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August 27, 2010

Under The Knife

Surgery for Strasburg

by Will Carroll

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Stephen Strasburg (strained/sprained elbow, 10/4)

The Nationals announced that Strasburg has a torn ulnar collateral ligament as well as the strained flexor tendon. This couldn't be any worse—or more surprising. All the protections and conservative buildup to his career did not work, but we're not sure why. Strasburg's elbow is damaged enough that we have to wonder if he had any chance, if there was any methodology to keep him healthy. The likely answer is no. The Nats did not address whether the earlier focus on the flexor tendon was wrong, or whether the strain is an issue as well as the sprain. There's a comp here if both are an issue that should make Nats fans feel a bit better—Edinson Volquez. Then again, there's Ben Sheets if you don't want to feel hopeful. While the Nats continue to look for the problem, they're not going to the root. Strasburg has not, as far as I can tell, ever had a biomechanical analysis done. Thursday on Twitter, I said that it would cost about 0.02% of what MLB teams spent on the DL in 2008 to do an analysis on the top 20 pitchers for every team. Once Strasburg is healthy enough to do it, I have no idea why the Nats wouldn't find a facility to do it, to find out whether they can ever hope for Strasburg to hold together. 

Manuel Corpas (strained elbow, 10/4)

While everyone's watching Strasburg's elbow, the Rockies have an elbow problem of their own. Reliever Corpas appears to have a flexor tendon strain as well. Like Strasburg, he's being sent to the DL. Like Strasburg, the initial MRI was unclear and they're awaiting the results of a second test. If Corpas does have a significant tear, the Rockies recent surge back into the race might have a harder time. The bullpen, exacerbated by injury all season long, has been the weak point. Keith Dugger and the Rockies staff won't be in the running for the Dick Martin Award, but there's certainly something to be said about the way the Rockies have been able to minimize problems, return players to the field productively, and done the best they could with the hand dealt. There are no awards in that, but maybe there should be.

Dustin Pedroia (fractured foot, 9/15)

Ballers ball, players play, and surgeons ... cut. At some level, what you are is defined by what you do. You could say that about Pedroia and you could say it about the surgeons that the Red Sox consulted about his foot. The two experts are focused on distinct surgical solutions to problem. By consulting with them, out of all the foot specialists they could have chosen, indicates that the Red Sox are very concerned about the foot. Sometimes you go this route to rule things out, so don't think this is a foregone conclusion. Pedroia's foot is more serious than initially indicated, but there are a wide range of possibilities. The biggest issue is that it appears Pedroia hid some of the issues he was having during his rehab. That's hardly a surprise, but no less a major issue, one that points back to the trust issues that players are having with the medical staff. For now, Pedroia is back in a walking boot with a determination to be made next week. The mid-September ERD is very fluid.

 Brandon Phillips (bruised hand, 8/28)

Phillips got smoked by a 95-mph from ... Santiago Casilla? Honestly, I don't know who that is. At the end of some pens in baseball are guys I literally haven't heard of, reminding me that the four-man rotation and shorter 'pens would do more than anything else to help the quality of pitching in the game. Phillips, who has had some wrist problems before and has a tendency to get his hands in, had some swelling Thursday morning. The x-rays were negative but the pain and swelling is going to be the big issue. In a tight chase, it's a very tough balance between letting a player go out at less the 100%, risking further injury. We'll have to see whether or not Phillips finds some sort of protection for the hand. His availability—and a lot of players heading into September division chases—might be the difference. I'd be surprised if Phillips rushed back, so a Saturday return seems reasonable.

Nelson Cruz (strained hamstring, 8/30)

Ian Kinsler (strained groin, 9/4)

There's been some talk about the Rangers going after Manny Ramirez. If so, I'm not sure how they would sort it out, but it would go in the "nice problem to have" category. With Cruz on his way back and Kinsler not far behind, things are looking up for the Rangers, not that they were that down. Cruz started a rehab assignment in nearby Double-A Frisco on Thursday night, going 0-for-3. The key is how his hamstring responds more than the results. If all goes well, he'll be back in the Rangers lineup on Monday. Kinsler will likely slot into the Frisco lineup about the time Cruz heads across town. (Yes, the Rough Riders are headed on the road, but they'll be going to the Ryan-owned Corpus Christi ballpark.) The Rangers are being conservative with Kinsler and may elect to hold him back, but current estimates have him back at the end of next week. For Kinsler, the Rangers are more focused on being able to keep him in the lineup than getting him back quickly.

Billy Butler (bruised hand, 8/29)

Butler without power is like an Aztek without ugly. There's just nothing beyond that. According to Bob Dutton of the Kansas City Star, Butler has been fighting the soreness for a month. There's no root cause that any source is aware of, lost somewhere in the ether a month of bad baseball can produce. The hand isn't significantly swollen, just sore, which might remind some of a similar situation and how it ended up for Kevin Youkilis. Again, sources aren't completely sure, but no one has compared the situations during the conversations I've had. To a man, they think this is soreness that should be controlled with a little time off and treatment. Given the context of the Royals season, I don't know why they wouldn't give him as much time as he needs. They have options.

