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April 15, 2011

Collateral Damage

Mauer Outage

by Corey Dawkins and Marc Normandin

Joe Mauer, MIN (Bilateral leg weakness)
As more information comes out, we are finding out the true reason for Mauer's weakness: Troy Polamalu tackled him after Mauer made fun of his hair.

Lower extremity weakness can be caused by what seems like a million different things. Neuromuscular fatigue, muscular atrophy, neuromuscular inhibition as a result of knee swelling, herniated discs in the spine, and certain diseases all can produce bilateral leg weakness in the absence of direct trauma to the legs. Since Mauer's condition is severe enough to require a stint on the disabled list, we're sure that if he hasn't already undergone MRI testing, he will be doing so within the next day. Without seeing the images directly, we will discuss the two most likely scenarios.

Mauer could have a large central herniated disc that is causing a narrowing of space for the spinal cord, resulting in pressure exerted directly on the spinal cord (especially if the symptoms in each leg are the same). If the symptoms are not symmetric—such as quad weakness in one leg and calf weakness in the other—then there are likely multiple disc injuries that are placing pressure on the nerve after they have exited the spine.

The intervertebral disc is composed of two types of tissues with different densities and tensile strengths that allow the discs to function the way they do. The outer ring of the disc is called the annulus fibrosis, a thick fibrous ring that keeps the gelatinous nucleus pulposus contained. Think of it as a round banana: the outer skin of the banana is the strong annulus fibrosis, while the edible part is the nucleus pulposus. These intervertebral discs act primarily as a shock absorber and provide a way for the spine to make movements necessary for sports or everyday life.

Intervertebral disc injuries can generally occur in two ways—acutely or through chronic degeneration—but they also seem to have a genetic component. Acute disc herniations can occur from a hyperflexion injury, extreme trauma (such as a motor vehicle accident), or extreme increases of pressure on the disc (as might occur during the lifting of heavy objects). A large portion of the nucleus pulposus can herniate or leak out, putting pressure on the nerves or spinal cord.

Degenerative injuries can also occur over time before a single episode starts producing pain. With degenerative changes, the discs lose their water content and begin thinning, becoming less flexible as a result. The pressures placed upon these particular discs can't be spread as evenly throughout the spine, sometimes resulting in a disc injury between the fourth and fifth vertebrae (or the fifth and the sacrum).

The second scenario entails Mauer not yet being fully recovered from his knee surgery in the offseason. He surely was limited in the amount of impact training he could perform over the winter and during spring training in an attempt to protect the knees. Unfortunately, there is only so much strength training one can do without having to perform those activities.

Our guess, based on Gardenhire's initial conversation with reporters on Thursday, is that Mauer's weakness is the result of a herniated disc. Gardenhire told reporters that Mauer was given Thursday off, but he did not dispense any other information when follow-up questions were asked. The only thing he did admit was that Mauer was sore: he could catch in an emergency, and he was going to be reevaluated on Friday.

Herniated discs do not automatically mean surgery, but they can be devastating to a catcher's career because of the flexion demands on the backstop throughout the game. Depending on the severity of his weakness and what the MRI shows, Mauer will consult with a surgeon to see what, if anything, needs to be done. The difference between the conservative non-surgical route and the surgical route is a rather large one.

For typical rehabilitation without surgery, the total time lost is approximately 60 days in catchers. We lack data on catchers recovering from surgery, but Brad Ausmus missed 100 days in 2010. We will keep you posted with any updates on Mauer's condition and whether he'll require surgery.

Aroldis Chapman, CIN (Arm inflammation)
Whenever Dusty Baker says that a pitcher should be fine in a day or two, we always get a little worried. Chapman's velocity dropped to the mere mortal level of 92 mph—you know, where his "changeup" was in 2010—so he saw the Reds' medical director, Dr. Timothy Kremchek. He was diagnosed with inflammation of the arm, a vague and somewhat unhelpful description. Thanks, doc.

As we have seen and discussed with other players, once something is inflamed, the inflammation doesn't just disappear overnight. If it is truly inflammation—and we have no reason to believe otherwise—it's unlikely that Chapman will return to pitching within a week. There is a chance that he will go on the disabled list, although no one wants to admit that. The value of his arm dictates that they will have to be conservative in this case, so even though good ol' Dusty said he is day-to-day, we would bet on his missing at least a week or two.

