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June 11, 2009

Under The Knife

For Better and Worse

by Will Carroll

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Carlos Quentin (60 DXL)
A tendon injury? Where the heck did this come from? In the news that Quentin would be out for the month and possibly until the All-Star break, the White Sox let slide into several beat reports that he has a strained mid-foot tendon. This isn't something that's been discussed publicly, and it wasn't in the whisper stream either. In fact, my best sources told me, clearly and forcefully, that the plantar fasciitis was the real issue, while the face-forward reports were saying "heel pain." (I should note here in light of the Raul Ibaņez Anti-Speculation Rule, that "heel pain" isn't a lie, so just stop before you send the e-mail. It's more along the lines of "lower body injury", describing a symptom instead of a diagnosis.) So is this a change in diagnosis, new information coming to light, or something else? I'll admit that I'm not sure yet. My best guess, based on information I have at this point, is that what's being described as a "tendon" is the fascia itself. It's a fine difference to be sure, but a significant one. The biggest note here isn't on my medical version of angels and pins, but that Quentin will be out until mid-July, no matter what the specifics are.

Brad Lidge (20 DXL)
Speaking of the specifics of injuries, the original reports that went out when Lidge went to the DL all said "sprained knee." As medheads here know, "sprain" is by definition a tearing of a ligament. This surprised me, given the symptoms and the lack of trauma. If forced to guess, I would have thought that Lidge was having some inflammation from a torn meniscus, or from the grinding due to his lack of a large piece of meniscus after last year's surgery. Just a few hours later, Mike Ferrin from XM got the scoop: Lidge has synovitis, an inflammation of the synovial capsule that surrounds the knee. Again, this is more symptom than diagnosis, but it's significant enough to necessitate some time off. Once the Phillies got J.C. Romero back, they'd been talking about giving Lidge a few weeks off to see if that would correct things, and that's exactly what has happened. If the problem truly is limited to synovitis, it should help, but it will come back unless things change structurally. The Phillies' medical staff will have to manage this one closely and hope that a couple weeks of rest gets them far enough ahead of it to make it to October. Don't be surprised if he goes past the minimum if Ryan Madson is solid in the closer's role in the meantime.

Josh Hamilton (30 DXL)
Hamilton had surgery on Tuesday to repair an abdominal wall tear (and not a sports hernia, as was originally feared), and he's already back with the team. That's just one of the reasons I'm optimistic about his coming back from surgery at the low end of the suggested range. He does have some injury issues that no one else has had, detailed wonderfully by Gordon Edes. I don't disagree with anything Edes says in his piece, or with the people he interviewed, but one thing bothers me-none of Hamilton's injuries have anything to do with past drug use or any possible effect from it. Do crackheads have hernias? Maybe, but I doubt they got it the way that Hamilton got his. That wrist injury in '07? His ribs this year? There could be some effect in his healing response, but there's absolutely no evidence, and even if there were, it would be nearly impossible to separate those effects from the others acting on any individual's healing response. I mean, Mike Hampton isn't a crack user, is he? To me, Ron Washington has the telling quote in Edes' piece, saying that Hamilton plays with reckless abandon and is likely to run into some other wall down the line. It's that attitude, one that might come from having stared demons in the face and living to tell about it, that might be the biggest effect of Hamilton's past upon his present.

Edwin Encarnacion (50 DXL)
The "major setback" must not have been very major, though my source on that continues to insist that Encarnacion's wrist is not stable and will not hold up. Wrist fractures are tough to read, so this one was going to bear close watching even before this issue arose. The team says that Encarnacion will be swinging a bat again by the weekend, with a rehab assignment soon after. The concern that I have at this stage is that the root cause of the inflammation that shut him down this week doesn't seem to have been addressed. Is it simply that he "overdid it," or is there something else underlying this issue? Rest and treatment can heal many things, but until Encarnacion is actually making it through games without trouble, I'm going to be a little dubious. Wrist injuries linger, my friends.

Kyle Lohse (30 DXL)
Lohse will miss a month as the forearm problem that's cropped up for him post-HBP hasn't gotten any better. The team is describing it as a strained flexor tendon, so if that's the case, the tendon must have been weakened or affected by the HBP, and then injured when he tried to throw in that state. The worry I have here is that the Cards seem very open-ended on this, as if there's something more going on, or that they don't have a good handle on. Strained flexor tendons are all too common in baseball, and shouldn't be that challenging, especially if they have good images. All the facts aren't out here, so I'll be digging more on this while the Cards dig for more pitching.

