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Under The Knife
Under The Knife
Will Carroll's Under The Knife is called the "industry standard" by
Peter Gammons and that's good enough for us. Carroll's groundbreaking
work on injuries have led to it becoming a standard part of the
discussion in baseball. Whether you're a fantasy fan or checking out
how your team will be without a star, there's simply no other place to
get this kind of daily information.
The Mets center fielder, out all season while recovering from microfracture knee surgery, begins a rehab assignment Thursday, along with other injury news from around the majors.
Carlos Beltran (arthritic knee, ERD 7/15) In what is sure to be a continuing series, the Beltran watch is now headed for a rehab assignment, which will start tomorrow at High-A St. Lucie. Beltran was watched by the Mets' top brass, including Omar Minaya, during an extended spring training game on Sunday and they felt the center fielder was ready to start his 20-day rehab clock. I've pushed the idea that Beltran needs to be up in Flushing as soon as he's physically able, but several people inside the game have told me that while there's merit in the concept, Beltran is human and needs a "spring training equivalent." The downside here is that he's going to be taxing the knee during that time. Of course, that's what rehab assignments are for. They'll be very controlled, perhaps not so much as the simulated games he's been in, but Beltran will have very specific steps and tests at each point. He'll have the DH option in most games as well, something he won't have when he makes it back to the Mets. Watching how often he needs to play there is going to be a big tell for his progress. The key will be how his knee responds and the Mets' ability to manage the inflammation and bruising that will inevitably occur inside the knee. The brace he is wearing is helping, but the continued idea that he's a center fielder is not. I'm most curious to see when that will be abandoned. One interesting concept that was tossed out by an MLB athletic trainer was the idea that Beltran could hit well enough to be in the lineup every day, but not play the field consistently. He wondered if there's a level and a cost where Beltran might make sense for an AL team. If Beltran were to show that, the idea of him being a modern-day Harold Baines would have to be intriguing for some teams as well as for the Mets escaping at least some of Beltran's contract. It's very equivalent to what the Twins did with Jim Thome, though he was a free agent.
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Colorado loses Tulo but sees Huston Street get closer to returning, along with other medical news from around the majors.
Troy Tulowitzki (fractured wrist, ERD 8/1)
Let's be clear: Tulowitzki fractured the hamate bone, one of the bones of the wrist. There have been various reports over the last few days that have said "broken hand." I'll let "broken" go; it's a colloquial term and most of us aren't confused by it. The hamate bone is one of the most commonly injured bones in the wrist. As yet, there's been no discussion of surgery, so the fracture might not be too severe. In many cases, most famously with Ken Griffey Jr., the hook of the hamate is removed surgically to speed healing. If you'll turn to page 130 in your Carroll Guide ... oh wait, you don't have one yet? What's a bit odd, but not unprecedented, here is that Tulowitzki's injury was caused by a pitch hitting him, rather than the typical "FOOSH" mechanism. FOOSH stands for "fall on out-stretched hand", the typical way that this injury occurs. A hard ball hitting the wrist at high velocity will accomplish it as well, but the forces are distributed differently. Initial images didn't show the fracture, but Tracy Ringolsby's report is a bit confusing, saying the fracture was found by Rockies doctors. I'm not sure if that means manual testing, a different reading by a radiologist, or what, and sources could not clarify. Either way, Tulowitzki is out for six weeks, maybe a bit less. Yes, I think he'll be on the low end of the six- to eight-week range because of the odd mechanism, his drive to return, and the team's need. I'm also sure that Tulowitzki will see the typical loss of power in players coming back from wrist injuries, something that lasts about as long as the initial recovery and in this case, would mean it's reasonable to expect the power loss to go the length of the season. He's still a better option that what the Rockies have available and even better than some mentioned trade possibilities, such as the Dan Uggla deal that Joe Sheehan mentioned in his newsletter over the weekend. Watch for Tulowitzki to be pulling on the reins by the end of the All-Star break and yes, that ERD is correct.
White Sox right-hander Jake Peavy will miss his scheduled start tonight, along with other injury news from around the major leagues.
