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May 27, 2010

Under The Knife

Thursday Update

by Will Carroll

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Kyle Lohse (compartment syndrome in forearm, ERD 9/1)
After reading Joe Strauss' story on Lohse, I erased most of what I had written about the Cardinals right-hander. Not because it was wrong, but because Strauss hit it out of the park, like an Albert Pujols homer. There's barely not a need to add anything here, but I have one thing that Strauss doesn't have—my injury database. There was one other pitcher with this diagnosis and it's both recent and convoluted. Noah Lowry was diagnosed with compartment syndrome, had the surgery and got no relief. Instead, he needed a second surgery for thoracic outlet syndrome. Last I heard, he was getting ready to throw back in spring training, but I'm not sure if he ever did. That's not something Lohse or the Cards are going to want to hear. Lohse's visit to the Kerlan-Jobe Clinic found him to have compartment syndrome in his forearm. I'm assuming that world-class facility both knew of Lowry's case and checked for that possibility. Still, it's hardly a surprise that it was so tough to diagnose. The recovery time from surgery is estimated at around seven weeks for motocross riders, who evidently get this from the combination of leaning on their arms, the vibration and stress, and the twisting motion of the throttle. For a pitcher, it's all guesswork. Lohse is likely headed for surgery in the very near future with little chance that he'll get back this season. I'm not ready to say "done for the season," but the Cardinals are going to have to operate under that assumption as they look in-house and out for a replacement.

Edinson Volquez (Tommy John surgery, ERD 7/15)
While serving his suspension for hCG use, Volquez is making good progress in his rehab from Tommy John surgery. While serving his suspension for hCG use, Volquez progressed from a program of long toss and flat ground throwing to mound work over the last few weeks. While serving his suspension for hCG use, the Reds right-hander moved faster than expected and threw a simulated game on Tuesday. While serving his suspension for hCG use, he had very good results, throwing well, hitting his spots, and having only "normal soreness" after the 40-pitch session. While serving his suspension for hCG use, he'll move on now to extended spring training and make a couple starts there. If you can't tell, I think it's worth remembering that this suspension is going to color everything Volquez does. It's not just going to be while serving his suspension for hCG use; it's forever, though I'm sure we won't see anyone throwing syringes or asterisks at him. It's the question marks he's put on his rehab that bother me most. When he comes back at the All-Star break, after serving his suspension for hCG use, no one will think it was the surgeon's techniques, the long hours put in by the medical staff, or even Volquez's hard work. We'll know more in the next few weeks about how the Reds plan to bring him back, with some thinking that a shift to the pen for this year might work best for both parties. They have time, since he'll be serving his suspension for hCG use for a bit more time.

Brett Anderson (strained forearm, ERD 5/29)
Things are looking better for Anderson and the Athletics. They've done all right without him, but the mix-and-match nature of the Oakland rotation is a tough one to grasp. The equation is really 162 x 7 / 8, meaning that the eight available starting pitchers each need to get to around 140 innings on the season. If one of them goes higher, someone can come up short. Ben Sheets has 55 innings in 10 starts, so expecting him to go to 175 is pushing it and requires his staying healthy. Dallas Braden is at 64 in 10 starts even with his last short outing. Gio Gonzalez is also on the right pace, but the rest of the team is coming up short for various reasons. A healthy Anderson could get back on the pace and with eight guys to choose from it doesn't have to be all at once. Any five will do and it doesn't have to be in any particular order. I'm sure Bob Geren could do with some certainty, but that's not the guiding principle here. If Anderson makes it through his bullpen session Thursday, he'll be back in the rotation on Saturday, chalking up his part of the workload. 

Edgar Renteria (strained hamstring, ERD 6/15)
The difference between who someone is and who we think they are is often pretty big. A lot of people still see an elite-level shortstop when they look at Renteria, who's hitting the DL with a Grade II hamstring strain. He really hasn't been that since he was in Atlanta. Now 34, Renteria is seeing a lot of things change. As he tried to run out a bunt on Tuesday, his hamstring changed and it appears to be in a bad spot. Renteria grabbed at his hamstring, as is natural, but grabbed very high. The location of a muscle strain is important, because location influences function. The strength, thickness and ability to rest a muscle all changes with location. Usually, the thickest part (or belly) of the muscle is easiest to overcome. The top of the hamstring is often stressed because of imbalances in strength between the quads and the hamstring, and by the activation of the glutes during a sprint. Renteria will miss well into June with this one. The Giants are hoping Juan Uribe can play well enough to let Renteria buy some time to heal up.

