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June 3, 2008

Under The Knife

The Wrist Bone's Connected to the...

by Will Carroll

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David Ortiz (35 DXL)
Everyone I spoke with was stunned when the wrist injury to Ortiz went from "mild annoyance" to "possible season-ender." The images that showed a "significant tear" caught everyone--especially the Red Sox--by surprise. As I said yesterday, everyone I spoke to seemed to think this was minor and would be a couple games. Instead, the sprain is going to cost Ortiz at least a month of the season, and could be far worse than that. The invocation of Nomar Garciaparra made originally by Tony Massarotti of the Boston Herald, who broke the story Monday night, caused wailing from Red Sox Nation (no doubt Bill Simmons covered his ears with his Celtics jersey). The team will wait for a month to see if rest alone is enough to heal the left wrist. There are reports that it's the tendon sheath rather than a ligament (via NESN), so there's still more to be sorted out here. If it is the sheath, it covers the extensor, the tendon that helps the wrist move "down" as if swinging a hammer, or medially (towards the body in anatomical position, though this can be confusing, since in anatomical position the palms face upwards). Take a quick "swing" and you'll see that this is precisely the kind of motion made on every swing of the bat. If there's any consolation, it's that Ortiz injured his "top hand" and that he's overcome wrist problems before (Ortiz broke his hamate in his right wrist during his Twins tenure). Even in the best case, Ortiz will miss a month and lose some power once he is back. For the Sox, they do have some interleague games coming up and could help Manny Ramirez's knees by shifting him to DH in the interim.

John Smoltz (0 DXL)
Smoltz came out as a closer on Monday throwing with a new motion. His very low release--I'm hesitant to call it sidearm, but I don't have a better term--allowed him to pitch at a reasonable level. According to Gameday, Smoltz was throwing at 95, an improvement over his pre-DL levels, but the angle appeared to take some of the depth out of his slider. The slinging motion is still a work in progress for Smoltz and pitching coach Roger McDowell, with the biggest difference being how his pitches act from the lower arm slot. While the fastball seemed live, the slider just spun up there. It makes sense if you understand how spin acts on the ball: from a normal high slot, the slider spins from 2 to 8 (as if on a clock) from the pitcher's point of view. Turn that on its side as Smoltz has, with his hand nearly underneath the ball, and you're going to get what amounts to a three-hour adjustment, or 5 to 11. Since no pitch is going to spin hard enough to actually break upwards, it will instead act to counter the downward force. Questions on Smoltz's health were partially answered; he's strong enough to throw at effective and even impressive velocity, but we don't yet know how he'll recover from having done so. The recovery concerns me far more than the mechanics at this stage, as Smoltz's pitching can be adjusted more easily than his shoulder can be healed.

Jake Westbrook (15 DXL)
We have to assume that this injury is a cascade. Just a week after coming off of the DL, Jake Westbrook is back on it with some elbow inflammation. After I analyzed him closely and saw Westbrook as someone who should be durable, he now has three DL stints since, but an arm injury is even more worrisome than a problem with his core. Westbrook has been sent back to Cleveland for tests, and with inflammation in the elbow remaining days after his start, this doesn't look minor. I've taken another look at Westbrook's last start, but I don't see any significant changes in his mechanics, though watching on TV is admittedly not the ideal way to analyze mechanics. The Indians are left scrambling for a replacement, as many of their options are either injured (notably Adam Miller, who's likely done for the season) or out of sequence. Eric Wedge may end up going with a bullpen game today against the hot-hitting Rangers, though that option has its perils as well. The images should give a clearer picture of where Westbrook's season is headed, so I'll be watching that closely for updates. The DXL is based on current information, but is very fluid.

Ryan Zimmerman (15 DXL)
Nick Johnson (45 DXL)
The contrast MRI done on Zimmerman showed a small labrum tear in his non-throwing shoulder. He should be able to play through this without significant problem, once the initial inflammation is gone and assuming that they can keep him from having any further irritation. The location and "cleanness" of the tear are key here. He would have missed some time as the contrast dye worked its way out and the inflammation reduced anyway, so the Nats have pushed Zimmerman to the DL. The Nats are consulting with several top surgeons, so it sounds as if a surgical option is on the table as well. With Johnson, the torn tendon sheath (yes, the same one that could be the problem with Ortiz) is not healing as expected, but if we extrapolate from his normal slow-healing tendencies, he's still not far off expectations. He'll be in a cast for two more weeks and could miss another couple of weeks after that. While we'd normally expect a short rehab stint, the Nats could try to get Johnson back in the lineup quickly. Their odd roster construction makes this one tough to read, so we'll just have to watch and wait. It was nice to see everything so detailed in their press release. More teams should try that.

