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June 30, 2009

Under The Knife

Pushing the Envelope?

by Will Carroll

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Carlos Beltran (30 DXL)
Everything I've read about Beltran heading to Vail has had a decidedly negative aspect to it. Yes, having Beltran in the home of microfracture surgery is certainly not something you'd want if given a choice, but the knee problem was already extant; worse, it was already recurrent. When he went onto the DL, this was always a possibility. What's making this so negative is that people are speaking about it as if it's an inevitability rather than just a possibility. Both Beltran and (to some extent) the Mets are speaking with some of the best orthopedic surgeons in the world about a procedure that could help one of their best players get back on the field. There's not much of a track record of microfracture procedures in baseball-the demands aren't the same as in basketball or football-but it has been reasonably successful. The questions now become if microfracture would in fact help Beltran, and then whether or not it can be delayed until the offseason. I'm still not reading too much into this yet, as I want more information.

Mike Lowell (14 DXL)
There were conflicting reports on what Lowell had done. First, he was expected to have Synvisc injected into his hip as a lubricant. Then, Ian Browne had reports that Lowell had fluid removed from the hip. There was some confusion as a result, but as it turns out, both happened: the fluid was extracted prior to the injection. Both procedures aren't good signs for the state of Lowell's hip. I spoke with an orthopedic specialist in hip-related procedures, though he has not examined Lowell, and he was surprised at the volume (15cc) of fluid. "That's the body's response to something going on in there. Lowell had the complete surgery done, as opposed to the half-step that Rodriguez had," he reminded me. "That the body is reacting and needing more lubrication in that area indicates that there's been a real change inside the space. Is there another tear in the labrum? A problem with the resurfaced femoral head? An irritation from the anchors, if that's how they repaired the labrum? It could be any of those, but the body is reacting as you would if there was a rock in your shoe. Something's going on that's irritating that space." Synvisc isn't going to cure the root problem, but it might get it to where Lowell can play comfortably and effectively. The Sox will give him a few days to let the Synvisc coat the area, and then see how he reacts. Because Synvisc is quick-acting and is removed by the body, putting him on the DL now would indicate that it didn't work, so this is going to require a very telling decision in the next few days.

Jake Peavy (90 DXL)
I always say not to listen to athletes when they self-diagnose, but Peavy is one who has proven time and again that he can pitch and pitch well despite pain and injury. He is due for testing on his ankle on Tuesday that will determine the next step; projecting forward to a rehab assignment at the end of July is a stretch. Sure, it's possible, but I wouldn't book the hotel room. Unless the Padres really think they can deal Peavy, there's no good reason to rush him back. It's that as much as the injury that's made me think he is essentially done for the season (although I've always entertained the possibility of a cameo start or two in September). In some ways, Peavy is a lot like his friend, Roy Oswalt, so it will be interesting to see how much pressure he puts on the team to allow him to come back.

Ervin Santana (15 DXL)
There's a big difference between the Arizona Rookie League and the American League. Still, 45 pitches for Santana in a complex game is something, and it's enough for the Angels to plan for him to come off of the DL. Reports have his velocity "touching 92," which isn't where he normally is. (Why hasn't someone replaced Josh Kalk's oft-missed pitcher cards with their own resource?) Santana will slot in to the Angels' rotation this weekend with a pitch limit and an elbow that hasn't held up after a sprain. I don't have high hopes for him being consistent or even available through the rest of the season.

Oliver Perez (60 DXL)
Tim Redding (0 DXL)

With the Mets having injury problems all over the place, it's interesting to see that the team is speaking about a creative solution to one issue. Jerry Manuel mentioned "piggybacking" Perez and Redding once Perez is back from his rehab assignment. Piggybacking is more commonly referred to as "tandem starters," and has been used in the minor leagues. Essentially, the two pitchers would be expected to go four innings each. The upside is that they shouldn't be fatigued, and it could limit the use of the bullpen, while keeping hitters from seeing either pitcher more than three times. The downside is that a tandem system doesn't make a pitcher perfect; either could still get roughed up and come out early, putting more pressure on the other guy or forcing the bullpen into action. Most tandem systems have been paired four-man rotations, and Manuel didn't speak of any other changes to his rotation, so much of the value of this arrangement would be in squeezing some value out of two pitchers who haven't been that good on their own. I'm not sure about the idea, but I'll give the team some credit for thinking outside of the box.

Gil Meche (0 DXL)
Meche was cleared to make his next start on Wednesday after a bullpen session went well. He's suffering from what the team is calling "dead arm," and he got crushed on Friday. He had terrible velocity and looked generally hittable. Of course, the Royals think he'll be fine, and they'll have him out there without even an extra day's rest, but I don't think any of us should be surprised given the way most of their medical cases have gone in the recent past. Meche has been everything the Royals hoped for and more since signing him, but with his workload and injury history, plus the $30 million or so left on his contract, you'd think a little caution might be called for. Meche is worth watching closely in the near term.

Josh Outman (90 DXL)
Outman is in all likelihood going to have Tommy John surgery. The A's didn't say it out loud, but we don't need a press release to give us "two" when we already have the one plus one. There's always the chance that Jim Andrews will look inside and see something good, akin to what happened recently with Akinori Iwamura. (Or if not good, at least not quite as bad as expected.) Outman will be out for the normal year post-TJ, and I'm reminded of his discussion with David Laurila about his pitching motion prior to coming to the big leagues. He was, in some ways, another Tim Lincecum, with an odd motion taught to him by his father that delivered great results. I wonder if Outman might switch back (or if the A's would allow it) during his rehab. If nothing else, Chris Lincecum now gets points for telling teams that they wouldn't be allowed to change his son's mechanics.

Colby Rasmus (1 DXL)
As far as I can tell, the Cardinals don't have a dietitian on staff. Some teams do, but not many. I'm sure that they have someone they could call, as most teams do with every medical specialty. It's just interesting that any team would spend millions of dollars on a player, then hand him a hundred bucks a day and expect him to handle his own nutrition. Sure, some of them can, but Rasmus is the same age as most college seniors. I'm betting most of them eat from the four food groups of Big Mac, Whopper, Qdoba, and Coors than they do balanced, healthy meals designed for an athlete. I'm not saying that teams need to get all paternalistic and enforce a training table, but that when problems like Rasmus' gastritis occur, we shouldn't be so surprised. Rasmus' problem results from too much late-night eating, something that can be easily corrected.

Quick Cuts: My birthday gift this year was a Kindle DX. In addition to the normal stuff, it also reads PDFs, which could make for some interesting things in the near future. ... Steve Swisher?. ... Sure didn't look as if there were any issues for Roy Halladay in his first start off of the DL. ... Carlos Quentin has been running and making good progress. He's still on track to return to the Sox lineup after the All-Star break. ... Joe Crede was held out as a precaution after some back spasms. ... Khalil Greene is back on the DL after what the Cards called a relapse of his social anxiety disorder. ... Scott Downs will test his toe by throwing off of the mound and doing some PFP. Don't take this as a sign that he's coming off of the DL when eligible on Friday. ... Shawn Hill had Tommy John surgery. ... Another nice article on Brandon Webb.

Related Content:  Josh Outman

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