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 White Sox pitcher's detached lat muscle is such a rare baseball occurrence that there is nothing comparable.
Jake Peavy (strained lat, ERD 10/4)
Not just strained, but detached. That was the piece of info that took this from being bad news for Peavy and the White Sox to being the worst-case scenario. Peavy has pulled the muscle out at the insertion. That's the point where it connects to the upper arm, as seen here. It's not the best comparison, but if you've ever broken down a chicken, this is very similar, though obviously there's a size (and species) difference. It's the same kind of muscles and tendons that are pulled apart when taking the wings off before adding the delicious sauce. Peavy will in all likelihood need surgery to reattach the muscle. He'll get a second opinion, maybe more, but doctors and therapists I spoke with said a complete detachment of this type can't heal on its own. This detachment is what differentiates this strain (and yes, it's still a strain; a detachment is just a specific kind of rupture, which itself is a complete strain) from the ones suffered by other pitchers, such as Brad Penny, Josh Beckett, and Ben Sheets. They had strains in the "belly" of the large muscle rather than at the thinner, weaker point nearer the arm. The cause is unknown and probably always will be. SBNation quoted me early in saying this was Don Cooper's fault, but that's not what I meant at all. In changing anything about a pitcher's delivery, there can be consequences, just as if a pitcher instinctively changes something to compensate for an injury. That's why it's so tough to see a pitcher with terrible mechanics but good results; even a small change might change things for the worse. The pitcher has done this for such a long time that his body, even his bones, have adjusted to that specific motion. The question now becomes whether or not Peavy can come back at all. There are no comparables for this. Again, I went to my doctors and therapists, who think that he can come back. "It's not a cuff," said one ortho, "and putting the muscle back in place isn't difficult. It's an anchor. It's not like there's multiple structures or ways to do it really." A physical therapist put it more succinctly: "If a nail comes out of your wall, you hammer it back in place. That's all this is." We've seen players come back from detached muscles before. The one that immediately comes to mind for me is the dreadful image of Dean Palmer's biceps strain. The muscle retracted, visibly rolling up his arm as he screamed in pain. I'm glad that's not on YouTube. Peavy is looking at a significant rehab and most likely his season is done. When he might be back on a mound remains to be seen.
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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.
Will some players show enough in what's left of the regular season to put themselves back in the playoff-roster picture?
Jorge Posada (9/25) Jerry Hairston Jr. (9/30)
Posada's a 38-year-old catcher coming off of shoulder surgery that cost him much of last season. He's spent much of this season taking foul tips off various parts of his body, so when he fouled a ball off of his foot Tuesday, he probably barely noticed, aside from the pain. Despite all that, he's pushing a 900 OPS and helping his team into the playoffs. For Posada, that's nothing new; his five wins of value isn't even a good year for his career. On a team of superstars, Posada might be the one who's overlooked. With this latest nick, he'll nevertheless be back quickly, perhaps tonight. In other news, things looked bad for Hairston on Wednesday, but Thursday's MRI made things a bit better-he'd felt something pop in his wrist, but the images showed no structural damage. The question now is will he feel pain when he picks up a bat. Function is key here, and wrists ... well, if you don't know by now, I'll point you to Medhead Rule #6: wrist injuries linger. Hairston's versatility makes him somewhat useful, but this injury could knock him off the playoff roster.
The Mets might resort to an unusual procedure with Jose Reyes, Puma's abortive job, and other news from the injury beat.
Jose Reyes (10/4) Luis Castillo (8/8)
It's not my rule, but it is the simplest of rules in sports medicine: do everything possible before surgery. Players, ATCs, even doctors do everything they can to avoid putting someone under the knife. Sometimes the timing and failure of the conservative approach makes people question this, but it's the rule for a reason. Now, with surgery back on the table for Reyes in light of his latest setback, many moaning Mets fans are wondering why this wasn't done earlier; I'm wondering why it's back on. The type of surgery being discussed would sever a tendon and has only been done in baseball a few times, with both Edgar Martinez and Ricky Ledee back in 2002. Both players came back, but neither plays the same way that Reyes does. It would stun me if the Mets went this route at this stage, even with the three- or four-month recovery period that surgery involves. Reyes overcame chronic hamstring problems at the start of his career, and had a subsequent long run of health. I can't believe they would abandon that for something so aggressive and truly untested. If Reyes is shut down or sent for surgery, that may affect the comeback of Carlos Beltran as well as a few others, though not Carlos Delgado or Billy Wagner, who need the showcasing. The Mets got more bad news last night with Castillo spraining his ankle. Worse, he did it in the dugout, not on the field. There's no word yet on the severity, though he's expected to miss at least a couple of games.