Ricky Nolasco (torn meniscus) 

While David Samson deals with a suddenly conscious Miami city council, Nolasco is dealing with something himself. Torn meniscus in his knee is causing some issue, but he's going to try to pitch through it. He's scheduled for a start on Saturday and the Marlins don't have a shadow pitcher, according to sources, indicating that they think he'll be fine. This is the time of the year where teams start thinking about shutting guys down, getting surgeries done early so that they'll be ready for next year. It's also the time when some guys try to push through, hitting some contract clauses or helping the numbers for a contract negotiation, knowing they can get the injury taken care of in the offseason and be ready for spring training. Nolasco is in that no-man's land, but if the knee is bothering him enough that he can't complete a bullpen session, I'm not sure how the team expects him to get through a game and not risk altering his mechanics, creating a bigger issue. Watch this one closely.

 Mat Latos

The Padres are in a position they never thought they'd be in with Latos. Heading into the season, the Pads were hoping Latos could establish himself in the rotation and give the team something to build on. Instead, they're considering how to best utilize him in a playoff run while protecting his future. He's already beyond the Verducci effect line, whether you use minor-league innings (as Verducci does) or whether you don't (as I calculate things) and he's about to pass even the highest projections for innings this season. At 150 innings, he's in a danger zone, but with a month and likely playoffs, he's starting to look more like Jaret Wright, 1997. But wait—look at Wright's career line and you'll see he was back in the playoffs in 1998. Many could see he was paying the price for going so deep into the previous season at that stage, but Latos isn't Wright. Even physically, while both have the "classic body", there's four inches difference in height. Latos doesn't have the thick legs that Wright does, but also lacks some of the top end velocity. Fact is, we don't know what, if any, similarities there are on the forces and the workloads. The Padres are a smart team and will err on the side of caution. We can only wonder what might have happened if the Indians had done the same over a decade ago.

 Jake Peavy (strained lat, 10/4)

Remember when Peavy tore the muscle off the bone in his shoulder? He had the surgery back in early July and he's making good progress. While he's a ways off from throwing, he's been cleared to begin a more involved rehab process including lifting weights and range of motion. Peavy is on track to be on a "normal" throwing program in January leading up to spring training. Of course, there's a lot of variation from team to team and pitcher to pitcher on what is normal, but the combination of Peavy and White Sox athletic trainer Herm Schneider is one that bears a lot of confidence. Peavy is probably more concerned at this point in the year about his hunting than he is pitching, but when the calendar flips to 2011, things sound like Peavy will be back for the Sox.

 Quick Cuts:

Jose Reyes has an oblique strain and will be held out a few days as the team monitors it ... I've been gone over a week, so did you miss news on Justin Morneau? Nope, no progress ... Aubrey Huff has an injury to his hand, but neither he nor the Giants seems too concerned by it ... Adam Jones is out for a second game with a sore shoulder. It's not considered serious, but while the Orioles tend to be a bit conservative, Showalter teams don't. We'll have to watch this ... Matt Lindstrom had a good bullpen session. If he has another tonight, the Astros will activate him over the weekend ... Jim Thome had a bruise so clear you could see the stitches tattooed on his thigh, but he was back in the lineup on Thursday ... Word out of Boston is that Jacoby Ellsbury will be "watched closely" over the winter. They're evidently curious just how long it will take for his ribs to heal without playing baseball. Curious ... I've heard some interesting rumors regarding Jamie Moyer and "alternative therapies" as he tries to return this year, but have been unable to confirm them. I mean, why not? ... Mike Hampton signed by the Diamondbacks? Think they're looking for some basis for comparison with Brandon Webb's shoulder, or is this an audition for a coaching job in the organization?

Related Content:  Back,  Year Of The Injury

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

BP Comment Quick Links

NealPhD

could have sworn I just saw Kevin's name as the author of this article. Good to have you back Will

Aug 27, 2010 10:58 AM
rating: 0
 
kddean

As did I. Either way, very odd.

Aug 27, 2010 10:59 AM
rating: 0
 
gluckschmerz

Hi Will. Where have you been?

Aug 27, 2010 11:00 AM
rating: 1
 
Jonathan

Hey Will,

RE: no teams doing biomechanical analysis -- I know you mention this often, and you juxtapose the cost of maybe learning something useful vs. the money lost to injury every year, and maybe you've answered this before and I'm not remembering, but...

Why don't teams do it?