Miguel Montero (meniscectomy, ERD 6/4)
Last year in the Football Outsiders Almanac 2009, I wrote an article about how a rehab goes. Most of it is mind numbing, a grind of drills, exercises and slow progress. It wasn't a fun article to write, though I'm proud of how it came out. If you get some time, check it out. (This year's piece is going to be on HGH, if you're wondering.) Montero has been doing that slow grind of rehab and he's close to seeing the payoff. He's been taking batting practice, so running the bases is a nice step for him just over a month after his knee was scoped to clean out a meniscal tear. As a catcher, there's another hurdle with the squatting, so he'll need to show he can do that during a rehab assignment. That could start as early as this weekend. It's doubtful he'll be ready for full-time duties behind the plate, so Chris Snyder will see plenty of time back there as well, even after Montero's return. The Diamondbacks aren't putting a hard date on it, but Montero could be back in a week.

Travis Snider (inflamed wrist, ERD 6/5)
The Blue Jays have cleared Snider for baseball activities. That's a nice phrase. What we don't know is exactly what they'll have him do and on what timeline. With any wrist injury to a hitter, we'll be looking for any evidence of power loss or reduced bat control. So far, Snider hasn't swung a bat at all, though often there's steps up to that. Things like "empty hands drill" and swinging with a broom handle are intermediate steps. Snider's eligible to come off the DL on Sunday, though there's very little chance of that. It's much more likely that we'll see him swinging by that point, on a rehab assignment next week, and back in the T-dot soon after, assuming his swing isn't causing any more inflammation inside the wrist. Any wrist injury requires adjustments at the plate, something Snider has struggled with during his time with the Jays. Call me a short-term pessimist on this one.

Gregg Zaun (torn labrum, ERD 7/10)
On top of the pitching issues the Brewers have had thus far, now they have trouble at the other end of the battery. Zaun has a torn glenoid labrum (shoulder) and will try to rehab it over the next few weeks. This isn't the normal "try to avoid surgery" mode; this is "if it doesn't work, Zaun will retire." At 39, Zaun has to be worried more about long-term function than a season where things are getting away from the team and he's likely to be transitioned out at some point anyway. It wasn't quite the plan as it was with Zaun and Matt Wieters last season with the Orioles, but some combination of Jonathon Lucroy and Angel Salome could work out. The estimates from the Brewers have Zaun's chance of playing again at 50-50, though at his age ... wait, that's my age ... it's probably a longer shot than that. We'll know inside of a month. I'm setting the ERD at the All-Star break. If he's not back by then, we've likely seen the last of Zaun behind the dish. He's one of those players that's often been talked about as a future manager, however.

Andy LaRoche (back spasms, ERD 5/30)
For five games, LaRoche has been on the bench. For five games, Pirates manager John Russell has been saying "he's making progress." You know what, Russell? Save it. I understand that there's a game being played. The manager doesn't want to say too much and yes, he's limited by HIPAA in some ways, as Terry Francona reminded us yesterday. At some point, however, with the writers in on it, it gets insulting. The Pirates have a top-notch medical staff, one that I'm sure is working hard on getting LaRoche past a bad episode of back spasms. Saying something over and over is not only insulting to the writers, but to the work going on in the training room. I'd honestly rather have "no comment" than something like this. LaRoche may yet avoid the DL, though the Bucs' medical staff will make a decision by the weekend. If anything, it will be a retro move. Neil Walker might just have a small window to remind the Pirates why he was once a prospect.

Quick Cuts: Late word out of Boston is that Jacoby Ellsbury is headed for more tests on his ribs. ... Erik Bedard will have a side session on Friday. The Mariners are hoping this goes better than recent sessions, but on this timeline, he's unlikely to be back in Seattle before the All-Star break. ... Orioles designated hitter Luke Scott is expected back in the lineup on Thursday. He's having some issues with his chronically bad shoulder. ... Brian McCann left Wednesday's game with a mild quad strain. The Braves catcher seemed to indicate it was right on the edge of being a lot worse, so watch this over the next 10 days, when the risk is highest. ... What is it with heel bruises this year? Must be the shoes! Jody Gerut hits the DL with one in Milwaukee. ... Great, great details from Tyler Kepner regarding Trevor Hoffman's makeover. ... The Padres are hoping Everth Cabrera can avoid a DL stint. His hamstring is bothering him again, just a couple weeks after returning from the DL. Bad news for a speed player. ... Reds pitcher Justin Lehr is headed for Tommy John surgery and is done for the year. Homer Bailey will tell us who to blame tomorrow. ... My dog tore his CCL, which is the equivalent of the ACL in a human knee. He's headed for surgery, so naturally, he's getting advanced care, including a kevlar fiber ligament. I'll have more details next week, but give him a good thought, huh?

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