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August 12, 2011

Collateral Damage

Cracking the Morse Code

by Corey Dawkins and Ben Lindbergh

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Mike Morse, WSN (Left elbow contusion) AGL: 1 (13DL), ATD: -.023 (+.019DL)] (Explanation)
Even though bruises sound simple enough, they can be debilitating and shut an athlete down for a few weeks or more. In many ways, bone bruises and fractures react the same in times of acute injury, such as when Morse took a Ryan Dempster fastball off his left arm just above the elbow yesterday. If the ball catches you just right—and it looks like it hit this spot on Morse—the ball will actually strike two of the three bones in the elbow. The ulna and its olecranon process is the bone you feel when pushing on the elbow in a bent position. The lateral epicondyle is the bump that is on the outside of the elbow in the same bent position.

Two main points before we move on. First and foremost, until a CT scan is performed, you can't completely rule out a fracture. How many times have we seen an initial diagnosis of a bruised bone in the hand, wrist, or foot that ended up being a small fracture not seen on x-ray? Second, an MRI will tell us that there is swelling in the area, including bones, but it can't rule out what we classically think of as a fracture. It can be helpful in assessing stress fractures, but in an acute injury like this, swelling in the bone from a bruise or from a fracture looks the same on MRIs.

The most common structures involved in the area—where we tend to see a ton of HBP—are the wrist extensors, distal triceps, lateral epicondyle, and olecranon. The wrist extensors are close to the surface on the outside of the elbow and insert into the lateral epicondyle of the humerus. The triceps is on the back of the arm but inserts onto the olecranon process and can also be bruised easily.

We've all experienced a bruise at some point, so we know the general symptoms. With a bruise, especially at the location where Morse’s was, the joint becomes very stiff as a protective measure and will remain stiff at least until the swelling dissipates. The area can remain painful and limiting until the swelling leaves the bone, and this can take several days to several weeks. As of now, Morse is day-to-day.

Hanley Ramirez, FLA (Left shoulder sprain) [AGL: 38, ATD: -.019]
After Hanley was unable to come back last weekend, it seemed likely that he would end up on the disabled list. On Wednesday, the Marlins made it official, placing him on the DL retroactive to August 3rd. His first eligible day to come off the disabled list would be August 18th, a little under one week away. It's not a certainty that he will return that quickly, though. Most sprains, once they reach the level of requiring a trip to the disabled list, take several more weeks to heal and even longer before the injured player’s performance returns to its pre-injury level. As more information comes out, we will be sure to keep you posted.

Zack Cozart, CIN (Left elbow surgery—Tommy John surgery) [AGL: 114, ATD: +.137]

It's not surprising that Cozart is undergoing surgery on his elbow, but the details of the surgery certainly are. Cozart will have Tommy John surgery, reconstructing the ligament on the inside aspect of the elbow. In the video above, at approximately 1:15, you will see how the elbow is hyperextended with a little valgus force where the wrist is being pulled further away from the body. This motion injured the UCL, and Cozart was unable to rehabilitate it properly. Since he’s a position player and the injury affected his non-dominant arm, he will be able to return faster than a pitcher, but he will still need several months of recovery.

Alex Cobb, TBY (Thoracic outlet syndrome surgery) [AGL: 97, ATD: +.129]
We finally learned the reason for the numbness in Cobb's fingers, but it may not be the news he wanted to hear. He was diagnosed with thoracic outlet syndrome and resulting compression of the vein near the first rib and will require season-ending surgery. Having Jeremy Bonderman and Noah Lowry as medical comps can't exactly give you warm and fuzzy feelings inside.

We spoke about Thoracic Outlet Syndrome (TOS) in detail when discussing the possibility of injury to Phil Hughes. In Cobb's case, part of the first rib will be removed in order to provide a greater space for the neurovascular structures to pass from the body and neck into the arm. This procedure requires a lengthy recovery, and there is still no totally positive comparison to give Cobb confidence. He will start a throwing program in about three months, so he could be ready for spring training next year.

Brennan Boesch, DET (Sprained right thumb) [AGL: 2(27DL), ATD: +.004 (-.025DL)]
Boesch aggravated his sprained right thumb on Wednesday and figures to miss at least a few days, with a move to the disabled list a real possibility. Most sprains are to the inside part of the thumb and cause issues with gripping of objects. The ligaments that stabilize the area lie in very close proximity to muscles that control the fine movements of the thumb, so it becomes very difficult to move the thumb properly when injured. Moderate sprains can take several days to a few weeks to recover, especially high-grade II or high-moderate sprains.

Manny Acosta, NYN (Right fingernail laceration) [AGL: 0 (10DL), ATD: +.045 (TBD DL)]
Acosta had to be handled carefully because of the possibility of a fracture in his right finger after he was struck by a comebacker on Wednesday. In cases where the fingernail is torn off by an acute injury like this, there could actually be an open fracture of the bone underneath the nail. X-rays were taken and ruled out the fracture. Since the fingernail isn’t present, the forces will be applied to the finger slightly differently than before. Assuming he didn't injure anything else, he will be able to return once he is able to grip the ball and go through a few bullpen sessions.

Flesh Wounds: Alex Rodriguez will start a rehabilitation assignment on Friday as his recovery from meniscal surgery in his right knee progresses... Matt Holliday has not started since Tuesday because of a strained back muscle suffered while lifting weights. The Cardinals say it is a minor injury, and he should be back any day... Craig Gentry was activated from the disabled list after clearing all steps in the concussion management protocol... Carlos Beltran was given a cortisone injection into his wrist but will still miss the weekend series, according to Bruce Bochy. This raises the possibility of a move to the disabled list because of the strain... Coco Crisp is still battling soreness in his right calf and could end up needing a move to the disabled list... Dee Gordon was placed on the disabled list with a bruised right shoulder... Alexi Casilla and his strained hamstring will be activated from the disabled list today... Tommy Hanson passed all the tests on his shoulder recently, and there is nothing structurally wrong... Lance Lynn was placed on the disabled list with a strained left oblique...Justin Ruggiano was placed on the disabled list with left knee bursitis... Orioles prospect David Klein is going to see Dr. Lewis Yocum about his continued right shoulder pain... Chris Narveson cut his left thumb and needed eight stitches to close the wound, sending him to the DL.

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

Related Content:  Surgery,  Alex Cobb,  Elbow,  The Process

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