Collateral Damage Daily for May 21

Medical technology is increasing exponentially; a 3-D printed jaw was recently implanted. A laser is used to heat titanium powder into thousands of layers in order to create a complete, implantable lower jaw. To give you an idea how many layers are needed, it takes 33 layers to get 1 millimeter of height. Now measure from the bottom of your jaw to the bottom of your eyes and that’s roughly how high the jaw needs to be. Three-dimensional printing has been around for a while, and it’s only a matter of time before tissues are printed and implanted into baseball players, whether it be for a ligament replacement or less traumatic surgery to deal with arthritis instead of having total joint replacements.

Until then, we will continue to deal with injuries as they come. In addition to the injuries listed below, Vernon Wells (thumb) and Ryan Langerhans (separated shoulder) will likely be headed to the disabled list because of their respective injuries. Austin Jackson’s abdominal strain also continues to bother him and may limit him for several more days.

Additions

• Lance Berkman is having a hard time staying healthy this year. His latest malady is an injured right knee. On Saturday, he reached out to grab a throw from Rafael Furcal and felt pain as he pushed up on his knee. The athletic trainers came out to check on Berkman before he left the game under his own power. He’s had surgery on his knee a couple times, including ACL surgery back in 2004.
  
  Early on, Berkman said he believes it may be a meniscal injury, although he has not undergone an MRI yet. Now Berkman is concerned the injury is more significant. His assessment of his knee could be spot-on, as his mechanism was one of the common ways to injure the meniscus. The MRI will be very helpful in this situation and can help tell us whether Berkman will need surgery.
• Unfortunately, Berkman was not the only Cardinal to head to the disabled list this weekend. Allen Craig was placed on the disabled list with a strained left hamstring that first bothered him Wednesday evening while trying to slide and catch a fly ball. After a few days of treating it as a day-to-day injury, it was apparent Craig was going to need more time. He was placed on the DL on Friday afternoon, which makes losing Berkman on Saturday all the more difficult. It’s expected that Craig will be able to come back near the minimum amount of time. In the meantime, Matt Adams will help Matt Carpenter fill in at first base.
• Kyle McClellan may be the most-missed Cardinal. He was placed on the DL Friday with a sprained UCL and partial tear of the flexor pronator mass tendon, which is quite a combo. As players age, the incidence of flexor mass tendon injuries in conjunction with ligament injuries rises. This study uses 30 years of age as the increased risk factor, and while McClellan is only 27 years old, he already underwent Tommy John surgery back in 2005. There is a good chance he can avoid surgery, but it sounds like he will miss several months regardless. Brandon Dickson was recalled to take McClellan’s roster spot.
• Mark Ellis had a painful and frightful weekend; he had to undergo emergency surgery to release the pressure in his leg that built up after Tyler Greene slid into him at second base late last week. It sounds like Ellis developed acute compartment syndrome, which very rarely occurs following traumatic injuries. The blood and swelling builds up significantly and places pressure on the neurovascular structures in the area, sometimes to the point of compromise. In severe untreated cases, the nerves can be significantly damaged with subsequent difficulty contracting muscles. What’s even worse is that occasionally the blood vessels are constricted to the point of complete compromise and the distal segment needs to be amputated.
  
  Ellis underwent surgery on Saturday and will remain in the hospital until Tuesday to monitor the bleeding. He will be out for at least six weeks. Ivan DeJesus and Adam Kennedy will likely get the bulk of the playing time in his absence.
• Geovany Soto was placed on the disabled list with a torn meniscus in his left knee that needs arthroscopic surgery. Soto first missed Thursday’s game with soreness in his left knee, and further testing revealed the tear. While no surgery is guaranteed, trimming of the meniscal tear has a very good outcome at least for the short term. The long-term ramifications are harder to predict because trimming out meniscal tissue may contribute to osteoarthritis later on down the line. Welington Castillo was going to take Soto’s place, but he sprained the MCL in his knee and will miss a week or so himself. The Cubs traded for Koyie Hill to hold down the fort in the short-term.
• Brandon McCarthy has dealt with numerous shoulder problems in the past, mostly related to stress fractures of his shoulder. Therefore, when McCarthy was placed on the disabled list over the weekend, everyone was holding their breath. It appears that the scapula is not the source of his pain this time around; instead, it’s a muscle strain in the shoulder that will likely keep him on the shelf for several weeks. McCarthy is going to have to be very careful throughout his rehab because of his history of stress fractures; you don’t want to have altered mechanics coming back from a shoulder strain that could lead to lead to stress injuries. He is eligible to return on June 2, but it wouldn’t surprise me to see him wait a little longer. Oakland called up Jim Miller to replace McCarthy on the roster.
• The Padres jumped over the Red Sox for the most DL moves (15 vs 14) this weekend. The club first placed Tim Stauffer on the 15-day DL. Stauffer went back on the disabled list with recurrent soreness in his right elbow. He dealt with an elbow strain at the start of the year and was activated on May 14. He lasted one start before returning to the DL. This quick recurrence is a big red flag for me and makes me concerned that the ligament is lax, if not compromised. More information should be available over the next several days, but in the interim, Eric Stults was claimed off waivers.
• The Padres also placed James Darnell on the DL with a subluxation of the left shoulder sustained while diving for a ball Thursday night. Darnell had surgery on his left shoulder last fall to tighten the capsule because of shoulder instability, a procedure that usually has a good success rate. Darnell’s injury is a partial shoulder dislocation. He’s not expected to need surgery at this point, but he might in the future. It’s too early to give a definitive timetable for his return.
• Emilio Bonifacio was placed on the disabled list for a sprained left thumb after jamming his thumb while trying to steal second base on Friday night. An MRI reportedly ruled out a fracture. Bonifacio feels he will be ready to return when he is eligible on June 3. Chris Coghlan was brought up from New Orleans to replace Bonifacio.
• Everett Teaford was placed on the disabled list Saturday with a lower abdominal strain. Teaford first felt pain in his lower abdomen while running on Friday. The pain did not subside overnightm so the Royals placed him on the DL. Kansas City recalled Nathan Adcock to take Teaford’s place. The Royals are tied for the third-most DL trips this season with 11.
• Miguel Batista left Saturday’s game after only two innings because of a strained lower back. Batista suffered from back problems in 2008, which kept him out of eight games. Lower back strains can be very difficult to fully get rid of, especially when you are a 41-year-old pitcher. Chris Schwinden was recalled from Buffalo to take Batista’s place.
• Speaking of bad backs, Mark Kotsay was placed on the disabled list because of his lower back strain. Kotsay has dealt with his troublesome back for a large part of his career and has had multiple surgeries on it. Given the length of his injury history, Kotsay has a good chance of staying on the DL for longer than the minimum. Blake Tekotte was brought up from Tucson.

Subtractions

• Chris Young was activated from the disabled list; he had been out for a month with a mild separated shoulder sustained by making a catch crashing into the outfield wall. Young’s case provides further evidence that the wall will always win. Young has gotten a few hits in his return, and these injuries don’t usually sap a hitter in the long term. For the sake of small samples, the Diamondbacks were 7-3 at the time of his injury and only 10-19 since. Young should be able to help them improve on that. A.J. Pollock was sent down.
• Carlos Gomez was activated from the disabled list on Sunday after missing 15 days because of a strained hamstring. The Brewers sent down Brooks Conrad.