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September 19, 2008

UTK Wrap

Extended Rap

by Will Carroll

Normally, Under The Knife and UTK Wrap cover the ten biggest injuries in the game. It's sometimes necessary to add one, or there are not enough good ones and I just go with eight or nine, especially if there's a lot to say about someone. My editors like it when I keep my word count down, after all! [Ed. note: We do not.] For today's Wrap, there are too many to cover, so I'm going seventeen deep to make sure that we get to all of the important injuries that could affect who's in and who's out for the playoffs. Since it's already running long, I'm not going to ramble. Powered by Ron Santo for the Hall of Fame, on to the injuries:

Erik Bedard (90 DXL/$8.5 million)
So the Mariners knew what this was all along. Bedard has been pitching with a torn labrum and a cyst inside his shoulder since July, yet the Mariners kept trying to trot him out there. That's to say nothing of the times he pitched with pain prior to that. You'll pardon me for cringing a bit at the use of the word prior there, but that's exactly what this situation reminds me of. Mark Prior pitched through a damaged shoulder that's necessitated two major repairs, and he will likely never pitch again-the result of overwork and deteriorating mechanics after his magical 2003 season. Bedard now finds himself in a similar position. What Dr. Lewis Yocum will be doing won't be so much of an exploratory surgery as he'll be checking to make sure there's nothing else going on in there. The best-case scenario is that Bedard will miss six months, but a post-labrum power pitcher isn't often on any best-case path. The more interesting thing here is that the tear may have been a cascade from his hip injury, suggesting a traumatic onset, rather than the insidious wearing down that can happen with overuse. Because we don't often know the true cause of any injury in the shoulder, it's impossible to tell how this will affect him and his future. We do know, however, that Bedard is not going to be tradeable this winter.

Ben Sheets (5 DXL/$0.3 million)
Yovani Gallardo (150 DXL/$9.7 million)
David Riske (10 DXL/$0.2 million)

About halfway into the e-mail barrage that happened Wednesday night, reader Bobby Mueller fired this one off to me: "I'm guessing you're getting flooded with questions about Sheets. I don't have a question, I just thought I'd mention that anyone who has Sheets on a fantasy team and is freaking out about this should be reminded that we (I have him on two teams myself) got 196 innings with a 2.98 ERA and 13 wins from Sheets this year-which is much more than we could have hoped for." That's small comfort for the Brewers, though maybe that night's win helped. Sheets left after two innings with forearm tightness, a worrisome diagnosis. This could be anything from cramps, to a flexor tendon problem, and everything in between, but a post-game revelation that he's been playing with pain for nearly a month is not a good sign, and neither is the "cutting sensation" that Sheets described. It's unclear if this is related in any way to his groin strain, or if that was just a cover for the elbow injury, but Sheets isn't ruling out a quick return, saying it's been "up and down" throughout the period he's been playing through it. The timing couldn't be worse for the Brewers, who need Sheets to make his next three scheduled starts, or for Sheets, who's on the verge of free agency. This could force the team to move up the return of Gallardo, though he will be working out of the bullpen; after a simulated game on Tuesday, Gallardo could join the team rather than throwing another that had been scheduled for Friday. Gallardo will be more of a replacement for Riske, who is scheduled for elbow surgery to remove bone chips.

Carl Crawford (50 DXL/$3.9 million)
Shawn Riggans (20 DXL/$0.3 million)
Troy Percival (3 DXL/$0.1 million)

Word came from sources in Tampa Bay that Crawford won't make it back for the final series as planned. At least, he won't be hitting at that point; there's a question as to whether or not Crawford would be valuable enough as a pinch-runner and defensive replacement to be on the playoff roster, for which that last series would serve as an audition to make sure he can play through any lingering effects from the injury on that level. (I don't think anyone has any real doubts about Crawford's ability, least of all Joe Maddon and the Rays' front office.) Crawford could be sent to the instructional league for some at-bats if he were cleared, but there are a lot of questions about those last few spots on the Rays' roster. With B.J. Upton still out and Crawford in question, multi-position players like Ben Zobrist, Willy Aybar, and Eric Hinske become even more valuable. The Rays will also be without Riggans for the rest of the season, including the playoffs, since he had to have surgery to remove an infected bursa sac in his knee. It's the same procedure undergone by Peyton Manning, and Riggans has a similar four- to six-week recovery period that won't have him ready even for late October.

