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August 17, 2011

Collateral Damage

Giant Problems

by Corey Dawkins and Ben Lindbergh

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Carlos Beltran, SFN (Right wrist strain) [AGL: 25, ATD: +.036] (Explanation)
After pulling out all the stops to try to get Beltran back in action, the Giants were forced to place him on the disabled list yesterday, along with Sergio Romo. Beltran's injury was described as a strain with resulting inflammation, not uncommon for acute injuries. On the outside of the wrist where his inflammation is—anatomically speaking, it's the inside aspect closer to the little finger—there are several structures that could be injured.

The most likely structures involved are the extensor tendons for the wrist itself. The tendons themselves can become strained, or a sheath of connective tissue covering the area and keeping the tendons in place can also be injured. This straining of the tendon is similar to Mark DeRosa's wrist, which obviously isn’t something most fans want to hear. It doesn't appear at this time to be as serious as the injury that DeRosa suffered and has continued to battle. The tearing of the sheath is similar to the injury that David Ortiz suffered back in 2008. Neither of these automatically requires surgery, but either could down the line.

Another common injury with that mechanism involves the cartilage and is called the triangular fibrocartilage complex, or TFCC for short. The TFCC is very complex and provides key functions to the wrist. Gliding motion of the wrist bones and rotation around the distal ulna would not be nearly as functional without the TFCC working properly. The TFCC can be injured by shearing and compressing forces with rotation of the wrist, such as swinging a baseball bat. Other common ways to injure the TFCC include load-bearing rotational actions like bracing oneself from falling.

There still hasn't been any official word as to what structure is injured in Beltran’s case, but we should hear something soon.

Edward Mujica, FLA (Strained right latissimus dorsi) [AGL: 15(44 DL), ATD: +.128(+.002 DL)]
Mujica pitched well Monday before straining his right latissimus dorsi in the eighth inning. It takes a lot of force to strain the lat muscle, which is a vital component in the pitching motion. The latissimus dorsi is one of the prime internal rotators of the shoulder and contributes to generating velocity. Because it is an important internal rotator, it also limits external rotation at a key moment. As we’ve discussed, there are two critical instants in the pitching motion at which injuries tend to occur.

The latissimus dorsi contracts eccentrically at one critical instant where maximal external rotation is reached, before then forcefully contracting during acceleration. The force produced during this stretching usually contributes to the strain itself. It is such a large key muscle that these often take several weeks to heal in pitchers, especially once they require a trip to the disabled list. The Marlins’ athletic trainers believe this is not a serious injury, according to manager Jack McKeon, but that remains to be seen.

Chipper Jones, ATL (Left knee soreness) [AGL: 2(29 DL), ATD: +.000(+.014 DL)]
It's been a week since Chipper last found his way into the column, so it’s about time he made another appearance. On Sunday, Chipper felt something in his surgically repaired knee when he was running down the first-base line, and he underwent an MRI on Monday. There was no significant structural damage to the knee, but it was painful enough that medication was required to allow him to sleep.

In or around post-surgical joints there can be bands of scar tissue that can break up at times. Tearing or breaking the scar tissue can result in pain, swelling, or the sensation of a pop similar to that felt when rupturing a ligament. This can be stressful for the athlete, who often feels as if he’s suffered a major setback. Most of the time, this dissipates over a few days, and the athlete feels better once the active inflammation has gone down. Chipper is going to do what he normally does, and we will probably see him back on the field before he is fully ready.

Chris Davis, BAL (Right shoulder labrum and rotator cuff tear) [AGL: 16, ATD: +.048]
Baltimore should hope that whoever replaces Davis doesn't have the same luck that he did. When Davis was acquired at the deadline, he replaced Luke Scott, who underwent season-ending surgery for a labral tear in his right shoulder on July 26th. Now Davis faces the possibility of season-ending surgery on his right shoulder in the near future.

Davis has been battling shoulder inflammation for a few weeks at minimum, and the pain has become too severe for him to continue, leading to the discovery of wear and tear in his rotator cuff and labrum. He will visit Dr. Yocum for another opinion in the coming days. If surgery is required and there is only fraying, then full recovery is expected, and he’s much more likely to be 100 percent by spring training 2012. If there are major tears to the rotator cuff or labrum and more of a repair needs to be performed, all bets are off, and he may end up needing even more time to recover.

A.J. Pierzynski, CHA (Left wrist fracture) [AGL: 45, ATD: +.003]
Yesterday, Pierzynski proved that there is a first time for everything. Pierzynski found himself on the disabled list for the first time in his major-league career (which has spanned 14 seasons) with a fractured left wrist that he suffered Friday night. Pierzynski was unable to avoid the high-80s slider from the immortal Bruce Chen before having the ball ricochet off his wrist into foul ground.

Initial x-rays were negative, but as is often the case, further testing revealed the fracture. The specific bone that suffered the fracture is still unidentified, but it appeared that the ball actually hit the distal ulna, making this technically a forearm fracture. Forearm fractures have a tendency to heal with fewer complications than true wrist fractures do.

Garrett Richards, LAA (Strained right groin) [AGL: 28, ATD: -.007]
It's not just the cagey veterans who get injured—the young pups get hurt just as often, if not more. On Tuesday, Richards was placed on the disabled list with a right groin strain that he suffered in the first inning on Monday night. The right-hander relies on his right leg to drive off the rubber while simultaneously using the adductors (groin) to help stabilize the pelvis.

In part because of the stabilizing effect, groin strains can have a tendency to linger longer than initially expected, so it would not be surprising if he ends up staying on the disabled list a bit beyond the minimum. It’s getting close enough to the end of the schedule that even a mild setback in his rehabilitation will likely end his season.

Jon Rauch, TOR (Appendicitis) [AGL: 39, ATD: -.003]
Rauch had a whirlwind 24 hours before ending up on the disabled list Tuesday. On Monday night, he was the unfortunate pitcher who gave up the eventual game-winning home run in the eighth inning. On Tuesday morning, he was lying on a gurney getting ready to count backwards for the anesthesiologist during appendix surgery at a Seattle hospital.

By Tuesday evening, Rauch was already back in the hotel recovering, surely with some pain medication on hand. He most likely underwent the laparoscopic procedure if he is already recovering at the hotel, which will certainly help limit the time he is on the disabled list. We have seen others this season come back in a relatively short amount of time from a laparoscopic appendectomy, so his three- to four-week timetable might be accelerated.

Pablo Sandoval, SFN (Right ankle contusion) [AGL: 1(14 DL), ATD: +.033(+.044 DL)]
As if the Giants didn't have enough to worry about—we'll get into that later—Sandoval left the game early on Monday after fouling a ball off his foot/ankle. As the ball struck him flush on the top inside aspect of the foot and ankle, Sandoval crumpled to the ground in pain. In general, there is little soft tissue in the foot that can absorb any of the energy from the ball. Initial x-rays didn't reveal any fracture, but that doesn't mean there isn't one hiding, just waiting for a CT scan to pick it up. The good news is that Sandoval showed up feeling good enough to want to try to play.

Adam Kennedy, SEA (Left foot and heel pain) [AGL: 1(2 DL), ATD: -.023(-.059 DL)]
Kennedy's left foot and heel have been bothering him for a while now. There are several causes of foot and heel pain, including plantar fasciitis, fat pad inflammation/bruising, and tarsal tunnel syndrome. The plantar fascia, which gives support to the arches, is one of the more common causes, with the pain situated a little bit away from the heel itself.

Plantar fasciitis can be excruciating in the morning because the tissues tend to tighten up overnight, sometimes even while wearing a night splint. Factors associated with plantar fasciitis include a tight  Achilles and foot type, to some degree. It can be hard to get foot and heel pain of any type under control, as we have seen in the cases of Pat Burrell and Scott Podsednik. With Kennedy only able to play in one game over the last week, a move to the disabled list is certainly a possibility.

Matt Daley, COL (Right shoulder surgery) [AGL: 113, ATD: -.033]
Daley has been battling inflammation from right shoulder impingement since early June, but he was unable to return and further steps were required. The arthroscopic surgery performed by Dr. Tom Noonan was deemed a success, but the real test will come when he returns. Details have been limited as to what was addressed during surgery, but it's not uncommon to find fraying of the rotator cuff and labrum in cases of impingement, if not partial thickness tears. Daley is done for 2011, and depending on what was corrected during surgery, he may not be ready for the start of 2012.

Flesh Wounds: Edgar Renteria had to leave yesterday's game with a strained left groin and will be reevaluated today... Conor Jackson remains out with neck tightness but could return any day... David Ortiz is dealing with right heel bursitis... Nelson Cruz was back in the lineup Tuesday night after coming out early Monday with a tight left quad... Prospect Drew Cumberland has retired from baseball with bilateral vestibulopathy, a condition that can cause dizziness, blurred vision, and headaches... Denard Span was out of Monday's lineup because of concussion symptoms related to his home plate collision in June... Cole Hamels was diagnosed with left shoulder inflammation following his MRI. He will skip his next turn in the rotation with a possibility of a move to the disabled list.

Limited edition San Francisco Giants section: Sergio Romo was placed on the disabled list with a sore elbow. He's going to be evaluated further and may miss the remainder of the season... Jonathan Sanchez sprained his ankle—at least—on Tuesday and could be out for an extended period of time... Teammate Nate Schierholtz fouled a ball off of his foot on Monday and had x-rays yesterday, which came back negative, of course. Depending on how he responds over the next few days, he may end up on the DL as well... Another day, another Giant injured. Jeff Keppinger injured his wrist in a collision with Freddie Freeman on Monday. He tried to hit off the tee Tuesday, but the wrist was extremely weak and painful... Lastly (hopefully), Aaron Rowand has a strained intercostal muscle and is day-to-day.

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

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