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September 21, 2011

Collateral Damage

A Pence for the Phillies' Thoughts

by Corey Dawkins and Ben Lindbergh

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Pablo Sandoval, SFN (Left shoulder strain) [AGL: 3 (29 DL), ATD: -.002 (+.031 DL)] (Explanation)
When Sandoval strained his shoulder in mid-August, few were expecting him to be limited for the remainder of the year as he has been. Still unable to hit from the right side because of the left shoulder pain, Sandoval may end up needing surgery after the season is completed. Typically, this mechanism of injury—Sandoval injured the left shoulder batting right-handed—is more indicative of instability or a partially torn labrum than a partial muscle tear.

In some cases, the ligaments and capsule are stretched and can be painful, while at other times the capsule and ligaments can be torn and end up needing to be stitched or anchored to bone for proper healing. The labrum can tear with a similar mechanism of injury and lead to deep pain and “something not feeling right” inside the shoulder itself.

There are examples of hitters injuring their front shoulders and needing surgery. Richie Sexson partially dislocated his shoulder in 2004 and wound up injuring the labrum and the capsule, hampering his ability to swing effectively. Dustin Moseley injured his left shoulder while swinging, and after enduring multiple episodes of further dislocations, he underwent surgery to stabilize it this past August. Adrian Gonzalez also had trouble with his front (right) shoulder and experienced deep pain that would not dissipate before undergoing surgery this past offseason. Dislocations and partial dislocations of the shoulder are relatively easy to diagnose, which unfortunately cannot always be said of ligament or labrum tears. Even with the contrast dye injected into the joint, labrum tears do not always show on MRI and appear extremely rarely on x-ray.

If Sandoval does undergo surgery, its exact nature and his subsequent recovery depend on what structure is injured and how much needs to be done. Most surgically repaired labrums in hitters heal by the start of the following season if surgery is performed immediately after the prior season. In the meantime, Sandoval will continue to sit out against left-handers and try to get as much treatment down the stretch as possible.

Hunter Pence, PHI (Left knee—patellar tendinitis) [AGL: 1 (24 DL), ATD: -.014 (+.055 DL)]
Pence was removed from yesterday’s game after favoring his left leg as a result of patellar tendinitis, which was confirmed after the game. He’s going to have an MRI today to rule out any sort of internal derangement, such as a torn meniscus or cartilage injury, as well as to evaluate the patellar tendon itself. As we’ve discussed before, chronic tendinopathy can lead to degeneration of the tendon tissue itself, making it more prone to complete rupture. If the tendon is necrotic, the chance of it healing on its own is fairly slim. The sheath surrounding the tendon can also be inflamed acutely, which an MRI will help determine. 

For now, Pence will receive daily therapy in order to decrease the pain and inflammation and get himself ready for the playoffs. Any sort of surgical procedure would obviously end his season, and Pence will try to avoid that outcome at all costs. Eventually, he may undergo platelet rich plasma (PRP) injections or surgery, although the latter is highly unlikely. He’ll likely miss a few days down the stretch but should be ready to play in the playoffs.

Cody Ross, SFN (Right hamstring strain)[AGL: 4 (27 DL), ATD: -.018 (-.005 DL)]
As we know, Ross strained his right hamstring on Friday and was initially expected to be out for at least a week. In an attempt to speed up his recovery, he had a cortisone injection on Sunday and believes he may be ready to play this upcoming weekend. Cortisone is a powerful anti-inflammatory, and once a player is past the initial injury phase, it can be very beneficial in speeding up the body’s natural healing process.

Cortisone can’t be used too liberally, however, since repeated injections can actually begin to break down the collagen matrix of the muscles and tendons, making them more prone to rupturing. When Ross does come back, he will have to be used sparingly at first in a pinch-hitting role before resuming full-time duties.

Asdrubal Cabrera, CLE (Back strain)[AGL: 3 (13 DL), ATD: -.037 (+.094 DL)]
Cabrera is day-to-day after straining his back in the first game of the doubleheader yesterday. Even though he has had several minor injuries in the past—plus a few more serious ones—none has involved his back. Even mild back strains can be extremely limiting because of the spasms associated with straining the muscles. Modalities, manual therapy, and muscle relaxers can help to alleviate the symptoms, but Cabrera isn’t guaranteed to return before the end of the season.

Kerry Wood, CHN (Left knee surgery—torn meniscus) [AGL: 4 (29 DL), ATD: TBD (-.008 DL)]
All good things must come to an end, and Wood’s 2011 seasons did just that on Saturday. He’s going to be shut down for the rest of the year and will undergo surgery on a torn meniscus in his left knee this week. The surgeon will try to preserve as much of the meniscus as possible, but a small portion of the meniscus will likely be trimmed out. Recovery for the partial meniscectomy is almost always easy and nothing like having the meniscus repaired, which requires crutches and a brace for several weeks. Wood will be ready for the 2012 season if he chooses to come back.

Flesh Wounds: Bud Norris left yesterday’s start with shoulder discomfort. He missed time in 2010 with shoulder inflammation of the biceps and the bursa. There hasn’t been an update yet… Carlos Ruiz has been dealing with a sore ankle for the last several days but was able to pinch-hit yesterday… Alex Gonzalez left Tuesday’s game with a strained right calf and is day-to-day… Kyle Blanks also left yesterday’s game, but with a right quad strain… Takashi Saito will rest a few days down the stretch with a sore right calf. Expect him to be fully ready come playoff time… No shortstop is safe on the Rockies. Hector Gomez has been out for the past few days with back spasms… Will Venable has also been out with back soreness. No word on his return yet… Ryan Adams is the latest to be diagnosed with a sports hernia. He is likely done for the season and may end up undergoing surgery… Brendan Ryan was diagnosed with a cervical disc issue that may or may not need surgery. His main complaint was of spasms and stiffness, so he may be able to return once those clear up… Matt Holliday has just been cleared to begin hitting off of a tee, but he’s cutting it close if he hopes to return this season… Kevin Youkilis still has not been able to return after increased soreness in his hip following a workout on Monday… Dan Wheeler is battling some forearm tightness and has limited availability… Aramis Ramirez strained his right quad and likely played his last home game at Wrigley Field.

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,  Shoulder,  Torn Labrum,  Quad-a

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<< Previous Article
The Prospectus Hit Lis... (09/21)
<< Previous Column
Premium Article Collateral Damage: Wea... (09/19)
Next Column >>
Collateral Damage: Pla... (09/23)
Next Article >>
The Lineup Card: 9 Bas... (09/21)

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