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April 29, 2010

Under The Knife

Bracing For a Return

by Will Carroll

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Carlos Beltran (multiple knee problems, 7/1)

A lot of people are focused on the idea that Beltran was given a custom brace last time he visited Vail's Steadman-Hawkins Clinic. The knee that has kept Beltran off the field for the last several months has had multiple problems, but none of them will be definitively solved by a brace. The current issue, the one that's keeping him from being cleared for activity, is that there's continued bruising­­—"hot spots", which is how they would appear on an MRI—inside the knee, likely on the tibial plateau. Those are the result of trauma, like any bruising. Most likely, the lack of cushioning inside the knee is causing the bone-on-bone grinding and even pounding and hence, symptoms like bruising and arthritis. The latter was cleaned out during his January surgery, so is the bruising curable? Not really. So why the brace? The theory must be that the knee not only lacks cushioning, but that the cushioning has led to some laxity. If the joint is flexing a bit more than normal, the bruising would have a larger pattern. A brace could make that smaller or perhaps direct some of it towards an area where the knee is more cushioned or even just a bit less damaged. Beltran and his doctors seem to be doing everything possible to avoid the next step, which is microfracture surgery. I'm pushing the ERD out to July, but don't be surprised if this gets accelerated. At some point, the Mets are going to have to see if Beltran is going to be able to contribute or not. The sooner that's possible, the better for everyone.
 

Brett Anderson (flexor strain, 6/1)

Kurt Suzuki (oblique strain, 5/20)

Daric Barton (fractured finger)

We got a bit more info on Anderson's strained elbow. While it's a minor detail, it's one that gives us just enough additional information to understand the injury better. Anderson's strain is not specifically in the flexor tendon, but in the muscle near the tendon. The transition from muscle to tendon is often a gray area, leading to some confusing diagnoses, but since Anderson has had this issue before, it's much more of a known. (Yes, that sounds similar to the cramping he'd had before and we know how that turned out.) According to multiple reports, Anderson will be out for four-to-six weeks, but won't begin a throwing program until mid-May. The other side of the battery is also having some issues. Suzuki has missed four game so far with an oblique strain and the Athletics have sent him for an MRI. While the results of the test were not publicly known, the indications are that he will be hitting the DL. The team's been going with Jake Fox behind the plate, but may use Suzuki's injury to get a fill-in for Anderson's slot, likely to be Vin Mazzaro. During Wednesday's game, Barton made a throwing error and was seen pulling off his brace afterwards. It's unclear whether it went back on later, but playing through this type of fracture without the brace is, well, nearly impossible. It's definitely not a good sign that Barton's having issues.
 

Jorge Posada (bruised knee, 5/1)

Baseballs hurt when they hit you. That's a simple baseball truism. What's key is where it hits a player. Posada was hit in what's been described as the back of the knee, but was actually the fibular head, the top of the small bone of the lower leg. By the time he'd come around the bases, the knee was "numb" according to Posada. That indicates some sort of nerve involvement, but isn't atypical for that kind of trauma. The nerves are overloaded and often go the other way. There's bound to be bruising, swelling, and more pain for Posada, precisely in an area that's stressed by squatting. There's also a small chance that the direct hit to a small bone could cause a break, but there's been no indication that the Yankees are thinking that's the issue. The Yankees may need to make a move for a catcher if Posada's going to need more than a couple days off from the catcher role. At this stage, it looks like he'll miss a game or two, especially if he's able to come back and DH rather than catch, but we'll have to watch how this progresses over that same time period.

Justin Morneau (strained oblique, 5/2)

The Twins are calling Morneau's back injury a "mid-oblique stiffness." Joe Christensen's tweet didn't have a lot of detail—it's a tweet—but the terminology is specific enough to let us know more. This isn't an oblique injury like we normally hear, much closer to the spine, which will hurt during any rotational activity. The "stiffness" part tells us that the strain isn't significant, but is painful enough to limit his movement, likely causing some level of spasm. Morneau's not going to be back before the weekend, but the Twins don't feel like this will be long term,either. They'll just have to watch it closely to make sure there's not a setback or recurrence once they get Morneau back in the batter's box.

Chris Young (shoulder rehab, 5/25)

The Padres are insisting that it's not a setback, but Young won't make his scheduled rehab start on Thursday because of soreness. That seems the very definition of setback, even if it's accurate to call it a minor one. Young simply didn't recover well enough from a Monday side session to be ready on Wednesday, a recovery issue that raises some questions about the strength in his pitching shoulder. There's no word on when Young will be ready to make the start or if he'll have another throwing session before then. The major questions are his ability to recover between starts and how long it will take for him to build up stamina. At this stage, it's unlikely we'll see Young in the rotation before late May or early June. The timetable for shoulder surgery rehabs should include this period, it seems, as so many pitchers seem to get close, then have a period like this where things go sideways.

Brian Roberts (herniated disc, 6/1)

It has not been a good or healthy spring for Roberts. He spent most of spring training dealing with a back injury, rehabbing just in time for opening day, only to re-injure the area after a cascade-inducing abdominal injury. While rehabbing those conditions, things haven't gotten much better. In her notes column, O's beat writer Brittany Ghiroli tells us that Roberts is headed for an endoscopy. It's unclear what's led to the need for that invasive test, but it's certainly not something done as a matter of course. Roberts doesn't have a good timeline for a return, but this type of setback isn't going to help things along the way. He's at least a month away from a return, but there hasn't been any real sign of progress for the O's star.

Kris Benson (shoulder, TBD)

Benson was brought in by the D-backs to bridge the gap to Brandon Webb's return. It doesn't look like he's going to make it. Benson left his last start with a sore shoulder and was sent for an MRI. Benson's long history of arm problems and his age double up to make this a very bad sign. If this is any sort of major injury, there's little chance that Benson will be able to come back and the window is closing with Webb making progress. It's been a while, 2005 or 2006, depending on how you define effectiveness, since Benson was able to hold a rotation slot. It's nice that he got that last shot and a shame it didn't work out, but that's the game. Benson was actually the first player I ever interviewed, back in the day of the original UTK.  He was coming back from Tommy John surgery and was surprised someone was interested in that process. Yes, this makes me feel old. 

Ryan Zimmerman (strained hamstring, 5/1)

A lot of people have been asking for details on Zimmerman. Thing is, there's not any. Zimmerman's hamstring strain is as simple as they come and so is the recovery. The timeline isn't flexible, it's just all predicated on healing and the team's confidence that they can put their star back on the field and not see him coming off it clutching the hamstring again. Essentially, they'll check him and say "not today" until he's ready. That's all there is and until the point they say "today's the day", there's really nothing to add. I try to avoid discussing injuries when there's nothing to add to the conversation. Don't take that as being dismissive of an injury. It's just a reality of doing this every day.

Quick Cuts:

Ian Kinsler had a steal in his last rehab game, a very good sign. He'll be activated for Friday's game ... Brad Lidge will also be back on Friday, in the Phillies' pen. It's unlikely he'll slot right back into the closer role ... The Phillies also got good news on Joe Blanton, who made it through his rehab outing without any issues. His oblique is healed up and he should be back in the Phils rotation early next week ... Mike Cameron has progressed to jogging, but sounds like he's a couple weeks away, at best, from a return from his sports hernia ... Matt Antonelli, the Padres prospect, will have surgery to fix his wrist. He'll be out til mid-summer, killing any chance of a call-up ... Comeback kid Jim Edmonds has injured his back. It's unclear on the severity, but he's expected to miss at least a couple games ... Miguel Olivo is either hardcore or crazy. Or both.

Related Content:  Joe Benson,  Back,  Brett Anderson

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