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.
Spring training has just started, but already players are nursing injuries.
Spring training has only just begun, but we already have news aplenty to digest. Let’s go right to the infirmary report:
Ryan Howard, PHI (Left Achilles Surgery)
Howard’s recovery from surgery on his torn left achilles tendon has been a rollercoaster ride. He was spotted taking grounders from a stationary position as well as running late last week, but with a limp. Subsequently, it was revealed that one of the stitches had a seroma forming around it. While this sounds ominous, a seroma is merely a pocket of fluid very similar to a cyst. This far out from surgery, the stitches involved are not the ones that you see on the skin’s surface, but rather a buried stitch used to close tissues deeper under the skin; the cyst developed become the body views it as a foreign invader. The body begins to “spit the stitch,” attempting to push it out of the body. This is not at all uncommon following surgery, particularly plastic surgery or mastectomies, and is different from an abscess in that it is not infected. They can be drained, but anytime you introduce a needle into the skin there is a chance infection will set in.
As the sad tale of Nick Johnson shows, a high on-base percentage doesn't help unless you can stay in the lineup
One of the most difficult aspects of injury projection is deciding how to deal with acute injuries. Athletes often acquire a “bad luck” label that follows them over the course of a season or a career, even if their injuries haven’t followed a predictable pattern. It isn’t much of a surprise that out of all the hitters in the last decade, one such injury-prone player, Nick Johnson, has missed the most days on the disabled list and the third-most of any player.
The New York Yankees drafted Johnson in the third round of the 1996 draft. Like all of the other players on the DL Kings list, when Johnson has been healthy, he’s been a productive player. In his first season in the Sally League, he displayed power, speed, and a good eye, only to improve over the next two years. He also got his first taste of the injury bug in 1998 when he dove for a ball, tore his labrum, and underwent surgery. He missed six weeks.
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Prince Fielder's new deal has albatross potential, but the Tigers hope it doesn't turn out like one of John's picks for the worst contracts of the free-agent era.
While looking toward the future with our comprehensive slate of current content, we'd also like to recognize our rich past by drawing upon our extensive (and mostly free) online archive of work dating back to 1997. In an effort to highlight the best of what's gone before, we'll be bringing you a weekly blast from BP's past, introducing or re-introducing you to some of the most informative and entertaining authors who have passed through our virtual halls. If you have fond recollections of a BP piece that you'd like to nominate for re-exposure to a wider audience, send us your suggestion.
As your mind reels at the size of Prince Fielder's payday, take a look at this list of 10 free-agent deals that didn't work out well for the teams that handed them out, which originally ran on February 20, 2007.
Catching up with the surgeries on and recoveries of Nick Markakis, Alex Rodriguez, Ian Kinsler, Jason Castro, Al Alburquerque, and other players.
Before long, spring training will be upon us, and we’ll be able to watch live baseball games again. Rounding up the usual injury suspects has been fun, and we’ll go into detail about several other injuries before putting the series on hold. However, injury news doesn’t stop being made at the end of the World Series, and since our last injury roundup, more than a few injuries have come to light. Therefore, we interrupt our regularly scheduled program to bring you this important news.
The skinny on an elusive injury that increasingly plagues pitchers.
Superior Labrum Anterior to Posterior (SLAP) tears are an increasingly common injury in baseball players. Much more common in throwing athletes than non-throwers, SLAP lesions have gained a lot more attention as baseball pitchers have been studied in greater detail.
Anatomy As we described in a previous article, the shoulder is made up of three bones but many different soft tissues. The clavicle, scapula, and humerus serve as attachment sites for the various muscles, ligaments, tendons, and nerves in order for proper function to occur. In the case of SLAP lesions, we are most interested in the labrum and the tendon of the long head of the biceps.
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.
Thumb injuries can be just as unfortunate for baseball players as they are for hitchhikers, Roger Ebert, and the Fonz.
Some would argue that the thumb’s primary purpose is to be raised in the manner of Arthur “Fonzie”Fonzarelli from Happy Days, but we are most concerned with its role in gripping and grabbing objects in baseball. In order for that to happen, the thumb has to be working right. You can’t play baseball at a high level with your thumb sticking up in the air like the Fonz, or if you just hit it with a hammer. One of the most common injuries to the thumb involves the ulnar collateral ligament of the metacarpophalangeal joint. In today’s installment, we are going to look at a few specific injuries to the UCL of the thumb, namely Gamekeeper’s thumb and Stener lesions.
Anatomy The thumb, despite its appearance, is an extremely complex group of bones, tendons, and ligaments that somehow work together to allow gripping of objects and marathon gaming sessions. It is composed of five different bones (metacarpal, proximal phalanx, distal phalanx, radial metacarpophalangeal (MCP) sesamoid, and ulnar MCPsesamoid) and three main joints (carpometacarpal, MCP, and interphalangeal). The MCP and IP joints also have ligaments on the ulnar side closest to the palm (UCL) and on the radial side on the outside of the thumb (RCL).
