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June 16, 2008

Under The Knife

Nothing Automatic

by Will Carroll

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Chris Carpenter (120 DXL)
Carpenter had a setback in his rehab, and it sounds like it's the oldest one in the book. After the surgery that has since taken his name, Tommy John himself had ulnar neuritis, which is a swelling of the nerve that you and I call the funny bone. It led to a change in the surgery by some physicians, moving (transposing) the nerve out of its normal groove in order to keep it from being irritated by the new ligament. No one is really sure why it happens in some cases, but surgeons continue to debate whether or not to move the nerve as a matter of course or whether to leave it in place, since most players have no issues. I once watched several top surgeons heatedly debate this at the Injuries in Baseball Course back in 2003, and was surprised at the passion they held for their position. Carpenter's irritation will be checked by Jim Andrews to see if he'll need rest or surgery to transpose the nerve. Rest would set him back about a month, pushing a return to August, while the surgery would end his chances for '08 and put it at around the start of spring training next season. Either way, the team now needs to fill that gap in their rotation and are hoping that Mark Mulder can at least be league average after some progress in his second go round at rehab. We'll have more word on Carpenter after his visit to Birmingham today.

Vernon Wells (0 DXL)
Quick returns always worry me, and Wells came back so quickly from his wrist injury that when he left the game on Saturday, I thought the worst. It turns out my thought was wrong--Wells did feel some pain in the wrist, common during this phase of recovery, and the team just smartly got him out of there. This is likely to happen more during the next month, so watch out for the occasional off day and added rest, such as giving Wells the day off before or after an off-day to add to the downtime. Overall, some Wells in the lineup is better than none, since his production has been pretty solid since being activated. He is still a recurrence risk and his bat control has been reduced over the past few games, perhaps an indication that the wrist is a bit more fatigued than Wells is letting on.

Brad Penny (TBD)
I just don't understand Penny, but besides that, he's headed for an MRI on his pitching shoulder. He tried to pitch to help the team on Saturday, saying he didn't want to leave them hanging even though he knew his shoulder didn't feel right during his warm-up. Of course, he's not going to help the team if he's on the DL due to adding to the damage in his shoulder. Penny made it clear that he didn't tell anyone, including Joe Torre and the team's medical staff, that he was pitching in pain until after the game. Until I know more about what's going on inside the shoulder, it's impossible to tell how long Penny might be out. Early indications are that the team will place him on the DL even if there's not much going on in order to force some rest and see if his velocity will come up. Penny has been down all season in terms of his strikeouts, making me wonder if he's losing movement as well as velocity. Using the data from Josh Kalk, it does look like there's a change.

Chien-ming Wang (90 DXL)
Consider this another point for the DH rule, because the Yankees' ace sprained his foot running the bases on Sunday and looks to be headed for the DL. Early reports indicated that Wang heard a "pop" on the top of his foot, a symptom that New Yorkers should be familiar with. If you don't remember that Brian Bruney is already out for the season with a Lisfranc sprain, you might remember that missed season by the recently retired Giant speedrusher Michael Strahan. (Here in Indianapolis, it's Dwight Freeney that comes to mind.) If Wang has injured the Lisfranc ligament or, worse, broken a bone, he's done for the season for all intents and purposes, putting the Yankees in a terrible position as far as their rotation. With Wang on crutches, the team is unlikely to wait and see on this one, and will likely push him to the DL. The calls are already coming out to go after C.C. Sabathia, but the Yankees are going to need immediate answers. Ian Kennedy is making progress, but isn't close enough to fill in for Wang's next scheduled start, leaving Jeff Karstens or Kei Igawa as the most likely fill-ins. We should find out more on how serious Wang's foot problem is in the next few days once the swelling is down enough for clear images. On the assumption that this is a Lisfranc sprain, I'm setting his DXL at three months.

Xavier Nady (5 DXL)
Sometimes a player is watched closely because he's irreplaceable to a team, and others, like Nady, are watched closely because he is replaceable. Nady figures to be one of the prime trade chips used by Neal Huntington as we move into trade season, but he won't be worth much if his shoulder is hurting. He's played through a series of leg injuries and now heads for imaging on the problematic left shoulder. Nady's crash into the Camden Yards wall didn't look especially violent, leading most to think that it's a simple but painful bruise in the area. The Pirates are hoping he'll just need a few days off to heal up, though the images will help them document things if it comes up later in a deal. The Pirates have replacements at the ready in Triple-A--including Andrew McCutcheon--but have to get a decent return for Nady to help further the rebuilding plan.

