Injuries can happen anywhere at any time. For Paul Molitor's finger, it was while running laps.
Spring training is the time of year when everyone's future is wide open and anything can happen. It's the time of year when players get into shape and play around with new skills. It's the time of year when fans come out to sit 20 feet from their favorite players and beg for autographs. It's the time of year when Joe Schlabotnik IV, wearing number 86, might face off against Señor Spielbergo (number 93) in a game-changing situation.
And it's the time of year for injuries. They happen everywhere: in the World Baseball Classic, in spring training games, in the hotel room, in dreams, at the car wash, and just about anywhere else you can imagine.
UCL injuries are less disastrous than they used to be but remain an injury to be reckoned with.
Tommy John surgery: three words that no player wants to hear. It doesn’t matter that technology, surgical techniques, and rehabilitation methods have significantly improved since the first surgery in 1974. All the injured player knows is that he’s going to be down for a while and that he’s not guaranteed to return to his pre-injury performance level. In 2011, several key players went down with Tommy John surgery (TJS), including Adam Wainwright, John Lackey, DaisukeMatsuzaka, Joba Chamberlain, Jorge De La Rosa, Brett Anderson, and Jenrry Mejia, and we also saw the return of Stephen Strasburg after TJS in 2010. We’ve touched on the surgical procedure before, but for our first installment of Collateral Damage in 2012, let’s review the ins and outs of Tommy John Surgery.
Unlike many of the other injuries we’ve discussed, the anatomy of TJS is fairly straightforward. The UCL arises off the medial epicondyle of the humerus and involves three major components. The anterior oblique bundle is a little over three-quarters of an inch in length and despite its small size is the main stabilizer between 20 and 120 degrees of flexion, making it the most stressed part during pitching. When the elbow is fully extended, the UCL, bony articulations, and other soft tissues like the capsule split the stress fairly evenly—roughly one-third for each.
The Rangers risk losing two pitchers for the playoffs, Scott Sizemore feels the pain of playing a new position, Brett Lawrie fractures a finger, and Phil Hughes tries to hurry back.
Mark Lowe, TEX (Right hamstring strain) [AGL: 9(30 DL), ATD: -.015(-.012 DL)] (Explanation)
Lowe injured his hamstring before the game on Wednesday, supplying further evidence that injuries can occur at any time. He suffered a Grade II strain of his hamstring while performing sprints warming up and is now expected to be out for several weeks. His availability for the playoffs is in doubt, especially the ALDS, but the Rangers are trying to speed up the healing process with a platelet rich plasma (PRP) injection.
PRP injections do not work overnight—if they work at all—so his latest treatment is not a guarantee that he will be ready in time for the playoffs. The major milestones that need to happen before he is ready include a decrease in inflammation and a restoration of normal range of motion, strength, and function of the hamstring. Until these goals are achieved, Lowe will be at risk for re-injury. The Rangers are going to have a tough decision ahead of them when arranging their playoff rosters but should have a very good idea about the part Lowe will play in one week.
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.
Juan Nicasio suffers a fractured neck, Jose Reyes' hamstring acts up again, Daniel Murphy has another knee issue, Ike Davis appears to be out for the season, Chase Headley fractures a finger, Alex Cobb has hand numbness, and Jair Jurrjens finally hits the DL.
Zack Cozart goes down as quickly as he came up, J.D. Drew gets back to being injury-prone, Adrian Beltre strains a hamstring, Kyle Lohse gives the Cardinals the middle finger, and Luke Scott is out for the season.
Zack Cozart, CIN (Right elbow hyperextension) [AGL: 26, ATD: +.025] (Explanation) It seems like everyone is having difficulty staying healthy nowadays, veterans and rookies alike. With Nate McLouth bearing down on him, Cozart reached for a throw, only to catch his glove on McLouth's left leg and body, painfully hyperextending his elbow and leading to a trip to the disabled list. After an injury with a major fracture or neurovascular compromise was ruled out, Cozart walked off the field with assistance and was later diagnosed with a hyperextended elbow following x-rays and MRIs.
The elbow is actually composed of three different joints, but the major joint is a hinged joint that forms between the humerus and ulna. The main movements of the humeroulnar joint include flexion and extension, although there is some circumduction motion as well. When the elbow hyperextends, several structures—the biceps, brachialis, joint capsule, and other structures—stretch and can tear, leading to dislocations in severe cases.
Dissecting the Pujols diagnosis, checking in on Chris Coghlan's knee, getting the finger from Brad Hawpe, and watching J.R. throw in the Towles.
Albert Pujols, STL (Left radius fracture and wrist sprain)
When a wrist is forced into hyperextension as Pujols’ was, it moves into what is called the “closed pack position” of the radiocarpal (radius and wrist bones) joint. The closed pack position is the position of the joint in which the bones have the maximum amount of contact with each other, and therefore the most bony stability.
While this position allows bony protection from dislocation of the joint, it prevents forces from being absorbed by the soft tissues, instead transmitting them directly to the bones themselves. In essence, it's like driving down a pothole-filled Boston road in a car without shock protectors.
Some of the things Baseball Prospectus' resident injury expert ponders on a daily basis.
In the last 24 hours, I've had three men I really respect discuss three topics with me. One asked about pain and baseball. Another asked about the dangers of wall vs. player collisions. The last one asked about the cost of injuries. This is a bit of a change of pace for UTK, but it's all related, so I wanted to share the type of things I think about on a day-to-day basis.