Laziness? Skepticism about the technology? Players and/or agents don't want to submit to the tests fearing it might haunt them in contract negotiations? Knowing next to nothing about it, it still boggles my mind that it's ignored.

Aug 27, 2010 11:17 AM
rating: 4
 
manhaus1

A team could fear that a player who is told their arm is going to blow up may pitch ineffectively because they are trying to protect their arm or may blow up their arm because of a self fulfilling prophecy. The mind is a very important part of injuries and messing with a player's mind could have negative effects on future performance.

This of course does not explain completely why a GM would not want the information. (Although there would be issues in hiding the info from the player) But, teams are optimistic and may just not want to know that their franchise savior is not going to have a healthy career.

Aug 27, 2010 12:15 PM
rating: 0
 
Matt Kory

In a chat on Fangraphs.com on Wednesday, Dave Cameron said, "The guys passing off mechanical analysis as some kind of injury predictor are basically just making stuff up." Of course, he gets more questions about that statement which I won't quote here (you can easily find it yourself if your curious) but I was wondering if that position is supported by Will? It sounds like it isn't, but I thought I'd throw it up here to see.

Aug 27, 2010 13:47 PM
rating: 0
 
dREaDS Fan

Maybe Will's got a financial interest in the one clinic that does biomechanical analyses. (I'm kidding.)

Aug 27, 2010 16:00 PM
rating: -1
 
Will Carroll

I won't speak for Dave at all, but if he's referring to people that say they can eyeball pitchers and tell you whether they're injury prone or not, I agree. If he's referring to biomechanical analysis of the type done by Dr. Glenn Fleisig and others, I disagree strongly.

Aug 27, 2010 18:09 PM
rating: 0
 
Tuck
(667)

Aw man. I wanted more BP drama.

Aug 27, 2010 11:18 AM
rating: 0
 
Brian Kopec

No intro. No continuation of the article-1000 countdown. Posting on twitter that he's not sure when or if his article would be posted.

The drama tank ain't on empty yet, unfortunately.

Aug 27, 2010 11:44 AM
rating: 2
 
amazin_mess

Yeah...no intro. That's not a good sign.

Aug 27, 2010 11:55 AM
rating: 0
 
Michael
(736)

Was there some recent BP drama that I missed?

Aug 27, 2010 13:55 PM
rating: 0
 
Matt Kory

I assume they're referring to Joe Sheehan, but maybe I missed something too.

Aug 27, 2010 13:57 PM
rating: 0
 
BarryR

Read the comments on John Perotto's Wednesday On The Beat.

Aug 27, 2010 15:27 PM
rating: 0
 
alanbw
(111)

Bloomquit at first or DH. Good one, Will.

Aug 27, 2010 11:24 AM
rating: 0
 
bobbygrace

Will, you've made two passing references to the so-called inverted W in the past, both dismissive. Everything I can find on the inverted W seems to lead back to one source, Chris O'Leary. Given that Strasburg was one of the pitchers that O'Leary and his followers marked as at-risk due to the inverted W thing, could you please let us know (a) who, if anyone, other than O'Leary argues for or against the dangers of the inverted W, and (b) why you're dismissive of inverted W phobia? Thanks.

Those unfamiliar with what I'm referring to may view O'Leary's inverted W lesson here:

http://www.chrisoleary.com/projects/Baseball/Pitching/RethinkingPitching/Essays/DeathToTheInvertedW.html

Aug 27, 2010 11:33 AM
rating: 2
 
bobbygrace

P.S. I should note that in the past, you suggested that Strasburg wasn't affected by the inverted W to begin with, but that people mistook his scapular loading for an inverted W.

Aug 27, 2010 11:37 AM
rating: 0
 
coachadams5

Dr. Mike Marshall (former Dodgers reliever) is a vocal opponent of the inverted "W" and the inverted "L" (where the front arm doesn't form the right side of the W but stays straight ala Chris Carpenter and Jake Peavy) and he also identified Strasburg's mechanical flaws early on. Any pitcher who uses a motion that features an inefficient path to release ("W's" and "L's") is subject to injury. Joel Zumaya is a classic "W" case as was Mark Prior.

Aug 27, 2010 12:50 PM
rating: 0
 
TADontAsk

And after all that talk about how we shouldn't judge pitchers on their W's and L's.

Aug 27, 2010 12:57 PM
rating: 21
 
coachadams5

By the way - inverted "W" is actually an "M", which is a much more descriptive term. The left and right angles of the "M" are the glove arm elbow and pitching arm elbow when facing a pitcher.

Aug 27, 2010 14:02 PM
rating: 0
 
JoeR
(98)

Dr. Marshall spoke to a group of us baseball fans down in Spring Training this year. He makes a very compelling case about the art of pitching based on what appear to be sound medical theories. He had me drinking the Kool Aid about 15 minutes into his lecture.