Jake Peavy (inflamed shoulder, ERD TBD) Herm Schneider is two things: effective and old school. The longtime White Sox athletic trainer uses terms like “achy shoulder” the same way trainers did back when they all had two tables, some tape, and a big tub of ointment that would work on your legs and your sinuses. Things are different now, but Schneider is still around because he’s one of the best at dealing with things like an “achy shoulder” on Peavy. Schneider will get some extra time to work on that while Ozzie Guillen juggles his rotation. A day off allowed the Sox to move everyone else up a day and plan on Peavy slotting in at the back if possible. Schneider has about three days—Peavy’s scheduled throw day—to figure out if he can get him back. There was no sign of trouble in Peavy’s last start, his latest effective, consistent outing. Almost all his starts this season have gone deep, between 98-119 pitches, a zone that Guillen and pitching coach Don Cooper use as a target zone with all their starters. There are no more specifics on the shoulder problem, so we’ll have to keep a close eye on this one.
The Dodgers get Vicente Padilla back but are forced to put Chad Billingsley on the DL, along with other injury news from around the majors.
Yesterday, I wrote a bit about Safari Reader. I got some e-mails about it and the use of ads and other things on BPro. I'm not the webmaster, the ad salesman, or a designer, but for the most part, I think we do OK here. We have a readable site, if nothing else. If you'd like to use AdBlock or view the site in Reader, well, that's your choice. I'm proud that the site has never used any of the tricks like multiple pages or other insidious techniques as discussed here (note: some NSFW language.) I agree completely that we have to earn your page views and your hard-earned dollars for subscriptions. The other thing we have to do is earn your trust. Anonymous sources are one of those really difficult things to deal with and more than anyone else here, I'm reliant on information from sources that are breaking confidences. Moneyball gave a good illustration of the game that reporters and teams play. It's an exchange of information. Sources give some to get some. Am I getting good information? I have to decide, report, and then let you decide if I did a good job. Things can change, things can be trial-ballooned, and at times, teams flat out lie. While you're deciding who to trust, I'm deciding which sources to listen to next time. "Fool me once, shame on you. Fool me twice, shame on me," holds very true. I wish that there was a website out there that "kept score" on these, even though I might not like seeing my score. Guys like Craig Calcaterra might get fooled once too, but he knows that if he's fooled too many times, there are other places you can go. Craig's a smart guy and knowing him the little I do, I don't think he blue-skied anything. He does a great job explaining himself in comments and I'll continue to read his column with little doubt. It happens to the best of 'em. I'm all but done, so let's get on to the injuries...
Good news for the long-absent Brian Roberts and Carlos Beltran, plus other news on the injury beat.
If there's one thing besides sports medicine that fascinates me, it's technology. When that meshes with writing, it definitely has my attention. While Shawn Hoffman and I are accused—rightly—of being Apple fanboys with our iPhones and iPads, it's a small, almost unnoticed feature in the latest release of Safari that interests me. The "Reader" feature is something of an offshoot of the popular Instapaper service that allows for simplified, offline reading. It mirrors and uses code from the bookmarklet Readability, which can be used on Firefox and Chrome. Both make for a more book-like reading experience. It's a simple but powerful change. BPro rocks the 1999 look-and-feel, but even when we brought ads to the site, it's been about simplicity and readability. Seeing how Reader makes my articles look makes me wish you didn't have to push a button to see them that way. Now if I can just figure out how FaceTime can be used to get my information to you faster, I'll be on to something. Then again, Microsoft and ESPN are looking to make sure that if you ever get off your couch, it's only to wave around in front of a new control scheme. The promise of on-demand highlights, essentially letting you produce your own personal SportsCenter, is pretty amazing. It's more amazing when you consider what goes in to the average highlight package—from rights issues to editing to voicing and broadcast. ESPN knows how to handle all that better than anyone, and we'll see how the average person deals with it. Right now, let's get on to the injuries:
Stephen Strasburg shows that Pitcher's Quality of Opponents is an overlooked metric.
