David Robertson battles a staircase while other players nurse their respective wounds.
David Robertson, New York Yankees (Right Mid-Foot Sprain)
Not all injuries occur on the baseball field. Robertson was moving boxes, missed a step, and fell down a flight of stairs. He went for an x-ray Wednesday night; the result was negative. An MRI was used to confirm a mid-foot sprain, but Robertson needed further tests, including a CT scan and a weight-bearing x-ray.
This combination of testing raises the concern for a Lisfranc injury, the same one that felled Chien-Ming Wang in 2008. The CT can provide a very detailed picture of that joint, including a 3-D reconstruction. The standing x-ray is the tip-off, though. The MRI reveals a mid-foot sprain in severe Lisfranc injuries, while the CT may or may not reveal a fracture in the area. The standing x-ray most likely won’t show a fracture, but it will show if there is any increased space between the bones, indicative of instability in the area. When there is instability, there is a significant risk of severe long-term damage if the area does not heal through conservative measures or surgery. Without knowing the results of all of the tests, we cannot definitively say surgery is necessary.
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Ankle sprains can heal fairly quickly, but when surgery is required, the injured player's season is at stake.
The ankle is among the most commonly injured body part across all sports. Thousands of people sprain their ankles every day during relatively routine activities. In baseball, ankle sprains don’t usually end up requiring an extended stay on the disabled list, but when they do, they’re gruesome to watch. In 2011 alone, severe ankle injuries took out Stephen Drew and Buster Posey, but they don’t have to be that severe in order to affect performance. Velocity and control can be affected in pitchers, while bat speed and control can be affected in hitters. With that in mind, let’s examine the different types of ankle sprains.
Anatomy What we consider the ankle joint is actually two different joints called the subtalar joint and the talocrural joint, which are composed of the tibia, fibula, talus, and calcaneus. For our purposes, the subtalar joint is the interaction between the talus and the calcaneus, while the talocrural joint is made up of the tibia, fibula, and talus. Together, these three bones of the talocrural joint are also called the mortise. The talocrural joint allows dorsiflexion and plantarflexion, while the subtalar joint allows for inversion, eversion, pronation, and supination.
Boston hopes Josh Beckett's ankle issues won't hamper his availability in October, Jose Tabata's wrist won't cooperate, and the rest of the aches and pains from around the league.
Josh Beckett, BOS (Right ankle sprain) [AGL: 2 (29 DL), ATD: +.001 (-.000 DL) (Explanation)
When Beckett left his start on Sunday, the initial diagnosis was a right ankle sprain. However, the symptoms he described didn’t sound like those of a typical ankle sprain. In this article, Beckett said it felt like the ankle locked up, then shifted on him, a sensation he had never felt before. By the time they reach Beckett’s level, most athletes have suffered a “normal” lateral ankle sprain and know what it feels like. This was different, and so he was seen back in Boston by Boston’s team physicians and specialists.
If this had been a typical sprain in terms of pain patterns and swelling, he would not have had to rush home and get it evaluated. Red Sox team physician Thomas Gill announced that Beckett did indeed suffer a sprain, and without specifying what structure was injured, he was able to rule out tendon damage to the foot and ankle, including the Achilles.
Nelson Cruz's old injury enemy strikes again, Darren O'Day tries to return for the stretch run, Brennan Boesch attempts to avoid surgery, Justin Morneau misses times amidst conflicting reports, Hanley Ramirez's shoulder woes could be more serious than initially believed, and the odds are against Pedro Feliciano.
Feliciano has spent the season on the disabled list trying anything possible to avoid undergoing a surgery whose previous recipients include Chien-Ming Wang, Scott Elarton, Johan Santana, and Dallas Braden. The shoulder capsule plays a role in the joint’s tensile stability during rotational movements, and it also creates a negative pressure inside the shoulder joint, further stabilizing it.
Carlos Quentin sprains a shoulder doing something he's done many times before, Brian Wilson suffers a cascade injury, Jimmy Rollins strains a groin, Jason Berken fears the worst for his elbow, Pablo Sandoval and Paul Maholm nurse their shoulders, and Freddy Garcia and Rafael Furcal deal with faulty fingers.
Brian Wilson, SFN (Right Elbow Inflammation) [AGL: 36, ATD: -.037] (Explanation)
Wilson's beard may be a natural wonder of the world, but unfortunately, his elbow might not be. Back soreness last week may have altered his mechanics just enough to cause elbow inflammation and a trip to the disabled list this weekend. The move, retroactive to August 16th, came early enough that even if Wilson does not return in the minimum, he can still see a few weeks of action before the playoffs start.
