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June 11, 2009

Under The Knife

For Better and Worse

by Will Carroll

Carlos Quentin (60 DXL)
A tendon injury? Where the heck did this come from? In the news that Quentin would be out for the month and possibly until the All-Star break, the White Sox let slide into several beat reports that he has a strained mid-foot tendon. This isn't something that's been discussed publicly, and it wasn't in the whisper stream either. In fact, my best sources told me, clearly and forcefully, that the plantar fasciitis was the real issue, while the face-forward reports were saying "heel pain." (I should note here in light of the Raul Ibañez Anti-Speculation Rule, that "heel pain" isn't a lie, so just stop before you send the e-mail. It's more along the lines of "lower body injury", describing a symptom instead of a diagnosis.) So is this a change in diagnosis, new information coming to light, or something else? I'll admit that I'm not sure yet. My best guess, based on information I have at this point, is that what's being described as a "tendon" is the fascia itself. It's a fine difference to be sure, but a significant one. The biggest note here isn't on my medical version of angels and pins, but that Quentin will be out until mid-July, no matter what the specifics are.

Brad Lidge (20 DXL)
Speaking of the specifics of injuries, the original reports that went out when Lidge went to the DL all said "sprained knee." As medheads here know, "sprain" is by definition a tearing of a ligament. This surprised me, given the symptoms and the lack of trauma. If forced to guess, I would have thought that Lidge was having some inflammation from a torn meniscus, or from the grinding due to his lack of a large piece of meniscus after last year's surgery. Just a few hours later, Mike Ferrin from XM got the scoop: Lidge has synovitis, an inflammation of the synovial capsule that surrounds the knee. Again, this is more symptom than diagnosis, but it's significant enough to necessitate some time off. Once the Phillies got J.C. Romero back, they'd been talking about giving Lidge a few weeks off to see if that would correct things, and that's exactly what has happened. If the problem truly is limited to synovitis, it should help, but it will come back unless things change structurally. The Phillies' medical staff will have to manage this one closely and hope that a couple weeks of rest gets them far enough ahead of it to make it to October. Don't be surprised if he goes past the minimum if Ryan Madson is solid in the closer's role in the meantime.

Josh Hamilton (30 DXL)
Hamilton had surgery on Tuesday to repair an abdominal wall tear (and not a sports hernia, as was originally feared), and he's already back with the team. That's just one of the reasons I'm optimistic about his coming back from surgery at the low end of the suggested range. He does have some injury issues that no one else has had, detailed wonderfully by Gordon Edes. I don't disagree with anything Edes says in his piece, or with the people he interviewed, but one thing bothers me—none of Hamilton's injuries have anything to do with past drug use or any possible effect from it. Do crackheads have hernias? Maybe, but I doubt they got it the way that Hamilton got his. That wrist injury in '07? His ribs this year? There could be some effect in his healing response, but there's absolutely no evidence, and even if there were, it would be nearly impossible to separate those effects from the others acting on any individual's healing response. I mean, Mike Hampton isn't a crack user, is he? To me, Ron Washington has the telling quote in Edes' piece, saying that Hamilton plays with reckless abandon and is likely to run into some other wall down the line. It's that attitude, one that might come from having stared demons in the face and living to tell about it, that might be the biggest effect of Hamilton's past upon his present.

Edwin Encarnacion (50 DXL)
The "major setback" must not have been very major, though my source on that continues to insist that Encarnacion's wrist is not stable and will not hold up. Wrist fractures are tough to read, so this one was going to bear close watching even before this issue arose. The team says that Encarnacion will be swinging a bat again by the weekend, with a rehab assignment soon after. The concern that I have at this stage is that the root cause of the inflammation that shut him down this week doesn't seem to have been addressed. Is it simply that he "overdid it," or is there something else underlying this issue? Rest and treatment can heal many things, but until Encarnacion is actually making it through games without trouble, I'm going to be a little dubious. Wrist injuries linger, my friends.

Kyle Lohse (30 DXL)
Lohse will miss a month as the forearm problem that's cropped up for him post-HBP hasn't gotten any better. The team is describing it as a strained flexor tendon, so if that's the case, the tendon must have been weakened or affected by the HBP, and then injured when he tried to throw in that state. The worry I have here is that the Cards seem very open-ended on this, as if there's something more going on, or that they don't have a good handle on. Strained flexor tendons are all too common in baseball, and shouldn't be that challenging, especially if they have good images. All the facts aren't out here, so I'll be digging more on this while the Cards dig for more pitching.