Denard Span (5 DXL)
Jorge Cantu (3 DXL)

If femoral-acetabular impingement and anxiety are the injuries du jour, then dizziness wants admision onto the menu. Joey Votto, Cantu, and now Span are all dealing with the symptoms, but all from varying and very vague causes. With Span, the culprit is still unknown, but the doctors seem to be focused on a thyroid condition. This isn't uncommon, and is actually more common among African-Americans; it's easily corrected and managed, so it should have little impact on Span beyond the short term. Span's absence did cause Michael Cuddyer to be pushed over to center field after Carlos Gomez left Wednesday's game, so a short bench becomes an issue for the Twins. For Cantu, the cause is a cholesterol medication, according to Joe Frisaro. He's been on the medication for a couple of weeks to take care of the all-too-common problem, but as with many, the side effects were worse than the cure, at least for now. He'll change medications, and the problem is expected to clear up.

John Baker (1 DXL)
Baker was out of the lineup on Wednesday after a bat to the face forced him to get six stitches. OK, that may be the fact of the matter, but let's face it, there's one little important detail that's been left out. The bat was in the hands of Albert Pujols, who was trying to turn on an inside pitch, and the bat got Baker's face on the backswing. Baker uses the standard mask (more effective against concussions) instead of the hockey-style, which is more effective against bats smacking one in the side of the head. Granted, he probably could have had side curtain airbags and Pujols' bat would have still gotten through. He's lucky that it was "just" stitches, and he should be back soon.

Anthony Reyes (120 DXL)
"Might have Tommy John surgery" is a phrase that confuses a lot of people. It came up in relation to Reyes, surprising many who thought that he was having the lesser ulnar transposition surgery. There's a simple explanation here, and it occurs with most elbow surgeries (and most surgeries, to be honest). Prior to undergoing the procedure, Reyes sat down with his surgeon, Lew Yocum, and Yocum said something like, "We'll get in there and look around. We'll get a good look at the UCL, and if it's damaged, we might as well go ahead and replace it. Is that OK?" Reyes will be unconscious during the surgery (we hope!) and it's not as if Yocum could wake him up to ask the question. The possibility is there, so surgeons ask for permission to take action if necessary. That he asks doesn't mean it will happen, though it usually indicates that there's some fraying of the ligament that they've seen on the images. Reyes is out for the year regardless, but Tommy John would cost him a portion of 2010 as well.

Quick Cuts: Brandon Webb is on track for a return at the All-Star break, but could he be traded? Yes, if he proves to be healthy. ... Roy Oswalt will have his next start pushed back a couple of days, so that he can deal with a sore wrist. ... Jeremy Bonderman will pitch long relief for now, but I bet that doesn't last long; it's a confusing decision by Jim Leyland. ... Aramis Ramirez is taking grounders, but sources tell me that the shoulder isn't yet stable enough for more intense activity. ... It sounds like the Mets are going to hold Jose Reyes back until the All-Star break at the very earliest due to his cascade hamstring injury. ... Isn't Jeff Kent about the last guy you'd expect to see on something like this? ... Torii Hunter has a miild straiin of his groiin. The Angels will hold him out to avoid Tropicana's turf. ... Rich Harden will be limited to about eighty pitches when he comes off of the DL on Saturday. ... Jason Bartlett is taking ground balls and looks close to a return. ... Jesse Litsch will have Tommy John surgery and miss a year or so. ... Charlie Morton's debut didn't last long. His hamstring tightened up early, and they pulled him as a precaution. ... Josh Hamilton is back with the team and has already begun his rehab. ... Don't miss out on the guys who could come back from TJS and contribute down the stretch, like Tim Hudson, Billy Wagner, and Jake Westbrook. Westbrook's return could signal Cliff Lee's departure if the Indians haven't turned things around by then.

Related Content:  Denard Span,  The Who,  Year Of The Injury

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

BP Comment Quick Links

WilliamWilde

Hey Will, are you hearing anything at all on Votto's return to baseball activities?

Jun 11, 2009 09:36 AM
rating: 1
 
BP staff member Will Carroll
BP staff

Nothing yet.

Jun 11, 2009 10:02 AM
 
Mountainhawk

Hey Will, what are the odds of Brett Myers getting back for this season? Most of what I read says he's done, but the Phillies got Utley back from hip surgery faster than most expected too.

Jun 11, 2009 09:50 AM
rating: -1
 
BP staff member Will Carroll
BP staff

We have an archive here and a search function, not to be rude.

Jun 11, 2009 10:02 AM
 
Mountainhawk

Sorry, missed the 29th article. Last one I saw had him at 5 days.

Jun 11, 2009 10:05 AM
rating: 1
 
dantroy

Votto, Jones, Cantu - a lot of dizzy spells this year. Doesn't appear to be anything other than a coincidence, though.

Jun 11, 2009 09:58 AM
rating: 0
 
dshugert

Dusty sends Cordero back into the game after a 2 hour 10 minute rain delay, and after pitching for the 5th time in 6 days - how long until we see Cordero on UTK?

