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May 27, 2009

Under The Knife

Stacking Up

by Will Carroll

Hanley Ramirez (3 DXL)
Before we get to the hard-hit teams, it's an injury to the hard-hitting Hanley that received a lot of attention last night. Ramirez strained his groin legging out a grounder, lunging at the bag. The weather was 52 degrees at game time, so shifting from Miami to Philly didn't help matters. MLB.com didn't immediately have video available, but observers say that while it was obvious something happened, it wasn't as if he was writhing in pain. The Marlins pulled him immediately, and I'm sure he spent much of his evening with ice in uncomfortable locations. The team will treat and monitor Ramirez for the next 24 hours before they make any determination; they'll be cautious, so it's likely that he'll miss a couple of games to make sure that he doesn't make things worse, and that's the upside. Ramirez is a quick healer, so at least he's got that going for him. The early word is that they don't think he'll head to the DL, but that he'll be out until at least the weekend.

Ryan Church (15 DXL)
Jose Reyes (20 DXL)
Carlos Beltran (5 DXL)

The Mets delayed their DL decisions as much as they could, but they've finally made them. Both Church (hamstring) and Reyes (knee tendonitis) head to the DL with retroactive moves, and the team is still trying to determine if Beltran will join them. I've been told that the moves were made because Jerry Manuel felt he was taking too much heat for playing shorthanded and he demanded a resolution. We'll see how that plays out, but for both Church and Reyes, it was clear that neither could play now, and whether either would have played before their DL time was up is questionable. Reyes has more uncertainty as his knee has been painful, and the team remembers the cascading hamstring and back problems that he suffered at the start of his career. Because of his speed and range, they'll likely hold him back a little longer to be sure that's not an issue.

A greater matter of concern is Beltran's situation. He played through a knee injury that has been diagnosed as a bruise to his tibial plateau. That's the 'top' of the bone, where most would say it's the knee, and where the load from the body is born. Yes, that means that the cushioning inside failed for some reason, and that the bruise was probably caused by the femur slamming into it enough to cause damage. That's very bad in the long term, especially if Beltran's meniscus has a deficit. (I couldn't find if he's had a previous meniscectomy, though I'm sure you'll chirp in comments.) If there's no cushioning, this will continue to be a problem, with grinding as well as the occasional traumatic injury such as a bruise or worse, a fracture. I think that we have to take a year or two off the back end of Beltran's career unless he finds something like Synvisc or microfracture to reduce some of the damage. For now, he'll miss a couple of games after a cortisone injection, but the team thinks he'll be able to avoid the DL.

Akinori Iwamura (120 DXL)
Jason Bartlett (20 DXL)
Pat Burrell (30 DXL)

The difference between the Rays now and the Rays from a few years ago is that devastating injuries don't crush them. It's bad to lose the whole middle infield, a starting pitcher, and the big free-agent acquisition of the winter in the space of a few weeks, but the Rays can make do better than most. (Play along at home: What would your favorite team do in similar circumstances?) The Rays fill in with two top prospects in David Price and Reid Brignac, plus a plethora of options for DH and at second base. Whether that keeps things together remains to be seen. There's at least some closure with Iwamura, who'll have his ACL replaced once the swelling is down. The rest of the damage will heal concurrently with the ACL rehab, and Iwamura should be back in plenty of time for spring training in 2010. It's a little less clear with Bartlett; his ankle sprain swelled more than was expected, and speaks to a more severe sprain. His lateral movement would have been compromised, and while it should heal at or near the minimum, the Rays decided they were better off with Brignac manning the middle than hoping that Bartlett wouldn't reinjure the ankle.

The Rays also will be without Burrell for a while longer. He had something of a setback with his neck, still feeling the pain despite rest, treatment, and at least a few cortisone injections. As with the Cubs' Derrek Lee, this is a problem that Burrell has had on and off for years, but this latest problem is a significant and lasting issue that might signal that it has been exacerbated. One doctor I spoke with suggested this might be a turf injury, but I reminded him that Burrell's only been DHing for the Rays. Instead, this is one of those injuries that may have been inevitable, but that no one could predict. Burrell will continue with treatment in hopes that he can try hitting on Friday, but this seems destined for surgery. The Rays just hope that's in November, not June.

