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June 17, 2008

Under The Knife

Stacked

by Will Carroll

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Chien-Ming Wang (90 DXL)
No one knows feet like Dr. Philip Kwong of Kerlan-Jobe, so I'll just let him tell you about Wang: "It is unusual to have both a Lisfranc ligament sprain and partial tear peroneal longus together, and longer time will be needed for recovery (8-12 weeks if no significant instability occurs at the Lisfranc joints). The combined injuries represent greater rotational stress than would be experienced for each injury alone. Prognosis and time line for recovery will depend on the exact amount of ligament/tendon tear sustained and on the amount of tissue remaining to provide stability. Healing is the formation of scar tissue and not regrowth of the normal ligament or tendon tissue; consequently, future problems such as arthritis can occur at Lisfranc's joints or reinjury of the peroneal longus tendon." So as I'd expected, the additional damage beyond the Lisfranc is likely to add to the time Wang is out. It leaves very little wiggle time for him to come back and throw meaningful innings, not unless the Yankees are right and Wang comes back at the extreme low end of expectations. I think the Yankees' record is going to dictate how this is eventually handled.

David Ortiz (35 DXL)
The cast is off, but Ortiz went right into a splint. What's the difference? It's pretty significant, actually. Ortiz can now do more in the way of treatments, especially the ones that will work on his range of motion. In essence, he's cleared the portion of his rehab focused on rest and made it into the more active portion, leading back to baseball activities. The most important takeaway from the cast's removal is that there was a clear milestone for it: he's free of any pain. Ortiz is nevertheless still a couple of weeks away at best from swinging a bat, and remains in jeopardy of setbacks. We'll be watching for that next milestone and for signs that the wrist has lost strength, as it's a big factor in Ortiz's power and bat control. At this point, it still looks like Ortiz should be back around the All-Star break.

Brad Penny (7 DXL)
It could have been much worse; Penny had an MRI and it provided the club with best-case news-he's dealing with bursitis and tendonitis. It's the perfect combination of the acute and chronic to explain Penny's issues. The bursitis is the most problematic, causing the pain and "catching" that Penny described after he came out of his last start. The Dodgers medical staff will work to get the inflammation down. Whether Penny makes his next start depends on his response to treatment, something that we won't know until his throw day or even after. At this stage, the Dodgers say that he could make his start, but they'll have a Plan B at close hand (and you should as well). I'm not sure that he won't make the start, but I am sure that if you have any other option, you should use it.

Yadier Molina (3 DXL)
The power of instinct is amazing. Molina was born to be a catcher, but seeing him hold the ball on that play at the plate reminded me just how deeply the instinct to hold the ball is. Molina was clearly concussed, though reports say that he never lost consciousness, which is a positive sign. The Cards' doctor was out there quickly, managing the process, and Molina was quickly under observation. As with any concussion, it's tough to say what's next, but it seems like the team is doing everything right. Molina is going to miss some time, depending on his recovery, but it's not clear yet how the team will deal with that. The hope is that he can avoid the DL, but it does put the Cards in a tough position over the next couple games. I'd guess based on current information that Molina will be back towards the end of the week.

Todd Wellemeyer (5 DXL)
Wellemeyer made his start, but things certainly didn't seem normal for yet another injured Cardinal. He was reportedly so swollen after his last start that he couldn't fully extend his elbow. His throw day is scheduled for today, but it seems that his making it is in question. If Wellemeyer can't go, the Cards are almost out of options or at least healthy pitchers who will give the team a chance to win. I've talked about the "death spiral" before, but this goes beyond that; this looks to be a combination of factors, including a number of risky players all rolling snake eyes at once, as well as an overtaxed medical staff struggling to keep up with the load. Wellemeyer's a symptom of the larger problem and how they deal with his symptoms will be telling. I'd be surprised if he makes his start and if he does, I hope you have more pitching options than the Cards do right now.

Bartolo Colon (5 DXL)
Colon left Monday's start with a stiff back, but his departure was more of a precaution; the back could have changed his mechanics, putting more strain on his shoulder in deceleration if he couldn't bend normally. With Daisuke Matsuzaka coming back, Colon might find himself on the outside looking in soon, so the soreness might push him to the DL as more a matter of roster juggling than as an indication of the injury's real severity. With all the options and variations that the Red Sox rotation has right now and going forward, Colon seems to be the pivot point. It allows the team to be even more patient, even more flexible, and when it comes to October, they should be even less fatigued. Colon's no longer a great pitcher, but he was a great signing by the Sox. Colon's likely to miss a start at the least, though we'll see how the shuffle comes out over the next week.