New York Yankees bullpen, NYA (Everyone)
That's not as much of a stretch as it sounds like. The Yankees have taken a beating with injuries, and it may not be over yet. Pedro Feliciano was originally diagnosed with a torn rotator cuff, but he actually has a torn capsule in the shoulder that was confirmed by the MR arthrogram.

A torn capsule is more difficult to recover from, as Yankees fans know first hand: the last player with this condition was former Yankee Chien-Ming Wang. If Feliciano decides to undergo surgery—a likely path—he will join fellow left-handed Yankees reliever Damaso Marte on the 60-day DL and be lost for the year. If he wants to give it one last try before surgery, he will undergo PRP injections and refrain from throwing for about six to eight weeks.

Luis Ayala went on the 15-day disabled list with a strained latissimus, a word you have all become familiar with this year. Phil Hughes once again started off a game with decreased velocity, and rumors of his going to the bullpen to “strengthen” his arm are starting to fly. If there is an underlying issue, switching to the bullpen may be the worst thing possible. Hughes has not had velocity even early on in games, so it's not likely that the decline is attributable to fatigue.

Flesh Wounds: Bryan Augenstein went on the 15-day disabled list with a strained right groin, but there is a good chance that he could be out significantly longer than that... Brian Tallet broke his right hand—at least it wasn't his pitching hand—but he did need surgery to put a pin in it, which should keep him out for four to six weeks... Aaron Cook was transferred to the 60-day disabled list, meaning that he won't be eligible to return until late May at the earliest... Robinson Tejeda went on the disabled list after a velocity drop of his own that resulted from inflammation in his shoulder... Chris Young of the Mets had his start pushed back due to right biceps tendinitis, but he may end up making a visit to the disabled list in the near future.

Corey Dawkins is an author of Baseball Prospectus. 
Click here to see Corey's other articles. You can contact Corey by clicking here

Related Content:  Surgery,  Quad-a

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

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dianagram

Well-played, Mauer. (sigh)

Get well soon Joe!

Apr 15, 2011 07:05 AM
rating: 1
 
The Game Is On

Excellent explanation and analysis of Mauer's unfortunate situation.

Apr 15, 2011 07:24 AM
rating: 5
 
dianagram

It may be well be way too early to speculate, but is this the tipping point that moves Mauer out from behind the plate? If it is indeed a herniated disc (and the resulting rehab/surgery), could he handle the wear and tear of 3B?

(bummed)

Apr 15, 2011 07:38 AM
rating: 1
 
bobbygrace

At the outset of the Mauer piece, several possibilities for bilateral weakness in the legs were presented. The rest of the piece was devoted to one possible diagnosis: a disc injury. Was there a reason for ruling out the other possible diagnoses?

I want to believe that it's something less severe....

Apr 15, 2011 07:49 AM
rating: 1
 
Marc Normandin

That's the best guess for what it could be, mostly because Corey and I didn't think it came from a swarm of ticks biting him while he ate blowfish at a sushi place. There are a ton of causes for this problem.

Apr 15, 2011 08:33 AM
rating: 0
 
BP staff member Corey Dawkins
BP staff

Also because it's unlikely to get that much swelling in both knees at the same time. Generally in order to get bilateral of anything (pain, weakness, numbness, etc) there has to be some systemic disease or something pushing on the nerves of the spine.

And I don't know how difficult it is to find blowfish in Minnesota.

Apr 15, 2011 09:15 AM
 
bobbygrace

This is a bummer, man. But thank you both for replying.

Apr 15, 2011 09:24 AM
rating: 2
 
Kyle E.

Improperly prepared fugu at a sushi restaurant?

Apr 17, 2011 17:36 PM
rating: -1
 
dianagram

Insult to injury:
http://www.cbssports.com/mlb/story/14950268/mauer-already-on-dl-hospitalized-thursday-with-flu/rss

General manager Bill Smith said Friday before the Twins' game at Tampa Bay that Mauer went to a hospital for evaluation and treatment Thursday night after "suffering from extreme flu-like symptoms."

Smith said Mauer was sick during and after the 4-3, 10th-inning loss to the Rays. Mauer received fluids and antibiotics and was discharged back to the team's hotel.

Apr 15, 2011 10:56 AM
rating: 0
 
BP staff member Jason Collette
BP staff

Can he rub a little Head and Shoulders into it to make it feel better?