Stephen Strasburg had eight strikeouts in his second start Sunday against the Indians, coming off a dominant 14-strikeout debut. David Wright had four strikeouts over the weekend, adding to his season total of 73 and putting him on pace for around 190 in 2010. Baseball is a game where everything balances—or every batter with a K beside his name on the scorecard, there's a pitcher that gets to add it to his stat line. I'm no stat guy, so I'm not going to go into what it means or the value, but I do want to address the perception of a strikeout. There's no question that Strasburg's dominant starts are in large part due to his ability to blow his pitches past hitters. It's to the Nationals right-hander's credit that he can do so. Read any media story about Strasburg and it's clear that he's being credited for striking players out. It's his skill that leads to the event. Read any story about Wright's strikeouts this season and the reverse is true. The Mets third baseman is being blamed for striking out. Both can't be true, can they? Is it the pitcher who strikes someone out or the hitter that strikes out? Is it more a positive event for a pitcher or a negative event for the hitter? Of course, the answer is both, but we seldom see this looked at from both angles. There were the occasional wags that griped that Strasburg's 14-K debut came against a weak Pirates lineup, but has anyone looked at the pitchers Wright has faced?
Jacoby Ellsbury will try a new program of rest and rehabiliation but won't be back soon, along with other injury news from around the majors.
Jacoby Ellsbury (fractured ribs, ERD 7/1)
Peter Abraham pretty much tells you everything you need to know in his Boston Globe article. That leaves me with... well, not much to add. The statement issued by the Red Sox is tiptoeing around the fact that twice they missed something when it came to Ellsbury. This is a world-class medical staff and this could have happened to anyone, but it did happen to the Red Sox. Ellsbury came out pretty strongly earlier, but was able to get back on the same page... or should we say get back in line? Ellsbury's two distinct rib injuries—separate areas and separate traumas—leave a lot of holes in how this played out. Right now, Ellsbury will head to Tempe to work with the API team to try and get him back to a point of comfort and function. That's going to take at least a couple of weeks and will likely require a rehab assignment to get him some swings. We could be looking as long as the All-Star break before we see Ellsbury back in the Sox' lineup.
Stephen Strasburg was as good as advertised, now let's hope his name stays out of this column.
Someone asked me Tuesday afternoon why I spent hours on the phone and typing out my article yesterday, adding to the hype of Strasburg's debut. He called me after the game and said "OK, I get it. The kid's good." Yeah, 14 strikeouts and the start of a mythology will do that. This was the first time I got to see Strasburg pitch in anything other than highlights and grainy scouting video. Like most of America, I was impressed. His fastball was nasty with apparent movement and discernible velocity. His slider—actually more of a slurve—was a kneebuckler and as I wrote, an umpire confounder. According to PitchFX, the comparison to Jonathon Broxton's slider was apt. Broxton's went eight inches across and seven down, while Strasburg's went seven across and eight down. And a 91 mph changeup? That's illegal in six states. Simply put, there was nothing I saw out of Strasburg that was unexpected given all that I'd been told by scouts and other baseball people. Given that they had all showered him with praise in every one of those conversations, he did more than live up to their expectations and the hype surrounding an event start. The only thing I'll note is that about the time the announcers started talking about the possibility of him coming out, his pitches were slowing slightly (down to a mere 95-96.) In his last two innings, he amped it up and kept it around 99, dominating in a way that recalled Kerry Wood's 20-strikeout outing. Yes, Strasburg's good and let's all hope this is his last appearance in UTK. The only thing holding him back, as it was with Wood, Mark Prior, and every other young pitcher, is health. Which brings me to my next point...
Grady Sizemore's recovery from microfracture knee surgery will be an interesting case study, along with other injury news from around the majors.
Grady Sizemore (microfracture knee surgery, ERD 10/4)
On Friday, Sizemore had microfracture surgery. As simple as that, Sizemore is done for the 2010 season and his future as an elite player is in doubt. Yes, most think that Sizemore can come back, but in baseball, there are no good comparable players who have had the procedure and returned, unless you're an Indians fan that really enjoyed the latter years of Sandy Alomar Jr. While you can look at advances in the procedure and a success rate in other sports, it's more difficult to make direct comparisons for Sizemore. First, let's be clear—we don't know where or how many holes were created during the microfracture part of the surgery. The Associated Press stated that Sizemore had holes drilled into his patella (knee cap), which is not a weight-bearing part of the joint. It's common to have problems with the "glide" of the patella and the groove of it, and the patellar tendon is in it. If this is the only part where microfracture took place, this is very significant. To say this very simply, this is not a Carlos Beltran situation, which is a weight-bearing problem. This is closer to, but not identical to, the problem that Magglio Ordonez had at the start of his Tigers tenure. Ordonez didn't have microfracture, but a different type of surgery using shock waves rather than a drill or awl. Sizemore will have the rest of 2010 to recover and rehab. The question is less about will he come back—that's almost assured—but can he adjust to the limitations and remain a star-level player in 2011 and beyond.