Matt Capps (5 DXL)
Capps took a comebacker off of his pitching elbow in Monday night's game, but came away with just a painful bruise. It could have been significantly worse in terms of the potential trauma, so now the team is hopeful that he'll be as lucky in not adjusting his mechanics and causing a follow-on problem. They'll be very careful with his usage over the next few days, and then will watch him closely when he's out on the mound, either in games or in side sessions. That could cost Capps a couple of save opportunities, which would be shuffled around to the rest of the pen. There's still a chance that he could end up on the DL, with a decision on that score getting made on Friday, but sources are unanimous in saying that's unlikely given his progress and prognosis.

Carlos Quentin (30 DXL)
The White Sox finally began saying "plantar fasciitis" publicly after Quentin pulled up after something "popped." He was running the bases, and while the team said this could be a good thing—that scar tissue was breaking up—the pain and swelling are said to be more severe after the incident. Quentin's headed back to Chicago for tests and treatment, with sources saying that the DL is almost inevitable for him as things stand now. As he was carried off the field, it was apparent that he was having a hard time bearing any weight on the affected foot, which is not a good sign. It's possible to play through it, as Albert Pujols did a few years back, but it's more likely to be a lingering issue. One option is lithotripsy, where sound waves are used to break up the spurs, and spur on healing. My guess is that he'll end up on the DL and miss significant time again this season.

Conor Jackson (30 DXL)
Coccidioidomycosis. Yeah, I used to think that typing out Doug Mientkiewicz was hard, and then Jackson went and got this mouthful of a fungal disease. Since it's better known as "Valley Fever" what do you say we stick with that? Name aside, this is no joke, as Valley Fever can be deadly and debilitating. Most patients aren't treated, but since it can linger for months, it will be interesting to see if Jackson responds to antifungals, which aren't normally prescribed to regular people unless the condition progresses. While Jackson isn't likely to be threatened by this in the long term, there's no real way of saying how it will affect him. One doctor I spoke with said the best way to think of this is that it's similar to mono; it will definitely slow him down and cost him some stamina, but since he's strong and athletic, he should have a better base to work from. There's absolutely no way to set a DXL, so 30 days is nothing more than a guess.

Quick Cuts: Mark Sheldon has the details, but the fact that Aaron Harang feels good after this doesn't make the decision any better. ... Brandon Phillips expects to be back on Friday, while Joey Votto is still dealing with the effects of his ear infection, costing him a few more games this weekend. I'm told that Votto's situation was more in regards to side effects of the medicine rather than effects of the infection, which is actually a good sign. ... Score one for Gene Monahan. He was able to reduce Melky Cabrera's dislocated shoulder on the field. We'll see how bad this is tomorrow, but it's not going to be good. ... Pablo Sandoval is out until at least Friday due to an elbow issue. My sources were very vague on the actual problem, though the plan to play him at first base suggests possible UCL issues. ... Vladimir Guerrero is back for the Angels, but it's sounding as if his manning the DH slot is going to be more than a temporary solution. ... Ryan Ludwick is expected back on Friday. ... Brian Bruney is headed to see Dr. Andrews, which as we should know by now, isn't always bad news. ... Koji Uehara will miss his next start with a strained hamstring. It's unclear what the Orioles will do to replace him, though they want to keep Brad Bergesen in line for Matt Wieters' first start on Friday. I have no idea why. ... David Riske is headed to Kerlan-Jobe and seems headed for Tommy John surgery. ... Coco Crisp is having problems with his shoulder again, and the Royals are worried that he may need a trip to the DL. ... Kenji Johjima heads to the DL with a broken toe; he'll miss roughly a month. ... Bad news for Jason Schmidt, who has been shut down due to shoulder pain. ... J.C. Romero is eligible to come off his suspension on June 3. If Brad Lidge is still struggling with his knee, sources tell me that the team thinks that Romero's return could make it possible to give Lidge some time off.

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