Things aren't looking any clearer in the pen either. One doctor I spoke to joked that Percival "has had enough epidurals so that he could give birth comfortably now." Percival's back problems aren't a laughing matter to him or to the Rays, however, as they try to hold on to the AL East and set up their bullpen for the playoffs. Another epidural this week is really about the last one he could safely have this season according to an unofficial count. The Rays have options here, but if they're going to shorten the pen for the playoffs, it will be interesting to see how they construct it out of a few starters who may be pushed back, some specialists, and guys like David Price-who may be better than the other options.

Vladimir Guerrero (5 DXL/$0.3 million)
Torii Hunter (7 DXL/$0.5 million)
Erick Aybar (20 DXL/$0.3 million)
Howie Kendrick (40 DXL/$2.1 million)

You'd think that, with all of these injuries, the team would be struggling, but they're not. Even with a number of name players out and the division long since clinched, the Angels just keep on winning. They're 7-3 through the last ten, though two of those losses came against the White Sox, the one winning team they've faced in September. Good teams beat whoever you put in front of them, and despite the injuries, the Angels' depth is doing enough to win. When the calendar flips, the team needs to not only have its best players healthy, they need to know who their best players are. Right now, it would seem that as many as four spots on the playoff roster are in doubt. With Guerrero's chronically sore knees, Hunter's ongoing problems with his quads and hamstrings, Kendrick's current hamstring issues, and Aybar's hamstring strain... notice a pattern? None of these should hold any of the players out into the playoffs, but with Guerrero and Kendrick, their fragility has to be considered when filling out the roster. The biggest question mark in the bunch is Kendrick, who had a setback during his rehab and is now not expected to return before the final week, and possibly later.

Carlos Quentin (30 DXL/$0.9 million)
A little more than a week since having an ORIF (open reduction, internal fixation) procedure-one you and I would call having a screw inserted in the wrist-Quentin had his cast taken off. That's a good sign, but it's still quite a ways from being able to swing a bat in anger. The White Sox will be watching closely as Herm Schneider works his rehab magic. While this is a good first step, it's still unlikely that Quentin will be ready for the Division Series, and even the LCS will be a challenge. Ozzie Guillen is using the last few weeks of the season as something of a tryout for Quentin's roster spot, costing Nick Swisher some playing time.

Nomar Garciaparra (5 DXL/$0.1 million)
People don't speak softly about Larry Bowa; they either love him or hate him. I won't say which side I heard from, but there are some that blame Bowa for Garciaparra's injury Wednesday night. I haven't seen the play so I can't vouch for this, but evidently Bowa put up a very late stop sign for Garciaparra, who tried to pull up too quickly and ended up having his left knee collapse. It's the same knee that he hurt back in late July, so if he's re-injured the MCL that he'd previously sprained, he could be out for the rest of the regular season. Garciaparra is going to try to play through this, but it's clear that he's on the edge of being functional. He can play with it braced, but it will certainly make things tougher for him in the field. With Rafael Furcal on the way back, Garciaparra could find himself left off of the playoff roster altogether.

Chris Carpenter (20 DXL/$0.7 million)
Carpenter is done for the season, one that barely ever got started, but there hasn't been a whole lot of information as to whyem>. Carpenter is reportedly out with "nerve issues," though the team has made it clear that this is not a recurrence of the ulnar neuritis that caused quite a scare last spring. There are some rumors, which I could not confirm, that the problem is in his shoulder, and given the symptoms that we do know-weakness, and an inability to recover-it suggests that it may be a problem in the brachial plexus, a group of nerves in the shoulder. Called "plexitis," this is a very uncommon condition, and is often mistaken for a cervical problem due to similar symptomology. The most worrisome aspect of plexitis is that it can cause weakness in the deltoid that can lead to subluxations of the humerus. A humeral subluxation can lead to labral tears, something you don't want happening to your ace. While I admit that I'm speculating here, it's based on a conversation with two physical therapists that I regularly consult with. One suggested the condition based on the symptoms, and the other concurred. Add in that the Cardinals treatment plan appears to be matching up with plexitis, so there's definitely some consideration that has to be given here, especially if you're making keeper decisions. The upside is that it's usually treatable without extraordinary measures.