Apr 15, 2011 11:42 AM
 
brokeslowly

Guys, a little bit of a stretch on the large herniated lumbar disk speculation. As a neurologist, I know that such an injury would usually be accompanied by severe low back pain; the back pain would be complaint #1 or #1a. We haven't heard anything about him suffering from back pain. My guess is that the leg weakness is a prodromal symptom of his "flu-like syndrome" that has put him in the hospital. There are other rare neurological birds that can cause bilateral leg weakness in the setting of "flu-like symptoms", for example, Guillan-Barre syndrome (don't look it up, it will scare the bejezzus out of you). All in all, though, you have to be very careful speculating about any neurological diagnosis without a heck of a lot more info than the reason for the DL statement "bilateral leg weakness" gives you.

Apr 15, 2011 14:47 PM
rating: 7
 
BP staff member Corey Dawkins
BP staff

Agreed about the low back pain. Prior to today however, there was no mention of him being sick and Gardenhire was very adamant about not providing further details other than he was sore (he wouldn't even say where) and then he was placed on the DL with bilateral leg weakness. I am familiar with Guillan-Barre syndrome but as a catcher the chances of it being a herniated lumbar intervertebral disk versus Guillan Barre. As a neurologist, I am sure you have seen cases where there was a large herniated disc in an elite athlete with minimal to no low back back, only manifesting itself through distal symptoms. I have actually seen a case in the last month where he was a 22 year old male with minimal back pain and a herniated disk producing weakness along the L3-4 and L4-5 distributions.

That's neither here nor there though. With word coming out that he was sick and vomiting and sent to the hospital, it becomes much more clear as to what was producing the weakness. There was no mention of flu-like symptoms in other parts of the body prior to mid morning after Collateral Damage was out but certainly with this new information he because too dehydrated, producing the fatigue and weakness.





Apr 15, 2011 18:59 PM
 
BP staff member Corey Dawkins
BP staff

Everyone can blame my poor spelling and double words on my stubby thumbs typing on a phone. Hopefully everyone understands what I was trying to say.

Apr 15, 2011 19:10 PM
 
RedsManRick

Perhaps Mauer has been hanging out with Bronson Arroyo. Wouldn't mono manifest in part as generalized fatigue?

Apr 15, 2011 16:32 PM
rating: 1
 
BP staff member Corey Dawkins
BP staff

There are many viral infections or other systemic conditions that can produce generalized fatigue. The conditions besides making you feel like crap also tend to dehydrate you. Now that word has come out that he has been suffering flu-like symptoms for a few days, almost certainly his bilateral leg weakness is a result of this.

How far is Minneapolis from Cincy?

Apr 15, 2011 19:06 PM
 
Hoff

so the flu rules out both of the above mentioned scenarios?

Apr 16, 2011 05:20 AM
rating: 0
 
BP staff member Corey Dawkins
BP staff

Honestly it depends when the "weakness" began and we're not getting a clear explanation as to when it began. If the weakness began last week and the flu-like symptoms began 3 days ago then no it doesn't rule anything out because that level of weakness doesn't start before the other symptoms.

(I know a simple no could have sufficed)

Apr 16, 2011 09:42 AM
 
Hoff

well, i suppose that makes sense, but can we really untangle any purely muscular "weakness" from "flu like symptoms". Unless you really know something else was wrong, its not ludicrous to believe the virus has been causing him problems for up to a week and then finally took over cause he was pushing. I guess a big question is how quicly can we expect someone who looks like they lost 20 pounds to come back.

Apr 18, 2011 09:15 AM
rating: 0
 
BP staff member Corey Dawkins
BP staff

He still probably won't have all 20 pounds back on at the end of the 15 days but but he probably should have 10-15 or so.

Apr 19, 2011 14:39 PM
 
urantia
Other readers have rated this comment below the viewing threshold. Click here to view anyway.

So did I look up all those big words just to expand my vocabulary? Am I the only one who misses Will Carroll? Why did he leave?

Apr 16, 2011 12:13 PM
rating: -12
 
vtadave

I think he left because of you.

Apr 16, 2011 21:59 PM
rating: 4
 
worldtour

Enough already - time to play left field!

Apr 18, 2011 12:02 PM
rating: 0
 
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Baseball ProGUESTus: T... (04/15)
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Premium Article Collateral Damage: Ham... (04/13)
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Collateral Damage: One... (04/18)
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The Week in Quotes: Ap... (04/18)

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