Jun 11, 2009 10:02 AM
rating: 1
 
Patrick

Will, can you explain what exactly a sports hernia is? I've heard the term used quite a bit in the past few years and wonder how it differs from any other kind of hernia.

Jun 11, 2009 10:08 AM
rating: -1
 
eighteen

Interwebs haz Search skillz.

http://en.wikipedia.org/wiki/Sports_hernia

Jun 11, 2009 10:38 AM
rating: 1
 
BP staff member Will Carroll
BP staff

THANK YOU.

Though I don't really care for Wikipedia on most medical stuff. I actually have a book on all this stuff if anyone's a publisher ...

Jun 11, 2009 11:45 AM
 
Fresh Hops

I'll buy that book from lulu.com if you self-published it.

Jun 11, 2009 13:25 PM
rating: 1
 
Patrick

Okay, I should have looked it up. However, I had this notion that it was a name for an inguinal hernia - caused by athletic activity - and not a slightly different condition with a misleading name. I wasn't looking for a lengthy description, just what the distinction was. In fact, it probably would have taken just as long to write as the above comment. Anyway, my apologies.

Jun 11, 2009 15:29 PM
rating: 3
 
Fresh Hops

I found a great website about that, which everyone should know about: http://lmgtfy.com/?q=sports+hernia

Jun 11, 2009 13:24 PM
rating: 1
 
makewayhomer

Hi Will,

Any more news on Sizemore? Odds of him needing injury/missing major time?

Jun 11, 2009 10:18 AM
rating: -1
 
buffum
(458)

He's having an MRI Monday. There really can't be any concrete estimate made until the results are back. He's "feeling better" with "more range of motion," but that doesn't go very far in predicting whether he can play six days a week.

Jun 11, 2009 10:22 AM
rating: 0
 
cbirkemeier

Odds of him needing injury? I'm gonna go with 0, since I highly doubt he either needs or wants injury.

Jun 11, 2009 12:49 PM
rating: 0
 
buffum
(458)

BTW, just wanted to let you know someone noticed the "groiin injury" and enjoyed it, thanks.

Jun 11, 2009 10:23 AM
rating: 1
 
BP staff member Will Carroll
BP staff

I try not to be too cute, but that actually started as a typo and I found it funny.

Jun 11, 2009 11:45 AM
 
BillJohnson

Will, are there any chances that Jaime Garcia could be one of those "guys who could come back from TJS and contribute down the stretch" that you talk about? Or was his surgery too late in 2008 for that to be realistic for him? St. Louis needs starting pitching so badly that they'd surely be glad to have him.

Jun 11, 2009 10:27 AM
rating: -1
 
grenadewade

Cholesterol medication for a 27-year-old professional athlete? (although the "athlete" part is sometimes stretch in baseball) Dizziness would also seem to be an odd side effect for such a medication, not that I'm any sort of expert on the subject.

Regarding Denard Span, there was some speculation (by Span himself) in the Star Tribune today that the dizzy spells may be attributable to Lasik surgery he had on one eye after the 2007 season. Obviously not from a medical source, but Span complained that he couldn't see the ball during recent plate appearances, so there may be something to it.

Jun 11, 2009 10:58 AM
rating: 1
 
BillJohnson

I'm not a doctor (or at least not "that kind" of doctor), but two comments. First, dizziness is one of the possible side effects of the particular cholesterol-reduction medication that I myself take. I've never actually experienced the dizziness, but it's a known possible problem.

Second, my son, who's a bit younger than this 27YO professional athlete in question, is a fit fellow without much excess weight on him, yet he himself suffers from a tendency toward high cholesterol and triglycerides that he apparently inherited from his old man. They're starting to treat that younger and younger these days.

Jun 11, 2009 14:30 PM
rating: 3
 
pbconnection

Will, thanks for the updates on Lidge and Jose Reyes. Do you think the Rangers put Frank Francisco back on the DL?

Jun 11, 2009 11:02 AM
rating: 1
 
SteveRuskowski

Will,
Any news on Jesus Flores? Is he done for the year?

Jun 11, 2009 11:25 AM
rating: 1
 
dantroy

September 1 for Wagner?

Jun 11, 2009 11:53 AM
rating: -1
 
kcheaden

Hamilton was injury prone before his drug use so I think that he just lacks the 6th skill of good health. If I remember correctly he starting using drugs when he was rehabbing a back injury (although I do believe the injury was from a car accident). I also think I remember a foot injury pre-drug use.

Jun 11, 2009 13:07 PM
rating: 1
 
beatolympics

why can't any blue jays starter stay healthy? what are they doing over there?

Jun 11, 2009 14:22 PM
rating: 1
 
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