Chris Young (30 DXL)
Jake Peavy (15 DXL)
The Pads' pitchers are making slow progress. Young continues to rest to make sure that small fractures in his nasal cavity don't become displaced more. There's a bit of fluid movement between the areas, raising the possibility of significant infection. He's on antibiotics to stave that off; once stable, he should be able to quickly return to pitching, though there's no way of knowing exactly when that will be. If the fractures don't stabilize, Young will need some surgery; given the nature and location, it's a complex procedure that could cost him significant time. The news is a bit better--or at least more predictable--for Peavy. After making it through a 30-pitch bullpen session, Peavy will throw another one either Tuesday or Wednesday (reports vary) that will include more effort and his full arsenal of pitches. Assuming that his stamina is solid and he recovers normally, Peavy would slot back into the rotation early next week. That would put him just past the fifteen-day minimum, even with the retro move that was made.

Jorge Posada (45 DXL)
Joba Chamberlain had hoped that Posada would be catching him when he makes his first major league start tonight. That's interesting, given Posada's inability to throw. Posada is on track to return to the Yankees on Thursday, and has made throws to second over the weekend, a big step for him. The throws were "strong" according to reports, but there's still some major question about his ability to combat the running game, as well as questions about whether he should. Most of Posada's value is in his bat, not his arm, and if keeping him healthy means he doesn't throw in all situations, there's going to be an interesting chess match between the Yankees and their opponents. With Trey Hillman doing the skippering for the Royals this weekend against Posada, it should be very interesting to see what happens.

Fernando Rodney (90 DXL)
Joel Zumaya (90 DXL)
The Tigers are trying to rebuild themselves on the fly, shifting their various parts around in hopes of maximizing the available talent. While Jim Leyland hasn't found the magic combination on the field yet, the returns of Rodney and Zumaya are on the horizon, potentially making the bullpen a source of strength, assuming that these two power relievers can resemble what they were over the past couple of seasons. Given their injuries, though, that's no easy assumption. Returning from his freakish shoulder injury, Zumaya faced the bigger initial questions, since no pitchers in recent memory have had a similar situation. I'd expected this to be a "binary injury"-- he'd recover fully, or he wouldn't at all--and things look positive so far. Zumaya has been throwing in the mid-90s, down from his peak, but useful and not in game situations, so there's some expectation that he's got some room to improve. He'll begin a rehab assignment today, putting him on track to be back at the end of the month. Rodney is a more tenuous situation, since the damage inside his shoulder is more chronic in nature. He's shown good progress since almost heading under the knife back in March and will start his rehab in Triple-A, though he also should be back near the end of the month. Rodney should be more prone to recovery problems initially, but the Tigers have to be pleased with their medical and rehab staff's work here.

Quick Cuts: Rafael Furcal is swinging a bat, but there's still no firm return date targeted. ... Tim Hudson says he'll make his next start after a hamstring strain, though Bobby Cox says that he'll have Plan B at the ready. ... The Rockies used a trip to Los Angeles to sneak in a checkup for Troy Tulowitzki. He remains ahead of schedule in returning from a quad strain. ... Kris Benson was scratched from his rehab start and could be scratched from the Phillies' plans before long. ... The Cubs got Carlos Zambrano out of the game quickly on Monday, his first after a 130-pitch effort; smart move. ... Rich Harden went 115 pitches, though he seemed quite fatigued at the end. He's still risky, but things are looking good after his off-season mechanical work. ... Jason Schmidt has a minor calf injury, re-setting his rehab clock. ... Katie Burkhart is 40-5 for Arizona State this year. Add in an 0.77 ERA, 40 CGs, and 11 relief appearances to her five hundred strikeouts, and it staggers the mind. I still think that despite the significant differences there's a lot to be learned from softball biomechanics.

Related Content:  The Who,  Jake Westbrook,  Quad-a

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