Aug 27, 2010 14:15 PM
rating: 0
 
Will Carroll

Supposedly, Glenn Beck is addressing a big group today. Kinda similar.

Aug 28, 2010 10:07 AM
rating: 3
 
PeterBNYC

Link doesn't work.

Aug 27, 2010 17:41 PM
rating: 0
 
gluckschmerz

"... I've been gone over a week". Inquiring minds are curious.

Aug 27, 2010 11:35 AM
rating: 3
 
Pat Folz

Santiago Casilla was once a highly-regarded prospect for Oakland named Jairo Garcia. You might remember him...?

Aug 27, 2010 11:37 AM
rating: 0
 
leites

Jairo Garcia, the A's top minor-league reliever, is now known as Santiago Casilla. That is his real name; Casilla used false documents when he signed his first contract, something that is not unusual in the Dominican Republic but that has been less frequent since a post-Sept. 11 crackdown on visas.

"It's something we didn't know about, but he came forward with the information, so I commend him for that," general manager Billy Beane said.

It's going to take the A's some getting used to. Beane referred to Casilla as "Jairo" several times. "I'm sure we'll all just keep calling him Jairo," Haren said. "That's such a good name, too."

- 1/27/2006

Aug 27, 2010 11:42 AM
rating: 0
 
BarryR

Welcome back, Will - you've been missed.

As for Latos - the Padres have to try and win now, so their focus should be on what would help them do that, which may also involve some extra rest for Latos, so he can be effective in October. The Verducci Effect is clearly meaningful, but did not come from a burning bush -- some pitchers survive it very well. And others have a bad season, then bounce back. Winning a championship for the Padres is why they have Mat Latos and it isn't an every year thing.

Aug 27, 2010 11:44 AM
rating: 0
 
tballgame

Welcome back

Aug 27, 2010 11:53 AM
rating: -1
 
jtrichey

I was under the impression that ricky Nolasco's bullpen on Wednesday went well. So where does this:

but if the knee is bothering him enough that he can't complete a bullpen session, I'm not sure how the team expects him to get through a game and not risk altering his mechanics, creating a bigger issue.

come from?

Aug 27, 2010 12:24 PM
rating: 0
 
Jim Humdingding

I didn't get that one either. Nolasco also passed a battery of fielding-related drills yesterday, with no discomfort except for jogging backwards. He reported that fielding bunts wasn't a problem.

Nolasco did say he won't hesitate to shut it down for the year if it acts up on him.

source: Miami Herald

Aug 27, 2010 12:45 PM
rating: 1
 
roycewebb

Nice call on the Aztek. That is easily the ugliest vehicle I have ever seen, or hope to. Could not believe my eyes the first time I saw one tooling down the highway.

Aug 27, 2010 13:53 PM
rating: 0
 
Randy Brown
(189)

Welcome back, Will? What's everyone talking about? And Strasburg is hurt? What??? Live under a rock for two weeks, and all hell breaks loose.

(Just kidding. Welcome back Will, you've been missed.)

Aug 27, 2010 14:01 PM
rating: 0
 
mikeduin

Will - is Liriano at all an applicable TJ comparable for Strasburg?

Aug 27, 2010 16:34 PM
rating: 0
 
Michael MacKuen

Great to see you Will. You were missed!

Aug 27, 2010 16:53 PM
rating: 0
 
PeterBNYC

Will, welcome back! In case you hadn't noticed, your readers are interested in an explanation of your absence. Some wild theories floating around....The speculation will continue, you know, until you or BP put out a statement.

Aug 27, 2010 17:45 PM
rating: 5
 
Richie

Better to remain silent and have people suspect the worst rather than speak out and remove all doubt.

Aug 27, 2010 19:16 PM
rating: 0
 
Brian Kopec

No "BP Staff" tag on Will's comment above. Oh well.

Aug 27, 2010 20:08 PM
rating: -1
 
cyborg

Come on...anyone can change their "pen name" they post under

Aug 28, 2010 10:27 AM
rating: 0
 
Brian Hays

This is bullshit. I never post, but first Sheehan, now Carroll. Get this shit taken care of now BP.

Aug 27, 2010 20:36 PM
rating: 1
 
Michael D

I honestly think it's pretty embarrassing that a baseball reporter is comfortable admitting he doesn't know who Santiago Casilla is. Not a household name, but he's appeared in nearly 200 games over the past few years...

Aug 27, 2010 20:55 PM
rating: 1
 
Will Carroll

There's a lot of middle relievers I probably couldn't name. If they don't get injured, they're a pretty anonymous bunch to me.

Aug 28, 2010 10:08 AM
rating: -1
 
tyjordan

It's not so much having to name all the middle relievers, but he has been pitching some pretty meaningful innings in a pennant/wild card race. C'mon Will, you're better than that.

Aug 28, 2010 16:28 PM
rating: 1
 
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