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May 2, 2008

UTK Wrap

Major Meltdowns

by Will Carroll

Philip Hughes (60 DXL/$2.31 million)
At this time yesterday, there was a lot of question about the validity of Hughes' injury. The odd timing-he's fine, and then suddenly he's not?-led many to wonder, including me. The problem is this is my area and I'm supposed to know, and Hughes wasn't faking anything and the Yankees weren't playing a roster shell game. Instead, he's got a stress fracture of his ninth rib on his right (pitching) side. Wonder how something like this gets missed? Check out this MRI and see if you see it. Here's an X-ray, which is usually clearer; while this is at the fifth, not the ninth you can see that even something easy like a traumatic fracture isn't clear. Hughes' injury was a stress fracture, a small break that results from the strains of activity rather than an incident, and it's very painful. Hughes is likely to miss at least two months with recovery and then rebuilding his stamina. The pain that he played through would explain his poor start, but he'll have to come back and pitch well for it to be that simple. So, Mr. Hughes, my apologies and best wishes in your recovery.

Jorge Posada (30 DXL/$2.64 million)
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 (15 DXL/$2.34 million)
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 II 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. For those counting, that's three Yankees injuries for $7.3 million in Injury Cost and no small difference in terms of real dollars lost.

Troy Tulowitzki (60 DXL/$5.42 million)
We all know that Tulowitzki idolizes Derek Jeter, but getting the same injury as his hero might be taking it a bit too far. Worse, he's done it better (or is it worse?) than his hero with a Grade III strain at the muscle/tendon junction that will put him out until around the All-Star break. He heads for the DL as 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 after his injury. 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. While the quad strain initially didn't appear serious, the muscle tear became apparent once the swelling went down. The time off 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. Injury Cost was made for this kind of situation. Tulowitzki's value lost is closer to the reality of the situation than the $250,00 in real dollars in terms of player salary that they'll lose.

Yovani Gallardo (0 DXL/0)
It looked bad, really bad, when Gallardo went down in a heap on a bunt play. He grabbed his knee, and it looked for all the world like it was some devastating injury. A closer look at the tape makes me wonder if it was the right decision to leave him in, but toughness is a quality that this Brewers team is looking for. Gallardo has it, and helped keep the game close enough to allow for a comeback. As far as what happened, when Gallardo leaped over Reed Johnson, he landed with his right knee hyperextended and rolled over the top of it. The way he grabbed the knee it looked like he'd lost lateral stability, but that wasn't the right mechanism. Instead, the mechanism would suggest a PCL strain or meniscus damage. We'll see how Gallardo comes back from this by his throw day, but he looked reasonably stable on the mound. You'll remember that Gallardo had knee surgery during spring training, but that was his left knee, which came out of the incident relatively unscathed. While there's a zero up there on the DXL, do not be surprised to see this change, even if it's just missing a start.

John Smoltz (30 DXL/$2.53 million)
Nothing's changed with Smoltz since I wrote about him yesterday-besides perception. The problem is that with Smoltz's announcement, first that he was willing to move back to the pen, then that he would be at least starting out in the pen when he returns from the shoulder problem, how this latest injury was seen changed quickly and sharply. However, there's no basis for it. Smoltz's shoulder isn't better served by his being in the pen, and in fact Smoltz had just as many problems while in the pen, fatiguing at the end of the season just as he has as a starter. The real problem is that we're in May and Smoltz is experiencing the same kinds of problems-inflammation, impingement, and pain-that he has at the end of the season. He's made just a handful of starts, and with each, the recovery period has stretched and the shoulder has swelled more, to the point where Smoltz's shoulder was swelling during his last start. Asking him to recover from shorter outings might appear to be different enough to allow him to stay more productive, but there's no evidence to support it; a sprinter and a marathon runner do vastly different tasks, but their bodies fatigue the same. Pitching isn't the enemy; fatigue is, and until we get a better understanding of that in both general and specific ways, we'll be talking about this again and again.