Wilson hasn't suffered any major arm injuries since undergoing Tommy John surgery performed by Dr. Andrews while at LSU in 2003 although there were a few blips along the way. In 2007, he strained his triceps, and an infection in his finger during 2009 spring training sidelined him for a little less than two weeks. Wilson's mild flexor strain and resulting inflammation should clear up in within a month, although San Francisco feels that it may be a matter of about three weeks. In the interim, the Giants are going to have their hands full trying to keep the antsy Wilson from going crazy on the bench sitting alongside the MASH unit in San Francisco uniforms.
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.
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.
Albert Pujols, Hunter Pence, and Matt LaPorta succumb to sprains, Tommy Hanson hurts his shoulder, the Red Sox suffer a rash of injuries, and John Danks survives a scare.
Albert Pujols, STL (Left wrist)
It seems as though hardly a week of the season has gone by without another event that causes Cardinals fans to hold their breath, starting in spring training with Adam Wainwright and continuing through the collision at first base involving Pujols. Collisions at first base happen all the time, but the ones that stick out in everyone's mind involve injuries similar to Brian Roberts’ in 2005 (dislocated elbow) and Derrek Lee’s in 2006 (broken wrist).
As Pujols was reaching up the line for the throw from second baseman Pete Kozma, he collided with Wilson Betemit. His wrist was bent backward to a disturbing degree, his elbow flexed to an odd position, and his shoulder was twisted. Pujols was clearly in immediate pain, mainly focusing on his wrist, but he also pointed to the shoulder at one point. The athletic trainers left the dugout to examine Pujols for any major fracture and quickly helped him from the field. Following the game, GM John Mozeliak described Pujols’ injury as a sprained left wrist after initial x-rays ruled out obvious fractures, but further tests will be performed on Monday.
A medical reason for Hanley's slump surfaces, a couple Cardinals succumb to strains, two Boston hurlers suffer serious elbow problems, and Ike Davis' ankle is slow to recover.
Hanley Ramirez, FLA (Low back pain and left leg sciatica)
Usually athletes don't disclose much information about injuries during media interviews, but Ramirez's interview earlier this week was the exception. The shortstop revealed one potential reason for his decreased production so far this year: his back has been bothering him for about a month, and he has also experienced numbness and pain shooting down his left leg. That’s close to a textbook description of sciatica, a common injury to the sciatic nerve in both active and sedentary people. Approximately one-third to one-half of the general public experiences sciatic pain traveling down the leg, but less than one percent of people suffer from associated numbness or muscle weakness.
The sciatic nerve is the largest nerve in the body—approximately the width of a thumb at its widest point—and is composed of a bunch of nerves that intertwine and become the sciatic nerve at the level of the piriformis, a muscle deep in the glutes. It then pierces through the piriformis muscle before traveling down the leg and branching off to various smaller nerves. An injury to the nerve and its resulting symptoms can occur anywhere along its length, from the spine on downward.
Grady Sizemore returns, Barry Zito is introduced to the DL, and a quartet of backs act up.
It’s not often we get a chance to write happy news in this space, but seeing Grady Sizemore return from a layoff that seemed even longer than it actually was is one of those rare times. Sadly, one successful comeback didn't slow the torrent of new injuries, but at least nothing on today’s docket can match Sizemore’s absence in terms of recovery time and days lost.
Barry Zito, SFN (Right mid-foot sprain)
Zito suffered a mid-foot sprain on Saturday after diving to field a bunt from Joe Saunders, and he was lifted from the game shortly afterward. This marks the first time that Zito has been on the disabled list in his 12-year major league career, and it's an injury that is likely going to cost him more than 15 games. As a result, this may also be the first full season in which Zito will make fewer than 30 starts.
Ready and rested, Will dives into dissecting a week's worth of breakdowns and injuries.
¡Hola, amigos! Acabo de regresar de una semana en Mexico - una semana de playa hermosa, la cerveza, y el beisbol no. (Mi espanol mejoro un poco tambien.) Oh, wait... English now. A week away provides a perspective, the same way that a fortieth birthday does. Being away, especially during a week where player after important player seemed to go down, reminded me why I do this every day. I see baseball through the lens of health and while sometimes, it would be a bit more accurate to wait or do something like write once a week or so, the story is lost. A player is injured-how bad is it? What is the medical staff doing? How are the players reacting? Is there a roster move? Is the team capable of filling in for the lost player? So much more happens than just the injury. Some of you missed having UTK here every day, some of you didn't, and the vast majority didn't notice, reading the rest of the content here. That's okay with me. I'm telling stories that involve injuries, not writing about injuries. It took me years to realize that and a beach. No matter ... a las lesions!