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August 31, 2011

Collateral Damage

See You in September?

by Corey Dawkins and Ben Lindbergh

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Pedro Feliciano, NYA (Left shoulder capsule sprain) [AGL: 145, ATD: +.081] (Explanation)

Feliciano has spent the season on the disabled list trying anything possible to avoid undergoing a surgery whose previous recipients include Chien-Ming Wang, Scott Elarton, Johan Santana, and Dallas Braden. The shoulder capsule plays a role in the joint’s tensile stability during rotational movements, and it also creates a negative pressure inside the shoulder joint, further stabilizing it.

Injuries to the capsule can be difficult to describe in terms of pain patterns, but generally, symptoms arise in the front and/or armpit area. Surgery would involve tightening the capsule through incisions and plications of the tissue. Another technique involves tightening the capsule through thermal shrinkage, which is very successful in the short term. There have been some studies that have shown that this method is not as successful in the long term with pitchers, who often end up needing another procedure. Given that Feliciano has failed rehabilitation and PRP injections, he is likely looking at surgery sooner rather than later. Out of the 14 cases with specified shoulder capsule injuries, only three—including Felciano—have remained non-surgical.

Nelson Cruz, TEX (Left Hamstring Strain) [AGL: 27, ATD: -.005]
Sunday evening saw the reemergence of Nelson Cruz's injury demons, namely the hamstrings. Cruz was placed on the disabled list with a left hamstring strain yesterday.  He missed significant amounts of time last year with multiple strains of the left hamstring, and this year he began having problems with his quads. His recent hamstring injury will likely keep him out about three weeks and continues a trend of musculoskeletal injuries plaguing him in the middle to end of the year.

Darren O'Day, TEX (Right shoulder inflammation) [AGL: 37, ATD: -.037]
O'Day added to the Rangers’ injury woes when he joined Nelson Cruz on the disabled list with right shoulder inflammation. O'Day was diagnosed with a torn labrum in his shoulder back in 2009 but was able to avoid surgery at that time. Once the labrum it torn, it's never the same, even if it becomes asymptomatic. The tissue will degrade over time, which diminishes the viability of a direct tissue repair. If the labral tear is the cause of his renewed inflammation, he will likely need to have it trimmed out. O'Day still has a good chance of coming back this year, especially if the old labrum tear is not the root cause of his inflammation.

Brennan Boesch, DET (Partial ligament tear—right thumb) [AGL: 27(27DL), ATD: +.006(-.020DL)]
Boesch first injured his thumb earlier in the year but then aggravated it in August. He was diagnosed with a Grade II (moderate) sprain of the ligament and unsuccessfully tried to play through it. He's almost certainly going to need surgery to repair or reconstruct the ligament, but he and the Tigers are trying everything possible to delay that until after the season. Unfortunately, that may not be possible, because the medical staff is still having problems getting the area stabilized enough for Boesch to swing a bat. Any surgery to repair the ligament in his thumb would end his season, but he should be completely healed in time for spring training.

Justin Morneau, MIN (Left Shoulder Soreness) [AGL: 2(46DL), ATD: +.011(+.083DL)]
There have been differing reports about what has been keeping Morneau out of the lineup for the past few days. Some reports have Morneau being held out because of left shoulder soreness after diving on Sunday night, while another pinpoints the reason as mild concussion symptoms. The last few years have been difficult ones for Morneau between the stress fracture in 2009, the concussion last year, and the neck surgery this year. The most concerning of the reported injuries would be the recurrence of his concussion symptoms.

These symptoms can be so debilitating in everyday life that it's almost impossible to understand fully unless you've witnessed or lived through them. If his problem is truly just mild symptoms related to a concussion, it should clear up within one or two weeks. If it is just shoulder soreness, then he should be back in a few days.

Hanley Ramirez, FLO (Left shoulder sprain) [AGL: 36, ATD: -.023]
Hopes of Ramirez returning to the lineup without a hitch quickly faded when he left yesterday's game after two plate appearances with renewed left shoulder soreness. When the Marlins diagnosed him with a sprain after that diving play earlier in August, it was assumed that it would be a day-to-day issue. Now almost a month later, the soreness is concerning because it could very well push him back another week, if not more.  Ramirez underwent surgery on the shoulder back in 2007 and has had some occasional soreness since. Unless the Marlins win out, they won't make the playoffs, so the risk of his worsening his shoulder injury should outweigh the benefit of his returning for a few weeks.

Flesh Wounds: Cameron Maybin's wrist MRI showed inflammation in the joint... Juan Gutierrez will undergo Tommy John surgery on September 6th... Jason Donald was scratched from Monday's lineup with a right index finger contusion... Damaso Marte suffered a setback in his comeback from shoulder surgery... Alex Rodriguez's thumb is still bothering him after he aggravated it during Sunday's game and received a cortisone injection earlier this week... Shin-Soo Choo is likely going to miss the next 7-10 days with left side soreness... Ronny Paulino's toe is broken after all... Ryan Raburn missed Sunday's game with a jammed right finger... Kevin Jepsen will have surgery on his right knee to clean out the joint today... Jordan Walden admitted to being tired now that he's thrown more this season than he has in any other season... Manny Parra underwent surgery yesterday to clean up the elbow and deal with a screw that was inserted when he was younger... Alexi Casilla aggravated his right hamstring during his rehabilitation start on Monday. This will likely push him back about a week or so.

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:  Sprain,  Surgery,  Shoulder,  Hamstring

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

BP Comment Quick Links

saigonsam

With roster expansions in one more day, why did the Rangers decide to put Cruz on the DL rather than just simply waiting to expand the roster? Are there economic benefits such as insurance? Most teams don't.

thanks

Aug 31, 2011 05:17 AM
rating: 0
 
saigonsam

Never mind, I just read "Paint it Black" and I can see the reason.

Aug 31, 2011 05:22 AM
rating: 0
 
escapingNihilism

does Jason Marquis have a chance of coming back this year?

Aug 31, 2011 06:48 AM
rating: 0
 
BP staff member Corey Dawkins
BP staff

Nope he was placed on the 60-day disabled list so he won't be eligible until October 15th.

Aug 31, 2011 17:29 PM
 
Richie

Ergo what for Cameron Maybin? Amputate? A couple of aspirin and he's back by the weekend? Something in between?

Aug 31, 2011 08:50 AM
rating: 0
 
BP staff member Corey Dawkins
BP staff

It sounds like something in between. I always worry about chronic or sub-acute wrist pain that there is something that doesn't show up on the MRIs, x-rays etc.

Aug 31, 2011 17:31 PM
 
kcheaden

Close to a decade ago WR Joey Galloway was having repeated issues with his legs which threatened his career since he was a speed based player. One offseason around the age of 34 he worked with a leg guru on a special training program and the leg issues disappeared for the remainder of his career. Cruz and Reyes need to find that guy.

Aug 31, 2011 09:48 AM
rating: 0
 
SGreenwell

Considering that he had good years at 35 and 36, then ceased being a productive player, I'm not sure that's the greatest solution.

Aug 31, 2011 13:23 PM
rating: 0
 
R.A.Wagman

They could also speak to Eric Thames about his yoga regimen, started after a torn quadriceps.

Aug 31, 2011 14:16 PM
rating: 0
 
BP staff member Corey Dawkins
BP staff

Yoga is beneficial and a lot of professional athletes are looking to Yoga for a way to maintain flexibility, especially with such a long season

Aug 31, 2011 17:27 PM
 
Llarry

Just ask Timmy Thomas and his friend, Stanley (Cup, that is).

Aug 31, 2011 17:49 PM
rating: 1
 
BP staff member Corey Dawkins
BP staff

I'm always skeptical in any sport for a 1-3 year injury hiatus. If he saw someone at age 27 and then didn't have any issues from then on, I'd be more impressed.

Certainly there are certainly rehabilitation specialists who are absolutely phenomenal at correcting these things but it may not have been the thing that kept Galloway injury free. It may have just been luck but the training program helped him be productive.

Aug 31, 2011 17:44 PM
 
thegeneral13

Corey - is the thermal procedure still being used? I had that done in 2000 and it basically reversed itself over the course of my rehab, such that I never made it back from surgery (though I also had a SLAP tear repaired). I opted to hang 'em up rather than get more surgery, but in 2007 I visited Dr. Andrews to see whether I should bite the bullet and get something done since I couldn't throw, lift, or carry heavy things with my right arm. He told me he had reverted back to the traditional "fold and stitch" method even though it is more invasive because thermal capsulorrhaphy was reversing itself as in my case. Given his leading position in the industry, I'm curious whether others have followed suit or whether people are still using the thermal procedure, or if there have been any other recent developments.

Aug 31, 2011 10:23 AM
rating: 3
 
BP staff member Corey Dawkins
BP staff

Awesome comment. Young baseball players will generally have that fold and stitch method because it gives them the best chance to have a healthy career from that part out.

Generally the only time the thermal method is used in high -level baseball players now is at the very last year or two of their career. It's like if a player only has one or two years left because it's a shorter rehab for the most part, but it's at the expense of long term stability.

So yeah, for baseball players most sports medicine (and that's a key part) surgeons will do the fold and stitch method.

Aug 31, 2011 17:36 PM
 
Richie

SGreenwell, resurrecting a speed receiver's NFL career at age 35 is one heck of an accomplishment. Even for just one year, never mind two.

Aug 31, 2011 14:54 PM
rating: 0
 
BrewersTT

Re Galloway, Richie is right. Keep in mind that most WRs are done by 37 anyway, so I see no a priori reason to say that the treatment failed after two years. It's at least as likely that he just got too old, healthy legs or not.

Sep 01, 2011 14:09 PM
rating: 0
 
BP staff member Corey Dawkins
BP staff

I was suggesting we didn't have enough proof to definitively say that this program was the reason for his good health the next few years.

Sep 01, 2011 20:53 PM
 
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