Chad Cordero (40 DXL/$1.12 million)
Here's the classic cascade injury. While compensating for a sore, weak shoulder, Cordero managed to tear one of the largest, strongest, and most resilient muscles in the body, the latissimus dorsi. The muscle does have a "bottleneck", the lateral aspect where it leads up to the shoulder where it's weakest and sources tell me that this is where Cordero's Grade II strain is located. This is a very similar injury to one that sidetracked Ben Sheets and was overcome by Jake Peavy a few seasons back. The tear will cost Cordero at least a month, but more importantly, the staff and the pitching coach especially will need to watch closely to make sure that another cascade doesn't occur. The kinetic chain is just like any chain; there's always a weak link. Problem is that for some pitchers, which link is weakest can change. I'm setting the DXL a bit longer than the announced month because I think this will linger and require more time to both heal up and get him strong enough to return to action.

Jacoby Ellsbury (5 DXL/$0.28 million)
People wondered-loudly-why Ellsbury came into the season with a red flag in the Red Sox Team Health Report. We got an object lesson as to why this week: Ellsbury's a player whose value is almost completely wrapped up in his speed, and now he has a mild groin strain. Since the Red Sox have options, they've rested him, costing him a couple of games' worth of at-bats and opportunities. The thing is, Ellsbury's getting the best of this, since most teams don't have the options the Sox do. Most teams would have to play him, hoping that he could stay healthy, and risking further, more serious, and lingering damage; it's that abstract player in that scenario who is even more risky than Ellsbury. One thing I did hear in the midst of the shrieking and rending of garments when I originally waved the flag was that Ellsbury is a very smart player, savvy enough to make fine adjustments. That's an adjustment that isn't in the system, and if true it would alter things slightly, though I honestly have no idea how to calculate that. I know some teams use personality tests, so an intelligence test like the Wunderlich wouldn't surprise me. Regardless, Ellsbury should be back shortly, and the Sox are smart to be conservative and won't let him back until both feel comfortable.

Brett Myers (0 DXL/0)
David Murphy (not that one) has the details in the Philly Daily News about how Myers has lost his fastball. While we've already talked a lot this season about velocity, this isn't a dead arm or a game-day situation; it appears something has actually just gone out of Myers' arm. The transition from starter to reliever and back is going to be looked at as a culprit, but there's no evidence that it's actually the cause. Instead, it seems that Myers' conditioning might be in question. In Murphy's article, pitching coach Rich Dubee is quoted saying that he wants Myers doing long toss, something the hurler's long avoided. While there's no indication that this is an injury, Myers is either going to have to find his heater quickly or make the shift to finesse pitcher in a hurry. Some might just call this karma. Even with Brad Lidge in place, I wonder if the Phillies might consider moving Myers back to the pen to see if he can find his fastball in shorter stints. The talk about Smoltz's shift might make this an easier move for Charlie Manuel.

Johnny Cueto (0 DXL/0)
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. The Reds see something too, giving him some extra rest and time to work on what they're calling "a mechanical issue."

Quick Cuts: B.J. Upton had a scary-looking shoulder injury, with observers invoking everyone from Dave Dravecky to Richie Sexson; the early diagnosis is a shoulder strain, though on replay it looked like a dislocation. He had a similar injury in 2006 and missed five games, so that's the best guideline. ... Jimmy Rollins is still having trouble with the ankle. However, it's not lateral motion, which is what you'd think with an ankle injury. Instead, it's when he plants and cuts. I'm honestly not sure if that's better or worse for a shortstop. ... A lot of you asked why there was no Injury Cost in last week's column. I wish I had a better excuse than 'I forgot,' but I don't. ... Paul Lo Duca will be activated from the DL on Friday. ... J.D. Drew will miss a couple more games after a mild strain of his quad. It's a precaution more than a serious injury. ... Alfonso Soriano is back in the lineup and batting leadoff for the Cubs, but under orders not to stress the leg too much. ... Jason Schmidt is going to air it out in a bullpen on Friday. If he does well, he'll head out on a rehab assignment. If not-well, let's not think about that. ... Joel Zumaya has begun throwing off a mound, and there are hopes that he could be back in late June.

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