A rotator cuff tears isn't a death sentence for a pitcher's career, but it's far from a positive prognosis.
Baseball pitchers and rotator cuff problems seem to go hand-in-hand despite the rotator cuff being much smaller than other muscles about the shoulder and upper back. The four small muscles that make up the rotator cuff are vital to the shoulder’s health and to a pitcher’s playing career. In fact, at one time, rotator cuff surgery was considered a career-ending sentence. That isn’t the case any longer, but it still hasn’t reached the level of relative certainty of ACL surgery or even Tommy John surgery. Without a healthy rotator cuff, a significant cascade effect culminating in shoulder instability and/or tears of the labrum is possible, if not inevitable. In today’s episode of Collateral Damage, we will be looking at the rotator cuff and ways of treating it in all of their complexity.
The rotator cuff is made up of four muscles that attach at different sites on the scapula, a.k.a. the shoulder blade. These four muscles are known as the supraspinatus, infraspinatus, teres minor, and subscapularis. The main function of the rotator cuff as a group is to ensure that the humeral head stays centralized in the glenoidfossa. This cannot be emphasized enough. Two of the muscles—infraspinatus and teres minor—assist in external rotation of the shoulder, while the subscapularis is the only rotator cuff muscle whose role is as an internal rotator. The supraspinatus also assists in abduction, especially early in the motion. Without that rotator cuff, the humeral head would slide all over the place and tear up the labrum, articular cartilage, and other tendons in the area.
We give you the lowdown on an ailment which is becoming increasingly common and the procedures that have been developed to combat it.
We’re hearing reports of microfracture surgery, arthritis, and osteochondral and articular cartilage injuries increasingly often. Given today’s emphasis on year-round training at an earlier and earlier age, cartilage injuries are going to become only more common in the future. We’ve made numerous advances in repairing cartilage injuries, but we still aren’t 100 percent there. Local cartilage defects are more of a problem than degenerative arthritis in the young, athletic population we report on here, so in this installment, we will primarily look at focal cartilage injuries and their management.
Background Anatomy Articular cartilage is the hyaline cartilage on the ends of the bones in a synovial joint, very similar to the white cartilage on the ends of chicken bones. It’s important to note that this is a different type of cartilage from that found in the labrum or meniscus. Typically we hear about cartilage injuries in the weight-bearing joints of the lower extremities, but there is articular cartilage throughout the remainder of the body. Synovial joints come in many different varieties, including ball-and-socket (hip and shoulder), hinged (elbow, knee, fingers, toes), gliding (wrist), pivot (top of neck), saddle (CMC joint of thumb), and condyloid (forearm to wrist joint). The cartilage gets the majority of its nutrition through the synovial fluid that is present inside the joints.
ACL treatments have improved dramatically since Mickey Mantle's day, but they still have the power to end a player's season.
Running down the first base line, the last thing Jason Castro expected in a spring training game was that in less than a second his season would be over. It’s something he had done a hundred times before without any inkling of an injury, and yet this time, for whatever reason, he ended up paying for it. As he tried to avoid the tag by Miguel Cabrera, his knee twisted awkwardly, and before he knew it he was done. Castro tore the anterior cruciate ligament (ACL) in his knee along with his meniscus and underwent surgery early in March 2011.
Injuries to the ACL, while more common in soccer, basketball, and football, still occur in baseball across all ages and experience levels. The ACL is usually torn in a non-contact, decelerating, twisting injury that stretches the ACL until its point of failure. ACL injuries are not new; in fact, the first surgery to reconstruct the ACL intraarticularly—inside the joint—was done back in 1917. Yes, almost 100 years ago. It used to be that ACL injuries were career-ending or career-altering, but as more research and better equipment was developed, the surgery became more commonplace, and the recovery time was reduced. Now, there are about 100,000 ACL surgeries each year, and over 200,000 ACL injuries. It seems that almost everyone has known someone or known of someone who has suffered an injury to the ACL.
Catching up with players who are recuperating from their time on the operating table this winter.
Injury news is slow this time of year, but it’s not nonexistent. Almost all of the news nowadays involves surgeries that were either planned or were complete surprises and the result of a new injury.
Tim Hudson, ATL (Low back herniated disc surgery) Tim Hudson underwent surgery on a herniated disc in his low back on November 28. His back has been bothering him off and on over the last few years but never to the point where he thought he would need surgery. During off-season workouts, his pain started to increase significantly, and not too long afterwards, he underwent surgery, which was most likely a microdiscectomy. This procedure is more successful than earlier operations and requires a much shorter recuperation period. Hudson should be able to resume throwing in about six weeks, which will give him enough time to go through his preseason program and be without limitations at the start of the season.