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April 30, 2008

Under The Knife

Bad Joints

by Will Carroll

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John Smoltz (30 DXL)
The good news is that he won't need surgery-Smoltz's shoulder has some mileage on it, and he's an older pitcher, but the joint doesn't have significant structural damage. A consultation with Dr. James Andrews came back with a diagnosis of an inflamed biceps tendon and some rotator cuff irritation, two interrelated conditions. Smoltz will be shut down for a period, then work to strengthen the muscle after the inflammation goes down. While he should be able to come back relatively quickly (assuming things calm down in the affected area as expected), there's still the problem of causation. Something in Smoltz's shoulder is causing this, whether it's the motion or something structural (not damage, just how they interact; inflamed tendons are often caused by rubbing or impingement). Older pitchers do tend to heal more slowly, and the Braves will be as conservative as they can afford to be without letting the Mets and Phillies run away. I'd expect Smoltz to be back somewhere around the 30-day mark, but I won't be a bit surprised to see him back a little bit earlier, though if he does come back that quickly, I'll be a lot more concerned about his recurrence risk.

Jorge Posada (30 DXL)
Now that the initial panic over Posada's shoulder is subsiding, we can focus on the facts. According to both the Yankees and Dr. James Andrews, Posada has a strained rotator cuff, but they've sent the images to Dr. Tim Kremchek and Dr. David Altcheck as well to get as many opinions as possible, which suggests that they're looking for a definitive answer. It also raises the question about whether or not there's a labrum tear. Even with images, those are extremely tough to diagnose without opening up the shoulder. People I spoke to familiar with the injury seem to discount the labrum theory, however. "He didn't show any problems hitting," one doctor said, "and I'd expect to have seen something there." While we're still at least a few days from the Yankees getting all their opinions and then working with Posada on a plan for his return, I don't see any information thus far that changes the expectations for his recovery. A month of rest and rehab should have him back at least to a hitting capacity, though getting back catching is a far different problem.

Alex Rodriguez (20 DXL)
A-Rod has a tendency to do things bigger than anybody else, perhaps a bit too big at times. He's done it again, trumping Derek Jeter's quad strain with a bigger strain of his own. Imaging showed that Rodriguez is dealing with a Grade 2 strain, in part because he re-injured it since returning to the lineup and made it worse. It's definitely a strike against the Yankee medical staff that he was back out there and put at risk, but sources tell me that Rodriguez bears most of the blame, insisting that he was fine and that the leg wasn't sore. He'll head to the DL and will likely miss at least the minimum, with the location of the injury and his ability to heal putting in question how long beyond the 15 days he'll go. Combined with Posada's injury, the DH slot won't be an option for any great length of time, so he'll need to be near full-go when he returns.

Troy Tulowitzki (15 DXL)
We all know that Tulowitzki idolizes Derek Jeter, but getting the same injury as his hero might be taking it a bit too far. Tulowitzki is headed for the DL with a strained left quad, part of a series of moves and injuries that has the Rockies in a quandary. The injury left them shorthanded in-game, so they had guys playing out of position last night. Tulowitzki was a symbol last year of the Rockies' resurgence, but this year, he's becoming a symbol of their struggles. This was a .500 team last season, playing some of the best baseball I've ever seen at precisely the right time. This year, that luck is evening out, but many have greater concerns over Tulowitzki's play, which most would normally just call a sophomore slump. The quad strain isn't serious, likely being a minimum stay, but it may allow Tulowitzki a bit of a mental break, which could end up a positive, assuming that he can dial it back a bit in the interim. One criticism that I'm hearing from scouts is that Tulo's "one speed" is starting to wear on him and his teammates.

Scott Kazmir (30 DXL)
Reader Eron Nicholson was at Kazmir's start at Triple-A Durham and filed this report: "First off, he seemed like a nice enough guy. He was joking around with some people during his warm-up and signed a few autographs for kids. I thought his warm-up looked good and easy despite being pushed back an hour due to rain. He didn't seem to have any trouble in the first inning.. hit 94-95 on the stadium gun a few times and had good late life on his fastball. He labored a bit in the subsequent innings, had issues throwing first-pitch strikes, got into some bad counts and had some pretty hard-hit balls go for outs. The one run he gave up was on a solo shot on a pitch low and middle-in. His velocity seemed to lag a bit in the middle innings as well. Also, I'm not sure if it's normal for him or not, but he warmed up very, very slowly between innings. It took him 5-6 pitches to get up to the mid-80s... the first few throws, he was literally just tossing the ball in." I also spoke with a scout who was at the game, but his information matched up very neatly with Eron's, plus Eron was nice enough to include some pictures, one of which is included at the bottom of UTK today. Thanks for the report and the image, Eron!