Curt Schilling (100 DXL)
Rehabs sound like slow progressions most of the time, as a player makes a slow and steady move from injured to healthy. However, it's seldom actually that simple. Instead, recovery comes in fits and starts, especially for pitchers that are struggling to build up their stamina and strength. Setbacks don't just happen, they're common, even expected. Certainly you'd rather they didn't happen, but they're part of the process and the timeline in most situations. Medical staffs work on minimizing them, making sure that the setback is just that rather than something more that needs to be corrected. So all of that said, the setback that has Schilling "on hold" according to Terry Francona is both a big deal and not a big deal. The setback itself isn't that big, but Schilling's response to it will be. Thinking of it as a plateau makes more sense than a real setback. Schilling will need to have a couple of more bullpen sessions, including some good ones, before he starts facing hitters. The All-Star break remains a possibility, but it's more at the front end of the expectation now than the target.

Daisuke Matsuzaka (15 DXL)
Things are much more positive for Matsuzaka. The rehab start went perfectly, getting through five innings on 65 pitches, the best indication that Matsuzaka had no problems with his arm or with Triple-A hitters. He showed good velocity and control, as well as movement that had one IronPig asking me what a gyroball should look like via text. Assuming that he recovers well, Matsuzaka's next start will come for the Red Sox, likely on Saturday against the Cardinals. Matsuzaka's rehab start and the efficiency he showed in it is interesting. While I think it was more a function of competition-there's not much hitting talent in the Pigs' lineup, and the two solid hitters on the team went 5-for-8-than a real change in style, throwing less pitches would not only take some wear off Matsuzaka's arm, it would decrease his frustration by allowing him to get deeper into games.

Mike Gonzalez (90 DXL)
The Braves don't have this particular closer back yet, but Gonzalez will be activated on Wednesday, and could be their go-to guy soon. With John Smoltz and Rafael Soriano gone or at least gone for now, Gonzalez is about all that's left of what could have been a deep bullpen. As Jon Sciambi detailed in his chat, the Braves problems in the close games might come back to the fact that they don't have good options back there. The closer slot isn't the problem really, it's the whole pen. They've adjusted to injuries and have been using their best available arms far more than the best arms they expected to have. For an exercise, take any team and drop the top two bullpen arms off it and see how good you think they'd be. That's the hand that Bobby Cox has been dealt, but getting Gonzalez back should help. His velocity and control have been solid; if you're looking for some saves and he's still on your league's waiver wire, grab him.

Troy Tulowitzki (45 DXL)
Word from Rockies sources is that Tulo is doing well during his rehab assignment, but that the team hadn't yet "seen him." While I grasp the concept of getting trusted scouts or even front office types out to see him in action, I have no idea why they haven't. Why do they pay coaches and trainers at the minor league level if they don't trust them enough to say "Tulowitzki looks healthy." While the young shortstop is certainly more valuable than whoever's playing short regularly for them in A-ball, they're both humans and have the same parts, and if you can tell whether one is healthy, you can tell if the other is. If the organization has this few "trusted members," maybe that's as big an issue as Tulowitzki's health. As for Tulowitzki, he's still expected back at the end of the week.

Quick Cuts: I finally made the "A List" in something! ... Eric Byrnes is expected to start his rehab assignment later this week. It's possible his return to the lineup could give the team the chance to send Justin Upton down for a quick confidence boost. ... Mike Hampton will start another rehab assignment, this time with the Rookie League-level Braves. ... Santiago Casilla threw well in Triple-A and is expected back with the A's. Not bad considering initial reports had him heading for TJ surgery. ... Fernando Rodney returned for the Tigers, throwing hard but flat. ... Both Mark Mulder and Matt Clement made starts in the minors. Neither was great, but "breathing" is a positive report these days for a Cards pitcher. ... The new Coldplay is growing on me. Good, not great.

Related Content:  Back,  Slow Start,  The Process

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