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June 22, 2009

Under The Knife

Trauma Unit

by Will Carroll

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Jose Reyes (50 DXL)
Carlos Beltran (0 DXL)

The Mets have had injury problems all year, but this is just a problem. After Omar Minaya said that Reyes was making progress and running, Reyes contradicted him. I wasn't there, so I'm unsure of the exact quotes, but Minaya doesn't just say things without information. Was he merely mistaken, or was he told that Reyes' progress is further along? Worse, is Reyes dragging his feet, or giving out his own misinformation? My sources say that Minaya was right, and that for whatever reason, Reyes was incorrect. Was Reyes working with a different definition of "running," where the treadmill doesn't count, even the underwater variety? What we do know is that baseball activities are still a ways off, and that there are some issues beyond the injuries with this Mets team.

The other big factor now is the continued problem with Beltran and his chronically sore knees. He's is headed for an MRI on Monday, but he played through the weekend... and played well! Beltran's knees have lost a lot of cushion, so much so that he's occasionally had bruising where the femur hits the tibial plateau. That's very bad long term, and not a good sign in the short term either. There has been discussion of possible fixes like Synvisc, or even a more radical procedure (video link). Beltran has two more years to go on his Mets contract, but it includes a lot of deferred money. He could be a good fit for a deal to an AL club this offseason.

Alex Rodriguez (0 DXL)
Mike Lowell (0 DXL)

Rodriguez is back in the Yankees' lineup, and it's clear that while his average is dropping, this wasn't a benching, but just a chance for him to get some rest. Peter Abraham had a great question in his column: Why did the Yankees ever get away from the planned days-off schedule they'd set up for Rodriguez? With Rodriguez tiring and Lowell having some soreness in his hip, there are a lot of questions about the FAIL procedure to repair hip injuries that so many players are coming back from lately. The thing is, there are only three that have played. Sure, Alex Gordon isn't far away, but the others are still rehabbing, so cue the sample-size orchestra. We simply don't know enough about how this surgery plays out in baseball, and we won't for some time yet. Two players have soreness, and Chase Utley seems fine? There's not enough to conclude anything more than that. Look for Rodriguez and Lowell to get some extra rest, costing them some at-bats, but hopefully keeping them more productive when they are back in the lineup.

Brandon Phillips (0 DXL)
Alex Gonzalez (30 DXL)

Phillips is playing through a hairline fracture in his right thumb. He aggravated it on Saturday night, but was back out on the field on Sunday. Is this a serious injury that he's pushing through, or is it something he just needs to adjust to? That remains to be seen. Phillips told reporters that the injury "throbs" when he throws or bats, two things that he's going to be expected to do in the course of playing, so this is an indication that this is more than just a comfort issue. The Reds' middle-infield situation might be contributing here, with them not wanting to lose both starters as Gonzalez is headed for elbow surgery to have bone chips removed. Rich Aurilia came back from similar surgery in just 15 days a couple of years back, but the Reds are expecting Gonzalez to miss a month.

Hanley Ramirez (0 DXL)
Saturday night I had hoped to be in Cincinnati for the Civil Rights Game, but for the second time this year, illness got in the way of my making it to an event. I was at home and ready to watch the festivities on the big screen... except for the blackout. Instead, MLBN showed me the Yankees-Marlins game, where I got to see A.J. Burnett's mechanics fall apart and Ramirez limping around. He looked awful running, and had no burst in the field, making me wonder why he's still out there. The groin issue isn't getting any better with him continually aggravating it, and watching him run looks punitive. Yes, it was a series where they actually had fans in the stands, but the Marlins aren't helping themselves with these kinds of situations.

Daisuke Matsuzaka (25 DXL)
The headlines are wrong. "MRI Shows Shoulder Weakness" is just one that I saw, and while I'm glad the mainstream media is taking note of injuries, I'm not glad that they're getting them wrong. (Have a question? E-mail, call, or tweet me.) This headline on Matsuzaka is conflating two things: the MRI that was taken, and the statement made by Terry Francona. Francona said that the MRI showed no structural damage, and that Matsuzaka is suffering from shoulder weakness. Both statements are correct, but the shoulder weakness is not something that was "seen" on the MRI. It was noted in the Sox's normal monitoring of all their pitchers, and resulted in his going for the MRI. If a shoulder (or any muscle) is weak, there's a possibility it is injured. If it's not, the most likely cause of weakness is fatigue. He'll head to the DL, and much like last season he'll focus on strengthening that shoulder, and will probably be out longer than the minimum. At some point, Matsuzaka is going to have to make adjustments to his style, or he'll continue to do this year after year.