Johnny Cueto (0 DXL)
A couple of weeks ago, after Cueto's second dominant start, I noticed something. With the assistance of Eric Seidman, the PitchFX data appears to be telling us something, but I was only confident enough to hint, but later in that start, I noticed that Cueto's release point appeared to stay very consistent. That played into a pet theory of mine: we know now, after years of research, that getting a pitcher's proprioception back is the hardest part of a Tommy John rehab. The pitcher loses some of the ability to note where his hand/arm is in space, leading to the "disconnected" sense that many of them struggle with, or did before changes to the rehab protocols. Now that we have accurate release point data, it will be interesting to see if my theory that we see early proprioceptive deficits-situations where we see wildness from a consistent release point-being predictive of early-stage injury. It's just a theory, mind you, but it does fit as an explanation for Cueto's more recent struggles.

Dustin Pedroia (0 DXL)
Pedroia said his shoulder "popped a little outside the socket" while he was making a play last night. That sounds serious, but his description of a mild subluxation is a chronic issue that doesn't appear to be a serious problem. Oddly, he's just a little hyperflexive. This video actually shows that Pedroia's shoulders are more flexible than most, which also isn't a problem. I never thought that video would be good for anything but a laugh, but watch how easily Pedroia reaches behind himself to pull off his shirt. Overall, this shouldn't be any more of a concern in the short-term, though Pedroia's going to have to keep the strength of his shoulder up to make sure that the musculature holds things in place. From that video, I think his muscles need some work.

Jonathon Broxton (3 DXL)
Grady Little is the gift that keeps on giving. At the end of last season, Jonathon Broxton was overused and worn out; he may be as big and strong as an ox, but even beasts of burden have their breaking point. Broxton seemed to stay just on this side of breaking, staying in the "heavy fatigue" area of the dial. Tony Jackson of the LA Daily News is saying that Broxton's lat is the area of concern, which is often injured after the shoulder is fatigued. Broxton was taken in for images, but results weren't yet known. Sources tell me the injury is considered minor and that the reliever is not headed for the DL. If anything, this seems like a precautionary move and a signal that Broxton is going to need to be rested more. I'm giving him three days here, which is really more of an indication of extra rest I think he'll get over the next couple weeks than actual missed games, though those are often difficult to read for relievers.

Erik Bedard (0 DXL)
I realized I never talked about Erik Bedard's return from the DL over the weekend. It happens sometimes, but this definitely bears watching, even after the solid early returns. He was certainly solid in his first game back, throwing 95 pitches and getting the win; he showed solid velocity and efficiency. The only kink was his command, giving up four walks and not being able to put the ball in spots the way he normally does. One observer at the game suggested that he'd altered his mechanics and Gameday suggests that this might indeed be the case. Bedard's release point was decidedly mobile over his selection of pitches. Check the at-bat in the second inning where he walked Bobby Crosby and watch the release point move around. We'll have to watch a couple more starts to see what, if any, changes were made and to see if those changes take some strain off his hip.

Quick Cuts: J.D. Drew was lifted from last night's game after appearing to injure his quad. I'll provide more info as it becomes available. ... Dontrelle Willis heads to a rehab assignment at Triple-A Toledo on Friday. He's had no problems during his rehab. ... Alfonso Soriano will be back in the Cubs lineup on Thursday. ... Roger Clemens' dignity is day-to-day. ... The Cards are upping their minor league pitch ceiling. It should be interesting to see how this goes. I'd have liked to have seen a more gradual approach, but I'm not against this. ... Chad Cordero is back on the DL with a strained lat, a classic cascade injury. Again, I'll have more on this as it comes out. ... Tom Glavine came off the DL and looked solid, with no apparent lingering concerns.

Related Content:  Back,  Shoulder,  Year Of The Injury,  The Call-up,  Quad-a

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