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Tommy John surgery claims several more pitchers, and Joba Chamberlain suffers an extremely gruesome ankle dislocation.

Ryan Madson, Cincinnati Reds (Tommy John Surgery)
On Friday, one of the most surprising bits of news with the greatest impact was that Madson needs Tommy John surgery. Madson had battled elbow trouble throughout the spring, but it looked like he was turning a corner as recently as last week. Unfortunately, in the few days prior to his scheduled debut, he suffered a setback and was sent to Dr. Tim Kremchek for further evaluation. Dr. Kremchek found that the ulnar collateral ligament was torn (some of it off the bone), and that the tear appeared to be recent because of the amount of bleeding present.

Madson signed a one-year deal with the Reds over the winter after his four-year deal with Philadelphia fell through. Madson’s injury throws everything in flux for the Reds’ pitching corps, but for now, Sean Marshall is the heir apparent as closer. General manager Walt Jocketty has not ruled moving Aroldis Chapman back into a bullpen role this year but insists nothing is set in stone. The only sure thing is that Madson will miss 2012 and will have a hard time convincing teams to sign him next winter as he completes his rehabilitation.

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August 24, 2011 5:00 am

Collateral Damage: The Wall Wins Again


Corey Dawkins and Ben Lindbergh

B.J. Upton strains his shoulder after colliding with a wall, Matt Holliday becomes Mothman, Nick Blackburn gets good news, Travis Hafner hits the DL, Steven Pearce has a finger fracture, Kevin Correia strains an oblique, and something finally stops Jose Constanza.

B.J. Upton, TBA (Right shoulder strain) [AGL: 3 (29 DL), ATD: -.004 (+.030)] (Explanation)
According to the team, Upton was diagnosed with a mild shoulder strain after running into the wall on Monday night. In the video seen most clearly around 40 seconds in, he braces himself from the impact but ends up putting his shoulder in a vulnerable position. The arm appears to torque awkwardly, and he might or might not sublux his shoulder.

One of the key pieces of information is the fact that he said the arm suffered transient numbness when he hit the wall. This is a very common symptom with episodes of shoulder dislocation or subluxation, but not as common with simple strains. The nerves in the shoulder can be stretched out and injured, sometimes resulting in numbness that lasts for a long time. Upton reports that he was already feeling better after the game, but the shoulder started to tighten up on him, which could be indicative of a strain or a subluxation. Upton has already injured—and played through—a torn labrum in his non-throwing shoulder in 2008, for which he underwent surgery in the offseason. His pain in that instance was different and located more toward the back of the shoulder.

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July 29, 2011 10:49 am

Collateral Damage: Explaining Sprains


Corey Dawkins and Ben Lindbergh

Rickie Weeks goes down with an ankle injury and takes Milwaukee's playoff odds with him, Dustin Moseley tries to make his way back, Clay Buchholz's back gets mysterious, and Craig Gentry suffers his fourth concussion.

Rickie Weeks, MIL (Left ankle sprain) [AGL: 29, ATD: -.003] (Explanation)
The Brewers' chances took a serious hit on Wednesday night once Weeks went down. In the midst of one of the top offensive seasons among NL second basemen, Weeks was lunging for first base trying to beat out a grounder when he injured his ankle. It rolled inward significantly into inversion (he was lucky that he did not suffer a concurrent injury with that mechanism). After the medical staff ruled out a major fracture at the stadium, Weeks went to the hospital for further specialized imaging and was diagnosed with a sprained ankle.

In reality, any sprain, even the mildest one, does ligament damage. When potential ligament damage is discussed in the various news and media outlets, it’s implied that it involves partial or complete tearing of the ligament. Grade II sprains include anything from 20 percent to 80 percent or more of the fibers torn, leaving a wide range in the prognosis that isn't very helpful to most of us trying to plan our fantasy trades approaching the wire.

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May 13, 2011 9:00 am

Collateral Damage: Stemming the Tide


Corey Dawkins and Marc Normandin

Bartolo Colon enlists the aid of modern medicine in an unorthodox recovery, Kendrys Morales still has ankle issues, and a pair of pitchers get their capsules repaired.

Bartolo Colon, NYA (Stem cell therapy)
Despite the potentially life-altering benefits of stem cell research and its potential real-life applications, negative attention and fierce debate have surrounded its ethics, cost, and effectiveness. The majority of the controversy arises from the use of fetal or embryonic stem cells for research and/or transplantation into another human.

This story on Bartolo Colon and the use of stem cells raised as many eyebrows throughout baseball as it did questions about the effectiveness of Colon's procedure and the obligation of a player to accept that his career has come to an end. Because Dr. Joseph Purita—the orthopedic surgeon who treated Colon—admitted to using HGH in procedures on the general public, MLB was forced to launch an investigation into both him and his practices. He claims not to have used HGH on professional baseball players—since it's illegal, and all—and for now we'll just have to take him at his word.

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Will has some thoughts on the Jason Grimsley situation, and has bad news on Rich Harden and Eric Gagne, among others.

Wrong. For every one of you that called for testing, you were right to do so. HGH (human growth hormone) and other recombinant versions of naturally occurring chemicals are the next shadow the game will confront, this time with no easy solution, no test on the horizon, and no shady chemist to blame. My position, both before and after writing "The Juice," was not strong enough and I acknowledge that. But by calling for testing, you must then accept the results and only the results. That leaves us with the moral grey areas, such as Jason Grimsley having not tested positive since results came public. It leaves some wondering if his miraculous comeback from Tommy John surgery wasn't so miraculous after all. I spoke with his surgeon, Tim Kremchek, this morning. Dr. Kremchek hadn't heard the news and was dumbfounded. "I don't prescribe [HGH], I don't recommend it, and I would never have one of my patients use it," he told me. It leaves us staring at the abyss of the non-analytic positive or just throwing up the collective hands of the game and handing over the wand to WADA. With the Grimsley case just beginning, and names--in the words of Dan Patrick, "shocking names"--hiding behind the black marker of Jeff Novitzky, we're only at the beginning of this story. Novitzky's pen is likely to get more use in the coming months, checking names off the list he's working from of implicated players with past positive tests and connections to the illegal use of performance-enhancing drugs.

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