Collateral Damage Daily for May 22

There’s been a lot of discussion about Ryan Howard and whether an injection was the right treatment at the time and whether it contributed to his Achilles rupturing. As with most things, it’s not clear. Corticosteroid injections have been used for years to treat localized areas of pain and inflammation. It’s very good at what it does. There are many different corticosteroids; cortisone is just one of them. Howard was dealing with a bursitis in his heel that was being pinched between the Achilles tendon and the heel bone. Injections are never done directly into the tendinous tissue; instead, that area is bathed. Yes, it’s true that repeated cortisone injection can weaken the cell matrix of the tendon, especially in the short term, but from all accounts I’ve seen Howard only had one injection into the pinched retrocalcaneal bursa. He was dealing with this heel pain for some time and likely had some degeneration of the tissues in the area as a result of the chronic inflammation. This can also weaken the tendon and make it more prone to ruptures.

So where does that leave us? Did the cortisone contribute to the rupture? Possibly, but there is no way of knowing. The force may have been just right in a chronically inflamed tendon to rupture the tendon, even in the absence of any cortisone. Nothing is ever as clear as it appears.

Additions

• Neftali Feliz was placed on the disabled list with inflammation of his right elbow, but it was really something more than that. The inflammation was a result of a sprain to the ulnar collateral ligament, the same ligament involved in Tommy John surgeries. No surgery is expected right now, but Feliz will be out until the All-Star break at least. One of the biggest factors to UCL ligament injuries is velocity, something that Feliz has plenty of. There are several options to replace Feliz in the rotation, including signing Roy Oswalt, although that remains a pretty low option on the realm of possibilities.
• Vernon Wells didn’t think the slide into second base was anything out of the ordinary until he felt his thumb shift out and then back into place. This resulted from tearing the ulnar collateral ligament in his thumb, which will put him on the sidelines for at least a few months. The Angels brought up Kole Calhoun to take Wells’ spot.
• In the same game that Wells was injured, the Angels also lost backup outfielder Ryan Langerhans to a separated right shoulder sustained while diving for a ball. The acromioclavicular joint ligaments were definitely injured, but luckily not to the point of requiring surgery. He will need to stay in a sling for a period of time to allow the ligaments to tighten up and not get stretched from the weight of the arm pulling on them. The Angels haven’t given an official timetable for his return yet, but it really depends on the severity of the injury. Minor ones can miss as little as a week, but if they are more severe, as it appears it may be with Langerhans, it could be about a month or so.
• Just when the Padres jumped ahead of the Red Sox for the most number of DL trips, Cody Ross came to the rescue and fouled a ball off his foot and is now on the disabled list. Ross fractured the navicular bone in his foot, which is one of the more common sites because of the location on the inside of the foot right near the middle of the arch. So when someone fouls a ball off their own foot, it often strikes this location. The player usually gets a bruise, but with more force, the chance of a fracture increases. Also, because of the location in the arch, it really needs to be fully healed before heading back to full activities. That’s the main reason why Ross is predicated to miss about six to eight weeks time.
• Jeff Keppingerwas placed on the DL with a fracture to his right big toe after being struck by a foul ball in the dugout. This is not in the same area as his troubles with the sesamoid, which eventually required surgery in January 2011. Tampa Bay traded for Pittsburgh’s Drew Sutton to take Keppinger’s spot.

Subtractions

• Coco Crisp was activated from the disabled list following an inner ear infection that hampered him for over a month. He missed 27 days. It will be interesting to see how Crisp responds now that he is healthy. Eric Sogard as sent down to make room for Crisp.