As the drama at Flushing Meadows whorls, sorting out the disconnects in the Lilly, Sizemore, and Slowey situations, and more.
I've been toying with the concept of DXL for a couple of years now, and after discussing the success and shortcomings of the number over at Unfiltered, I'm going to do a bit of experimenting. Instead of DXL, I'm going to include a target return date. This is an estimate based on the best currently available information, and should not be taken as any kind of prediction. It's going to move backward and forward when there's new information to add, changes, setbacks, and shifts in the team context. I'm not sure how it will work out, but I decided it was better to try and make it better now rather than ride out the year with DXL. Players that aren't expected to miss time won't have a date (with Grady Sizemore representing a good example today).
Assorted contenders lose players for varying lengths of time, while the Pads' survive a frightening beaning.
Edgar Gonzalez (20 DXL)
There's no scarier injury than a beaning. Jason Hammel's pitch was clearly unintentional, but Gonzalez got one of the worst ones we've seen this year. The batting helmet saved his life, but even with the helmet, he's still feeling the effects of taking a pitch off of the head, and remains hospitalized with post-concussive symptoms. The medical staff not only got there quickly, but made all the right moves, then was backed by the team who took no chances and immediately placed Gonzalez on the DL. It's easy to do with a replaceable player like Gonzalez without the pressure of a division race, but let's give the Padres their due here. This is exactly the kind of concussion management that more teams (and leagues) should adopt. The NATA's position papers on the issue could easily be adopted and the issue fixed industry-wide, but that's unlikely, even though it's an area where baseball could grab the high ground from the NFL. It's sad to say that the league with the best concussion management system is the UFC. Gonzalez will be fine in the long term, but they'll take it slow.
It'll take more than an impending trip to the DL to keep UTK from making a rare Sunday start.
Yes, it's been a week since we last talked. It's as weird for me to not write as it is not have UTK up. It's a "near-daily" column largely because I don't think it can be done right any other way. Once a week doesn't show the flow of things, the daily changes, and how new information adjusts any one player's prognosis. Sure, I've been over at Twitter and even punched out my first football column of the year-as well as debuting my new NFL injury service-but I'm happy to get back to baseball. Sadly, there are always going to be injuries to write about.
Several players will have to play through injuries this season, presenting management and maintenance challenges to their teams.
Travis Hafner (20 DXL)
It took an extra day due to flights, the vagaries of press availability, and the internal discussions that the Indians always have about any issue, but the news about Pronk's shoulder is good. He saw James Andrews on Monday and he thinks that the soreness and weakness in his shoulder is typical after the type of surgery that Hafner had. The concern remains that the stamina and crepitus in Hafner's shoulder won't allow him to play all season without problems like this. The natural solution will be a strengthening-and-conditioning program. The Indians' training staff is one of the best in the game, so if anyone can keep him healthy, it's them, especially with their intimate knowledge of the situation. Hafner is likely to miss a bit more than just the minimum, but he should be back to level quickly thereafter.
The Yankees and Red Sox have positions with overlapping injury issues, while the Pirates catch a bad break behind the plate.
Xavier Nady (30 DXL) Hideki Matsui (0 DXL)
It's important to note what is and what isn't going on with Nady's arm. As easy as it is to confuse 'sprain' and 'strain,' it's also become too easy to confuse the usage of 'sprain' and 'tear.' Too often the word tear is used in place of
'rupture,' which means a complete tear or loss of structural integrity in a particular anatomical structure. While any sprain is by definition a tearing of ligament fibers, not every sprain is a rupture. So the question is not whether Nady's elbow is damaged, but if it is too damaged to be able to rehab and heal. There are examples of those who have played through significant elbow sprains, with Albert Pujols taking center stage. By Nady's not having Tommy John now, the hope is that the surrounding structures can be strengthened enough to allow a weakened ligament to not be overtaxed, and to have natural healing give additional strength. The downside for Nady and the Yankees is best exemplified by Pujols' case-throwing is the activity that is going to have to be avoided and/or adjusted for. That was easy enough for the Cardinals, running Edgar Renteria out deep to take cut-off throws from left field, and then moving Pujols to first base to limit it further, but the Yankees don't have that kind of flexibility. If Nady is only a DH, the current roster becomes even less flexible, and the concurrent problems with Matsui's knees might do more to open up that slot. Even without playing the field, Matsui's knees are swelling up and need to be drained at a far more aggressive pace than the Yankees had anticipated. That's leading to some talk that Matsui might need time away, or the possibility that he could retire, rather than having a more extensive surgery. Nady is expected to be rehabbing the elbow for the next three weeks, giving the team time to figure out what's up with Matsui, before any decisions need to be made.