Mike Lowell (0 DXL/0)
While newspapers seem to be curling up and yellowing like last week's news, creative outlets like WEEI.com are doing more and getting results. (I can't wait to see what justification the BBWAA uses on this one.) Rob Bradford got the scoop on Lowell, who's been battling a torn acetabular labrum. The hip injury is bothersome and irritating, but doesn't reach the point of pain that often. It is something that will necessitate an eventual surgical fix, but he's playing through it pretty well, popping a home run in a big win against the Rays. It's another involved management situation for the Red Sox medical staff, but one they've been dealing with all season long. Somehow, they've managed to hold things together enough to help keep the team in the race. The zero DXL here doesn't so much indicate that he won't miss time-he was out of the lineup on Thursday-but that he'll be hit and miss, with Terry Francona taking advantage of the team's roster flexibility to buy him some rest through the last two weeks of the season.

Tim Lincecum (0 DXL/0)
From the sheer volume of e-mails, it seems that everyone not in the path of Hurricane Ike was watching Lincecum's pitch count. There was an interesting internal discussion about the value of a shutout, his long-term health, and his general Freakness. Let's look at the facts: Lincecum threw 138 pitches, an average of just over 15 per inning, and his single-inning high for the game was 22 in the first. He had thrown a 132-pitch game three starts ago, had followed that high-count outing with a 92-pitch game where his effectiveness was down, but he came right back with an effective 127-pitch game before his most recent outing. His fastball sat at 92/93 all game long, and he did not appear to be reaching back in the later innings. In fact, it seems that he was pitching to contact and trying to go for quick outs rather than strikeouts in the later innings. While I'm not big on the value of a shutout, I'm not sure that Lincecum was taxed by this. Just after the game, I wondered if the Giants might be thinking of shutting him down, and that's still not the worst idea, especially given that Brandon Webb's 20th win likely takes Lincecum out of the Cy Young running. All that said, I completely agree with Gary Huckabay-there was no reason to do this. There's a giant difference between "could" and "should," and apparently Bruce Bochy doesn't understand that. Worse, he followed up this high-count game with a 118-pitch complete game on Thursday.

Carlos Zambrano (0 DXL/0)
I told you that Zambrano would be helped by the extra rest, but I had no idea that a no-hitter would be coming. He dominated the Astros in Milwaukee-now there's an odd statement-completing the game in 110 pitches. He was clearly refreshed from the time off, and perhaps helped by the cortisone in his shoulder, throwing 95 mph in the first inning, and reaching as high as 97 (via Gameday). The key was that his elbow was higher, and on most pitches, it was right at the level of his shoulder and didn't dip as low as previously. At the very least, he was very consistent to the naked eye, so I'll be interested to see if Pitch-f/x agrees. The worry is that, as before, he'll come off of the DL rested and relatively pain-free, and then the inflammation will slowly come back. If the Cubs medical staff can't get him through the playoffs before that happens, they'll deal with the consequences. The 110 pitches in this context is tough to figure; he was cruising, and 110 isn't that high for Zambrano in normal circumstances, but then these aren't normal circumstances, so I'd have liked to have seen more caution here. His next start will be the tell. I'm also relatively sure that he threw the first no-hitter ever thrown in the first game after coming off of the DL. Even Baseball Reference doesn't have an instance of that!

Quick Cuts: Ben Sheets is listed as day to day, but he's unlikely to make his next start on time. ... Edinson Volquez is suffering from fatigue and has lost much of his control. You fill in the blank. ... Eric Patterson is done for the year with a strained hamstring. ... Rod Barajas is done for the year after suffering a severely-strained hamstring. ... Shawn Marcum is headed to see Dr. Andrews after an MRI showed elbow issues. ... Justin Duchscherer could be back for a start this week. ... Anthony Reyes has been shut down by the Indians. ... This column may be written by me, but there are a lot of people that help behind the scenes, so with just a week left, I want to thank Bil Burke, Rodrigo Pereira, Chase Gherrity, Jeff Erickson and the Rotowire crew, and Trace Longo. This column might happen without them, but it wouldn't be nearly as good.

10 comments have been left for this article.

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