Brad Lidge (15 DXL)
Lidge has done well during his couple of weeks off, and the knee seems to have responded to the rest and to the program that the Phillies' medical staff has put him on. He'll have one more outing in Clearwater on Tuesday before coming back to the team. The question now is are the Phillies ahead of this knee problem, allowing them to keep Lidge effective throughout the rest of the season with only routine maintenance, or is he going to need more advanced care? Worse, might he need a few more weeks off at some point? The latter is the larger concern, and a source tells me that in all likelihood, Lidge will need at least a week off. If the Phillies open up a lead, they're hoping to give him a break during the first few weeks of September, though they wouldn't have to use the DL then. This is going to be a real issue for both the Phils and fantasy players for the remainder of the season.

CC Sabathia (5 DXL)
When Sabathia left Sunday's game after just more than an inning of work, the talk immediately centered on his conditioning. Yes, he's big, and yes, it was hot, but Sabathia is not "out of condition." Matter of fact, he may be one of the most purpose-built athletes around, but even he can have issues. It wasn't all the heat's doing, though that may have been a contributing factor to the tightness he felt in his biceps. Now, let's be clear-this is a shoulder problem, up where the biceps connect to the shoulder. Sabathia felt "tightness" there, and the team elected to get him out before it became anything more. He's not scheduled for any imaging yet, but let's keep an eye on whether he makes it through his throw day before we conclude that he's in the clear.

Quick Cuts: When you hear "Brandon Webb" and "exploratory shoulder surgery" in the same sentence, it's not good. ... Raul Ibaņez had an MRI done, and it showed a simple groin strain. That's very good news in Philly. ... Endy Chavez tore his ACL and is done for the year, which could force Ken Griffey Jr. to play more often in the outfield. ... It looks like Manny Corpas is headed for surgery; at the very least he has bone chips in his pitching elbow. ... The Reds hope to see Edinson Volquez throw from a mound this week. Depending on how that goes, we should have a better idea when he'll return. ... Josh Outman could miss his Wednesday start if the A's elect to have an MRI done on Monday. That's because his elbow may require contrast dye, which needs a few days to clear out of a person's system. ... The Brewers are saying that it's just a dead arm for David Bush. They're working to see how to restructure their rotation to give him some rest. ... Scott Kazmir vs. Clay Buchholz tonight is more Kevin Goldstein's turf than mine, but Kazmir could be making his last rehab start. He's much more confident after his mechanics were corrected. ... Babe F. Ruth. Wait, there's an assistant hitting coach? How many teams have that? ... Speaking of Babe, Josh Hamilton is swinging a bat again and looks to be on track for an All-Star break return. ... Joey Votto is close to a return after some rehabilitation games, but since we still know nothing about why he was on the DL, it's hard to say if he'll stay off of it once he's back. We can only hope so. ... Jake Westbrook's setback in rehab is considered minor, but it's going to push back his return to the end of July. That could complicate some trade scenarios. ... Grady Sizemore is doing well in his early rehab efforts, including his throwing. The multiple-itises in his elbow responded well to rest and treatment. ... Scouting combines for elementary school? Just scary, but with Bryce Harper, we're going to see more of this in baseball.

25 comments have been left for this article. (Click to hide comments)

BP Comment Quick Links

Sharky

Will, thanks for the link to the meniscus transplant surgery. Hadn't heard of that before, and it's pretty cool. My sense is that most patients who have a meniscus removed or cut down eventually must have knee replacements. It would be interesting to find out if the transplant surgery reduces or eliminates that need.

Jun 22, 2009 08:58 AM
rating: 0
 
ZacharyRD

You say in the hip section, "Peter Abraham had a great question in his column" -- what column? Can you please provide a link? Thanks.

Jun 22, 2009 09:30 AM
rating: 0
 
BP staff member Will Carroll
BP staff

I would but Lohud was down for maintenance (and still is.)

Jun 22, 2009 10:17 AM
 
BP staff member Jay Jaffe
BP staff

It's back up: http://yankees.lhblogs.com/2009/06/20/why-didnt-the-yankees-stick-with-the-plan/

Jun 22, 2009 11:00 AM
 
WilliamWilde

Hi Will, great piece as usual. When you say that Matsuzaka must change his "style" to avoid future shoulder weakness do you mean the style of his delivery/mechanics or his tendency to nibble around the plate leading to high pitch counts early in the game?

