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July 21, 2008

Under The Knife

Desperate Measures

by Will Carroll

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For those of you reading BP and Under The Knife for the first time thanks to our Free Preview Week, what I do here is to take a look at baseball through the lens of sports medicine. Injuries aren't just 'part of the game' as most have conceded over the years. The hard work of both players and medical staffs can make a big difference in whether a team wins or loses. Whether it's one game, or over the course of an entire season, there's a high correlation between team health and team results. I don't read the news and guess; I have a team of consultants and I go directly to my sources—team trainers, doctors, and officials who understand exactly what's going on—who often quite literally have their hands on the situation. I'm here nearly every day talking with these people, gathering the best possible information so that you'll know what's up—both with the real teams you follow and the fantasy teams you manage. In addition to all of the analysis, stats, and information that you find with your BP subscription, you'll get the best injury information in the industry. Moreover, I always try to answer emails—my address is at the bottom of every column. Powered by our upcoming Ballpark Event in Tampa on August 29th, on to the injuries:

Curt Schilling (180 DXL)
Schilling is trying to put me out of a job. That's because if every player or every team would be this transparent about their injuries, I'd have nothing to talk about. Schilling's done for the season, so there's no advantage or disadvantage to in this transparency. It might help him in discussions with teams next year, but I doubt that's his motive. Schilling's surgical recap says it all, so I'll just point out the interesting parts. First, Schilling states that other pitchers have had tenodesis done before. I don't know who they are, but I'd be very curious to have some comparables to help gauge our expectations. Second, and most applicable to other cases, is how Schilling's labrum tore, or rather re-tore. That Schilling could pitch for nearly a decade with a repaired shoulder is impressive, but his labrum showed almost no sign of the previous injury. Granted, this event was more significant than the original, but both the healing and the degree of tearing is one of the reasons that labrum injuries are so tough to evaluate. Finally, I'm going to disagree with Schilling on his assessment about when he tore his labrum. I think it happened late in his no-hit bid, and that he didn't feel it because of the adrenaline. Going that deep, that hard, with underlying existing damage, was the likeliest culprit, and makes what he did afterwards a bit more understandable. Pitchers do amazing things!

Roy Oswalt (30 DXL)
What the Astros are saying and what the medical information tells us about Oswalt are two different things. Oswalt was responsible for trying to pitch through what was thought to be just a mild hip strain, but beyond this muscle injury, Oswalt also has a disc problem in his lower back that's causing some radiating pain down into his leg. Cecil Cooper continues to give blank quotes about Oswalt getting on the mound, but this one is going to take longer than most are saying. Oswalt always pitches—and pitches well—through injury, but when he's shut down, that means that it's serious enough that the medical staff is, as one put it, "blocking the exits." Look for Oswalt to push to come back early, and with the Astros insisting that they're not out of the race, they'll probably let him. Considering how bad he looked in his last one-inning stint, that's not going to be pretty.

Fausto Carmona (60 DXL)
For some idea on how long just a hip adductor strain can keep someone out, the Astros need only look to Carmona. He's finally back on a mound after nearly two months on the shelf. Carmona had a mild setback along the way, though the Indians record has guided their pace as well. Carmona will throw on the side Monday in Anaheim in front of Eric Wedge and Lonnie Soloff after his rehab start went well over the weekend. He could be back in the rotation immediately, which would slot him in Friday, or given his performance at Double-A, they could elect to give him one more minor league start. One observer at that game in Akron said that Carmona didn't look to be pitching much, just trying to get in his work. We'll have a solid idea by this time tomorrow. Carmona likely won't get many wins, but he has a chance to put in 9-10 starts before the end of the season, returning some value to those that drafted him high.

Kerry Wood (15 DXL)
Alfonso Soriano (45 DXL)

Wood isn't Josh Beckett, but the problem he has is the same. Wood's blister simply isn't healing enough to get him out on the mound without aggravating it and putting him back at square one. In Cubs Country, that means he's hearing all the folk remedies and Moises Alou jokes he can handle. The blister isn't serious long term, but with an already-creaking bullpen, missing Wood is putting more strain on it. He could go to the DL in a retro move that would only cost him a few more days—days he'll likely need anyway—while allowing some extra help to be brought in. Carlos Marmol will get the save chances in the interim, but he's already on pace to go 90 games, so any additional workload, especially in stressful situations, could end up being costly. The news is better on Soriano, as he'll head out on a quick rehab assignment to get in some live swings in Arizona and perhaps Iowa, though there's some discussion about activating him without the trip to Triple-A.

Trot Nixon (45 DXL)
The Mets continue to chase the Phillies, and they continue to have a gaping hole in their outfield. With Ryan Church still out with post-concussion syndrome, Nixon's groin strain mysteriously morphed into hernia surgery. That sounds significantly worse, but the time difference isn't as significant as one would think, and the recurrence risk is lower given modern techniques. Installation of a mesh support structure sounds painful, technical, and a bit science-fictiony, but it's a common technique. Nixon could be back by mid-August, but with Fernando Tatis and Nick Evans as corner outfielders, everyone expects the Mets to go and get someone—anyone—to shore up the position, but they won't panic, and are more likely to get a second tier outfielder in hopes that Church is able to return.

Yunel Escobar (7 DXL)
Despite the strained rotator cuff, Escobar is likely to be back in the Braves lineup soon. It's his glove side, so the throws from shortstop won't be affected, and a session of hitting in the cage gave Bobby Cox a positive vibe. Escobar will likely need some days off here and there, plus he'll have to avoid dives, which could affect his range and his steals, but even with the limitations he's the best option that the Braves have. Atlanta is deep in evaluation mode right now, so they'd like to see as close to a complete roster as possible in the last week of July. They won't be sellers, but the choice now is to either look for some mid-range help, or to hold steady and focus on 2009. As for Escobar, he shouldn't have much problem in playing through this, though the recurrence risk is pretty high.

Ryan Zimmerman (60 DXL)
Dmitri Young (30 DXL)

The Nats have some comings and goings going on. Zimmerman is doing well working to come back from his shoulder injury, looking solid at the start of a rehab assignment. No one expected problems in the field, and all reports have Zimmerman showing no problems at the plate either. There may be a slight loss of power, but sources think he'll just hit a few more doubles rather than homers. While he's still likely to have surgery this offseason, which could make for an early exit with the Nats already well out of contention, Zimmerman will be back soon, and should be one of few reasons to go see the team in the meantime. On the other hand, Young might be done for a while, which is a bigger issue with Nick Johnson still out. Young is having trouble with his diabetes, and the team has put him on the DL until it's under control. Young is huge right now and hasn't gotten any smaller during the season—"he's eaten his whole contract," one observer said—so this could be longer than many expect. With Jim Bowden already-tenuous situation in DC, losing Young for the season could be the last straw. I'm setting the DXL at 30 for Young, but there's really no telling how long this will actually take.

Adam Loewen (90 DXL)
I have a reader who would ask me about Loewen every week or so. My reply is always given in that Ron Silver voice in my head—"He has a screw in his elbow!" Sure, Cal Eldred was able to do it for a while, but I never had much confidence that Loewen, a much younger and much less experienced pitcher, would be able to pull it off. Now that he's reinjured the elbow, he's trying to follow not in Eldred's footsteps, but in Rick Ankiel's. Whether he can do even that remains to be seen—the elbow should heal somewhat, making a comeback down the line a possibility. If he's that good a hitter, I will again wonder why that talent can't be put to more use, though I know every scout in the world seems to disagree with me. Loewen's pitching career is stalled for the year and likely just done, as it would be for any young pitcher who puts that much stress on his elbow. We'll leave the second-guessing regarding the Orioles' previous pitching program to others.

Quick Cuts: I watched Carlos Zambrano at the All-Star Game, as well as in his first start back, and his arm slot really worries me, because it's down where it was just before he hit the DL. ... Pedro Martinez is targeting a Friday start, but he and his groin have to get through a Tuesday bullpen session. ... Troy Tulowitzki is expected back Monday, but reports from Tulsa say that his lacerated palm is still affecting his swing. ... Daric Barton was lucky that all he got was a strained neck when diving into a shallow pool. That could have been much worse than a 15-day injury. ... J.J. Putz was activated, but won't immediately go back to his closer role. Reports are very mixed on him, and he could be a sell-high candidate. ... After putting on a show in Pawtucket, all systems look go for a David Ortiz return later this week. Three home runs in three games proves that the wrist is okay, and that Triple-A pitching doesn't challenge Big Papi. I'm wondering if the minor leaguers shifted on him. ... The Rockies are moving Garrett Atkins across the diamond to first, a sign many are taking as a bad one for Todd Helton and his back and hip woes. ... Even people in St. Louis doubted me when I said that Chris Carpenter would be back in early August. The question now is how effective will he be once he's come back that quickly. ... Brad Penny is making some progress and looking good in side sessions, but the Dodgers still think he's a few weeks and maybe a quick rehab assignment away from returning. ... Scott Kazmir was pushed back as a precaution after his All-Star appearance, but reports are that he feels good. ... Troy Percival is back in the closer role for the Rays, though Joe Maddon appears to have new confidence in Grant Balfour, who should continue to get the occasional save opportunity. ... Greg Reynolds missed his last start at Triple-A. Some scouts are whispering that his shoulder won't hold up to a starter's workload. ... Carlos Silva may be headed to the DL with a back injury. He left Sunday's game and will undergo tests tomorrow. ... If anyone tells you that Tim Lincecum will be affected in the second half by his All-Star illness, don't believe them. And next time someone mentions the way that the media deals with players now, versus what they did with Mickey Mantle, don't believe that either. ... Billy Wagner is having his shoulder checked. Results should be known Monday, but most sources don't seem concerned that this is anything more than Wagner hitting his late-season wall a bit early.

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