot continues to bother him enough to limit his playing time. He will likely need off-season surgery in order to correct it... Nick Blackburn's transfer to the 60-day disabled list for forearm nerve entrapment has ended his season... Nate McLouth was also transferred to the 60-day disabled list while he recovers from sports hernia surgery that took place in early August... Jeff Karstens is still dealing with shoulder soreness and will likely have his next start pushed back... Ben Zobrist was out of the lineup for the last few days with neck stiffness... Felipe Paulino's low back tightness improved and allowed him to start yesterday. He may have wished that he’d waited at least one more day after being blasted for six runs in less than five innings... Yunel Escobar was forced from Saturday's game with a sprained left wrist. Toronto has said that Escobar will be day-to-day... Yadier Molina is day-to-day with a sore left calf... Jed Lowrie had to leave Saturday's game with tightness in the same shoulder that cost him two months of the season. He and the Red Sox both feel that it is fatigued more than anything else, and he should be able to return any day... Brian Duensing left Saturday's start with a right oblique strain. He is hoping that it's only a day-to-day issue, but that is unlikely... Alcides Escobar left Friday's game with a left ankle sprain. Like everyone else, he's day-to-day at this point... Jack Hannahan will miss several days with a minor calf strain... Roger Bernadina will miss several days with a laceration of his hand after sliding on Sunday... Jonathan Herrera caught his right index finger in a door, resulting in a fracture that could end his season. Not exactly the best way to go out...Josh Beckett will be given at least one extra day off before making his next start. He was forced to leave Monday's game with a sprained right ankle... Erik Bedard will skip his next start after feeling tightness behind his left knee again.
Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP