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April 22, 2009

Under The Knife

Mid-Week Update

by Will Carroll

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Xavier Nady (30 DXL)
Hideki Matsui (0 DXL)

It's important to note what is and what isn't going on with Nady's arm. As easy as it is to confuse 'sprain' and 'strain,' it's also become too easy to confuse the usage of 'sprain' and 'tear.' Too often the word tear is used in place of 'rupture,' which means a complete tear or loss of structural integrity in a particular anatomical structure. While any sprain is by definition a tearing of ligament fibers, not every sprain is a rupture. So the question is not whether Nady's elbow is damaged, but if it is too damaged to be able to rehab and heal. There are examples of those who have played through significant elbow sprains, with Albert Pujols taking center stage. By Nady's not having Tommy John now, the hope is that the surrounding structures can be strengthened enough to allow a weakened ligament to not be overtaxed, and to have natural healing give additional strength. The downside for Nady and the Yankees is best exemplified by Pujols' case-throwing is the activity that is going to have to be avoided and/or adjusted for. That was easy enough for the Cardinals, running Edgar Renteria out deep to take cut-off throws from left field, and then moving Pujols to first base to limit it further, but the Yankees don't have that kind of flexibility. If Nady is only a DH, the current roster becomes even less flexible, and the concurrent problems with Matsui's knees might do more to open up that slot. Even without playing the field, Matsui's knees are swelling up and need to be drained at a far more aggressive pace than the Yankees had anticipated. That's leading to some talk that Matsui might need time away, or the possibility that he could retire, rather than having a more extensive surgery. Nady is expected to be rehabbing the elbow for the next three weeks, giving the team time to figure out what's up with Matsui, before any decisions need to be made.

Jed Lowrie (50 DXL)
Julio Lugo (25 DXL)
Rocco Baldelli (20 DXL)

Lowrie had surgery on his wrist... kind of. This is an injury where the practical anatomy is different from the actual anatomy, enough to where it makes a difference in assessing how he should come back. Lowrie has a fractured ulnar styloid process at the end of the arm, not at the actual anatomical wrist. If he were to point to the injury or you saw his scar, you'd say "that's his wrist," but the wrist is actually the group of small bones between the arm and the hand, so what Lowrie did is almost the same as what Evan Longoria did last season-he broke his arm. This is important, in that wrist injuries tend to sap power and create some bat control issues, while broken arms just heal up. The location of Lowrie's fracture has some ligament and joint involvement, so it's not quite equivalent to Longoria's more simple fracture, but it's closer to that than most wrist fractures. With Lowrie out for at least six weeks, the move of Lugo up to Pawtucket takes on new importance; his knee has held up well, and the level of concern for a minor 'scoping seems a little out of whack. He should have no trouble with it, yet the team is being very conservative, making me wonder if this was just a quick fix for a larger underlying issue. Lugo's stay in Pawtucket isn't expected to be long, with getting him at-bats being a bigger challenge than figuring out how his knee is going to react. If there are any physical issues during his time there, like limping or swelling, I'm going to be a lot more concerned than current facts have led me to be; if he's there for more than a week, I'll be very surprised. Finally, the Red Sox put Baldelli on the DL with what the team is calling a "simple hamstring strain." Nothing is simple with Baldelli, but sources tell me that this is really just a garden-variety strain, but that Baldelli's slow healing and recovery have led them to proceed cautiously, especially this early in the season.

Ryan Doumit
While Lowrie's wrist injury isn't really in his wrist, Doumit's wrist injury really is. Unfortunately, he's fractured the worst of the possible wrist bones for a baseball player, the scaphoid. It's a slow healer, and one that, even when fixated with pins and wire as Doumit will have done later this week, often lingers. Essentially, there's going to be surgery, and then a great deal of hope and prayer. The procedure's success is often determined about a month out, with bone scans that reveal whether or not the small bone is healing properly. If not, it could take more surgery, or more time to allow for the healing. As with any wrist injury, even if things go well, Doumit will return with a drop in both power and bat control, not to mention the increased risk of having him behind the plate... and playing for a team that has no DH option available to protect him.

Brian McCann (0 DXL)
After all of the concern about McCann over the past few days, the fix was really very simple. McCann put in a contact lens, and his vision corrected immediately. He'll likely need a re-do of the Lasik surgery in the future, but the new contact will allow him to wait and have that procedure done in the offseason. While vision concerns are very serious, especially if you're trying to catch breaking balls for a living, this should end almost all of the fears that McCann might miss substantial time, and it gives us something to go on in the future. He wore contacts prior to having the surgery, so there shouldn't be much of an adjustment period, though we should watch his hitting stats over the next week to see if there are any real changes.

B.J. Upton (3 DXL)
Evan Longoria (1 DXL)

The Rays are a changed organization in many ways, or perhaps it just seems like that's the case now that the baseball world is finally paying attention to them. One thing that hasn't changed is their medical staff, though. There was a time when it was one of the few bright spots in the organization, and for them, being on the conservative side is just how they roll. They err on the side of caution in almost every situation, which is why they tend to catch injuries before they become exacerbated. That appears to be what is going on with Upton. He has a very mild quad strain, and they're holding him out a game, maybe two, to make sure that it doesn't turn into something more. He'll probably be slowed on the basepaths in the very short term, but missing a few games now should work out for the Rays in the long term. The same holds true for Longoria, whose mild foot issue-sources disagree on whether it's a bone bruise or a mid-foot sprain-kept him off of the field for a couple of games. Longoria was able to DH, but he should be back on the field in the next day or so. With games scheduled for 40 out of the next 41 days, the Rays can't let the small things build up on them now.

Mike Pelfrey (9 DXL)
Pelfrey says that he's ready for his Saturday start after a good side session, but the Mets aren't so sure. They're going to wait in case he has any issues leading in, and they might wait until the day before. Pelfrey is prepping as if he'll make his start, so he'll be ready in any case, but the Mets want to make sure that he's the best option they have. If the weather gives them a chance to juggle the rotation, they would likely cycle Pelfrey back a few days to buy him a bit more healing time. The biggest concern seems to be that the soreness in his forearm could go back to its full severity after the start, which would indicate that they believe it's only aggravated at full effort. This is definitely one to watch, whether Pelfrey starts or not, since that next full effort outing will be the biggest test for his arm.

Quick Cuts: Chien-Ming Wang is headed to Tampa to work on his arm strength. That could portend a DL move for a shoulder strain of some kind. ... Joey Devine had to have Tommy John surgery, as expected, and will miss the rest of the season. ... Brandon Webb made it through a side session. ... Trevor Hoffman and Jason Isringhausen had solid openers at their minor league rehab stints. Both will have at least one more, with Hoffman likely headed up by the weekend. ... Marlins pitcher Andrew Miller goes to the DL with an oblique strain, and will miss at least a month. ... Hope to see many of you in St. Louis for tomorrow's event!

Related Content:  Sprain,  Broken Wrist,  Quad-a

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