Jun 22, 2009 10:00 AM
rating: 1
 
BP staff member Will Carroll
BP staff

The latter. The league has adjusted to him.

Jun 22, 2009 10:16 AM
 
Matt Kory

I agree, but that wasn't the problem in his last start. After four pitches he'd given up a homer, a single and a double.

Jun 22, 2009 12:37 PM
rating: 1
 
twon88

So is surgery at all an option or possibility for Reyes? Matt Cerrone seems to think it is, but isn't time all he should need to heal?

Jun 22, 2009 10:04 AM
rating: 0
 
BP staff member Will Carroll
BP staff

Possibility? Yes. Likely? No. I told Matt when he asked that if Reyes had ruptured the tendon, there would have been no need for the PRP.

Jun 22, 2009 10:18 AM
 
dianagram

A-Rod to rest one day per week through ASB ...
http://tinyurl.com/lpukj7

Will ... is A-Rod better off with multiple consecutive days off now, or the 1 day of rest per week plan?

Jun 22, 2009 10:31 AM
rating: 0
 
BP staff member Will Carroll
BP staff

See the Rodriguez article from today. We have NO idea what works for this.

Jun 22, 2009 11:47 AM
 
Sparky's Pitch Fork

Is it safe to say my investment into Webb is now worthless? Let's be honest, there is nothing exploratory about surgery. There has to be a decent amount of evidence that some thing is fundamentally wrong to opt for surgery. If Webb goes under the scalpel, is his season over with?

Jun 22, 2009 10:54 AM
rating: -1
 
BP staff member Will Carroll
BP staff

No, I disagree with your premise here. Absent evidence and in the continued presence of symptoms, the final option is to go in and look around. Bedard last year is a perfect example. That said, yes, his season would likely be over, but this is not a done deal yet. It's an almost complete unknown.

Jun 22, 2009 11:48 AM
 
jake29

Will,

Would you be trying to sell high on Utley with the rash of hip flare-ups?

Jun 22, 2009 11:01 AM
rating: 0
 
BP staff member Will Carroll
BP staff

Not based on that, no. As above, I'll note that we still know NOTHING about this injury and the recovery as it applies to baseball.

Jun 22, 2009 11:48 AM
 
R.A.Wagman

Jeremy Accardo left yesterday's game with some discomfort. Any news? Watching him pitch the last few days gave Jays' fans hope he could replicate some of his success from 2007.

Jun 22, 2009 11:57 AM
rating: 0
 
bpars3

Will, in regards to Beltran, I am in a weekly league and need to set the lineups this afternoon. Is Beltran worth a gamble to play this week or should I stay conservative and replace him in the lineup?

Jun 22, 2009 12:17 PM
rating: 0
 
Quagmire

"I had hoped to be in Cincinnati for the Civil Rights Game, except for the blackout." Anyone else notice the irony that the Civil Rights Game was subject to blackout?

Jun 22, 2009 13:10 PM
rating: -3
 
kerrigrr

NY Daily News has "breaking news" on their site now that Beltran "could be" headed to the DL today. Any updates?

Jun 22, 2009 13:23 PM
rating: 0
 
kerrigrr

Beltran officially DL'ed - they just announced.

Jun 22, 2009 13:51 PM
rating: 0
 
cyborg

I find it interesting the with CC "the talk immediately centered on his conditioning". I immediately thought about his workload with the Brewers the 2nd half of last season. 7 CG and several starts on 3-days rest with MIL.

Jun 22, 2009 14:11 PM
rating: 3
 
BP staff member Will Carroll
BP staff

You, sir, are apparently not an announcer for YES.

Jun 22, 2009 15:39 PM
 
Drew Miller

Were the reports that Votto had an ear infection incorrect?

Jun 22, 2009 15:55 PM
rating: 0
 
BP staff member Will Carroll
BP staff

No, he had the ear infection and the stress-related issue. There were reports that they were somehow interrelated, but again, without knowing more, I can't even guess as to how one affected the other or not.

Jun 22, 2009 21:17 PM
 
Drew Miller

Thanks Will. Having had a bad ear infection before, I can say that it caused both dizziness and anxiety. My own guess would be that he'll be fine once he recovers from the ear.

Jun 23, 2009 13:26 PM
rating: 0
 
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