Brett Anderson and Ryan Sweeney go down in the same game for the A's, plus other injury news from around the majors.
Brett Anderson (strained elbow, ERD 7/15) Josh Outman (Tommy John surgery, ERD 8/1) Ryan Sweeney (concussion, ERD 6/6)
The Athletics only got two innings out of Anderson yesterday against the Red Sox before his elbow tightened up on him again. It's the dreaded recurrence, one that has to have the team's medical staff beside themselves. Anderson passed all the tests, but there's no way to truly simulate everything that goes into a real start against real hitters with a real crowd. That full-go setting pushed Anderson back to an injured state and likely back to the DL. The issue now is that from what we know about the injury, there's no real fix beyond waiting for it to heal. Given that he was just out for almost a month and almost immediately had similar if not identical symptoms, it's tough to say that it won't take significantly longer now. He'll have more tests, but Anderson is likely out until the All-Star break, if not beyond. It was a tough game for Oakland, especially Sweeney, who took a knee to the head on a defensive play. He was removed from the game with dizziness, a symptom of a probable concussion. He'll be monitored and miss a couple games, though I shouldn't have to remind you how unpredictable post-concussion symptoms can be. Let's toss in a little bit of good news for the Bay Area—Outman, one of the solid young Oakland pitchers, is back to throwing after a setback in his Tommy John rehab. He's about a year post-surgery at this stage, but just a bit behind schedule. He'll need to make it through the next month without issue if he'll be able to get back for anything more than a cameo this season.
Jorge Posada returns as the Yankees' designated hitter and Mark Teixeira stays in the Bombers' lineup.
Mark Teixeira (bruised foot) Jorge Posada (fractured foot) "Didn't Jorge Posada have negative x-rays?" That's the type of irrational behavior that just flummoxes me. A Yankee fanatic—not fan, but fanatic—asked this question after it was announced that Teixeira had good news. Teixeira's foot is bruised and sore, but according to images, not broken. Yes, it's possible that a fracture can be missed, such as when a fracture is so small that it only takes two weeks to heal, as it did with Posada. Teixeira was back in the lineup at first base on Wednesday and it appears that the breathless Yankees fans can go back to complaining about something else as they dust off their championships. As for Posada, he returned from the DL and immediately went to DH. The question now is when he can move from DH to catching. Joe Girardi said that Posada had not been cleared by doctors to catch, so we have to think there's some reason. According to one of my favorite orthos, he thinks the answer is in the fracture. "If he's back there squatting, he's putting pressure on that bone in a way that he wouldn't walking, standing, or even running," he explained. "Squatting puts a lot of pressure on the forefoot and toes, so if this fracture is up there, as we'd guess it would be, putting 200 pounds of pressure on it is going to test just how healed it is." Caution's the play here and Francisco Cervelli is helping them be patient. Posada didn't appear to be wearing anything at bat, so I'm guessing that he has some sort of padding or hard plastic in the shoe or even in an ankle wrap.
Kendry Morales has a good chance of returning to the Angels' lineup this season, along with other injury news from around the majors.
Kendry Morales (fractured tibia, ERD 9/1) Morales didn't have surgery on Sunday as expected. His ankle/lower leg was still swollen and the doctors decided to wait until that swelling was down before going in and fixating the leg. That's reasonable and shouldn't affect the return time for the first baseman significantly. Examinations the last couple days have the Angels thinking that Morales will be back around the end of August or early September. The chance to get some at-bats at the minor-league level is key, as is the Angels' record at that point. Many have asked if this is a reasonable return time, so we look to the comps. The most recent comp is Scott Sizemore, the Tigers' second baseman who snapped his leg at a similar point during the 2009 Arizona Fall League season. Sizemore came back for spring training and the time period doesn't look good. Remember that there was no baseball three months after the point where Sizemore injured himself. A better comp might be Angels center fielder Torii Hunter, who went through a similar process when he had an ugly encounter with a wall. Two injuries that aren't good comps but came up in discussions were Robin Ventura and Jason Kendall. In both those cases, the player dislocated the ankle, which had ligament and tendon issues on top of any fractures. This injury should heal cleanly, especially once it's fixated, with few long-term consequences.