Mike Gonzalez (90 DXL)
Rafael Soriano (30 DXL)
The Braves bullpen continues to be a sore point. Literally. Soriano can't get his elbow to recover, leaving him unavailable too much for even Bobby Cox, a manager who's known for mixing things up and playing a man down. The continued problems with his surgically repaired elbow are making Soriano more of a "wouldn't it be nice" return rather than an expected thing for the Braves. Even a visit to Lewis Yocum didn't really clear up either the causation or the timetable. That leaves them watching Gonzalez more closely. The lefty has been dominating at Triple-A, walking only one during his five innings of work. He's shown good velocity, no problem with recovery, and the control is a big plus. He's expected to be activated as early as this weekend and, given the state of the Braves pen, he should slot right into the closer committee if not the closer role upon getting back to Atlanta.

J.J. Putz (30 DXL)
Players are seldom good sources of information about their own injuries. However, every once in a while they'll say something that gives us some insight. Putz admitted that he'd changed his delivery slightly after his rib injury in order to take stress off the area. It wasn't that the ribs were painful, according to Putz, but that he was thinking about them. That "guarding" and the associated mechanical changes could be a part of why his elbow got new stresses. I'm a bit hesitant to give all the blame/credit to this since Putz "slammed closed" his elbow and that hard hyperextension is not often the result of a mechanical change. The difference is so noticeable that pitchers normally quickly alter things unless they simply cannot make the necessary adjustments. Some have been confused by the "slammed closed" designation I used previously. It's simply taking the elbow joint to its fullest extension, with the arm straight. The "closed" part refers to the bones and their spacing, not the joint's extension. Due to the mechanism on this, I'm not sure that the root cause is addressed yet and am worried that this will become recurrent, causing further wear and tear to the muscles and ligaments of Putz's elbow.

Gary Sheffield (20 DXL)
The Tigers are already on a bit of a roll, but they should also get Sheffield back sometime early next week. He's begun taking swings in batting practice and doesn't seem to have any problems with his strained oblique lingering. Sheffield's violent swing tests all of his body, so the team has to be careful that they don't let him tax the muscle again before it's ready to hold up under that force. The time off has also helped his shoulder, though sources say that any rest will calm the problem. The issue is how long it will be before that recurs under the load of baseball activities. He'll start a rehab assignment alongside Dontrelle Willis in Lakeland and should be back quickly, perhaps this week.

Jake Westbrook (110 DXL)
Great question from Dave of Niceville, Florida: "Why did Jake Westbrook's recent surgery take a tendon from his right wrist to repair his right elbow? In my mind the right wrist would seem to be as important as the right elbow for a right-handed pitcher--so, procedurally, why cut on the right instead of the left wrist--which doesn't impart anything to right-hander's delivery of the baseball?" The answer is that it's simply stronger, usually. The tendons are under load more on the dominant side and the wrist heals up faster than the elbow, making it negligible to the overall rehab. The other reason is that it allows Westbrook to have one "good arm" during his recovery, which will allow him to pick things up, feed himself, etc, during the first couple weeks of his rehab.

Quick Cuts: Troy Tulowitzki is scheduled to be activated by the Rockies on Friday. Why wait? ... Phil Hughes is a week away from throwing, meaning that he might not be back until August. ... Jeff Keppinger is expected to play the field this week in Triple-A Louisville, then be back in Cincy by the end of the week. ... Rocco Baldelli will start a rehab assignment soon. He's expected to play out all twenty games at Single-A as they test whether or not he'll be able to recover over a long stretch of games. ... Travis Hafner has begun swinging again, though there's no return date yet. ... The Cards activated Jason Isringhausen as part of their "desperately seeking live arms" series of roster moves. The team says he won't get save opportunities right off, but it won't be long before he's at least in a co-closer situation with Ryan Franklin. ... Jim Thome is having one of his occasional battles with back stiffness. The Sox usually do a great job of minimizing this. ... Fernando Rodney was activated for the DL. The Tigers think he'll stay on the field and out of my column for a while.

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