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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.

Joba Chamberlain, New York Yankees (Right Ankle Dislocation Surgery)
Very late Thursday night and into Friday, news started coming out about how severe Chamberlain’s injury really was. Chamberlain, who was ahead of schedule in his Tommy John surgery rehab, went out to play with his son and started jumping on a small trampoline, like so many parents have done before. However, unlike many parents before him, he suffered a truly gruesome, open dislocation of the ankle on his drive leg. Bones were sticking out of the skin, making it a clear medical emergency.

There are differing reports, but while waiting for the ambulance, it seems Chamberlain lost a fair amount of blood. You can imagine this would bleed a fair amount just from the broken skin, but if it was life-threatening, there is a good chance he nicked a small artery. Chamberlain was rushed to the hospital and underwent surgery. Two main things will dictate his recovery time: presence of infection and musculoskeletal healing. Assuming no infection sets in, he will be in a non-weight-bearing cast for six weeks before transitioning to a walking boot. He will use this for several weeks while the ankle and leg get used to having stress placed across its tissues. If an infection sets in at any point, all bets are off as to when he will progress to the next stage.

An optimistic return to throwing would be the All-Star break. While Chamberlain will do rehab exercises to keep his arm strength up, nothing replicates throwing from a mound. Once he is cleared to start throwing, he will have to build up his arm strength, so the righty’s 2012 season is in jeopardy. It’s too early to tell if this is a career-ending injury, but it could be.

Chipper Jones, Atlanta Braves (Left Knee Meniscus Surgery)
Jones was participating in pregame exercises last week when he slipped and tore the meniscus in his left knee, which required surgery to repair. It is well-known that Jones is consistently injured, but he usually ends up on the disabled list toward midseason, not kicking off the year. There is still a chance that Jones avoids the disabled list, but he will certainly miss Opening Day. The Chipper farewell tour is not off to a chipper start.

Chris Carpenter, St. Louis Cardinals (Cervical Nerve Inflammation)
The good news is that Carpenter’s troubles are not related to the bulging disc found earlier this spring. The bad news is that it is a different area that is inflamed and causing weakness in his neck and shoulder. Any nerve injury can be difficult to deal with. They are slow to respond to treatment, if at all, and when they reach the point where weakness sets in, it becomes much harder. The Cardinals have not given an estimate as to when Carpenter will return, but it seems reasonable to expect he’ll be on the shelf for at least a few months. General manager John Mozeliak says surgery is “not on the table,” which ironically leads us to believe it will not be a quick fix. Addressing weakness from a nerve injury takes time, something that the Cardinals do not have a lot of.

Chase Utley, Philadelphia Phillies (Left Knee Inflammation)
The cartilage on the back of Utley’s kneecap is roughened and inflamed in a condition known as patellar chondromalacia. Once this cartilage is lost, there really is no way to get it back without some sort of procedure. The second baseman does not think it needs microfracture surgery yet, and even if it does, Utley has said that he is not interested in surgery. He is moving forward with physical therapy and different mobilization techniques to loosen the area around the knee. By addressing any contractures or soft tissue adhesions, he is trying to get the kneecap to glide smoothly down the groove and load the cartilage properly.

Don’t let him fool you, though; it’s easier said than done. The body got used to doing something a certain way, and it’s going to down with a fight. And while this approach can be helpful in alleviating pain and swelling, it’s not going to solve the underlying cartilage problem. Yes, Utley may be able to get back to playing, but no, his cartilage is not going to look any better other than being less inflamed. The worn-down spots will still be worn down.

So what does that all mean? Well, Utley is going to miss some time at the beginning of the year. That’s the only certainty. It’s most likely going to be at least four to six weeks, but nothing is set in stone in terms of a return to play. Utley still has not really done all the things one normally does in spring training and will need to work his way back slowly.

Sergio Escalona, Houston Astros (Tommy John Surgery)
It’s raining Tommy John surgeries. Escalona joins Arodys Vizcaino, Joakim Soria (soon), and Ryan Madson (soon) in the pre-season Tommy John surgery club. However, Escalona was different from his compadres; he finished his ligament off while batting, hyperextending his elbow. When it didn’t improve after a few weeks, further testing was done, which revealed the ligament tear. As with all of his brothers in arms this spring, Escalona will miss all of 2012.

Logan Morrison, Miami Marlins (Right Knee Swelling)
It looked like Morrison was going to get back onto the field last week, but the swelling in his right knee returned. Knee joints do not just start swelling up for no reason; there’s always a cause. It could be something minor, like scar tissue, or something more serious, like meniscus or cartilage tears. Oftentimes, reviewing a person’s medical history or using an MRI can find the cause, but sometimes the only way to figure it out is by going in surgically and poking around, literally. Morrison was able to take part in a scrimmage on Saturday but was not in the game on Sunday. It appears he is still day-to-day, but that leaves a bit of a bad taste in our mouths.

Flesh Wounds
Ben Francisco
is expected to miss about a week while he deals with a strained his left hamstring. … Jason Bay is day-to-day after being hit by a pitch on the forearm. … Endy Chavez is battling groin soreness but should be back any day now. … Jai Miller should be coming back soon from knee tendinitis. … According to pitching coach Don Cooper, Jesse Crain is tentatively scheduled to get back into game action tomorrow. … Ted Lilly isn’t going to take the mound until his neck stiffness resolves. … Jack Hannahan is continuing to battle lower back tightness. He is technically day-to-day, but if this doesn’t resolve soon, he may end up on the disabled list. … Giancarlo Stanton is also day-to-day with right knee soreness, but he was able to take part in a minor-league scrimmage Saturday. … Corey Wimberly is going to be out four to six weeks after fracturing his left hand in a collision… Dustin McGowan is fighting plantar fasciitis in his right foot and had to leave his minor-league start on Sunday. These can be tricky to heal, but for now, he is day-to-day. … Kevin Youkilis was not able to make the Red Sox’ bus trip because of a stiff back. He should return shortly. … Yoenis Cespedes felt his left quad cramp up during Sunday’s exhibition game in Japan and needed liquids. It just goes to show you, everyone needs to stay hydrated. … Julio Teheran is dealing with some shoulder stiffness and may have to skip his start on Friday. … Fred Lewis is out with a sore right elbow. There is no word on when to expect him back yet. … David Wright (strained ribcage) has tolerated full baseball activities and may return to the lineup tomorrow. … Andres Torresleft calf strain has not been improving. He may end up on the disabled list to start the season. … Cristian Guzman strained his right hamstring on Friday and will miss at least a week. … Jeff Suppan is out indefinitely after straining his triceps while pitching on March 17. … Kerry Wood has been sidelined by lower back tightness. He is day-to-day…

Marcos Mateo had an MRI, which was negative for major elbow structural issues. He missed the second half of 2011 because of elbow/forearm issues. Mateo will not throw for about two weeks, and then begin rehab. It’ll likely be at least one month before we see him in games again. … Jeremy Moore will have surgery on his right hip today and miss at least three months for rehabilitation. … Freddy Sanchez will likely start the 2012 season on the disabled list while he strengthens his surgically-repaired right shoulder. … Anthony Varvaro strained his right pectoral muscle but remains uncertain when he will return. … Atlanta is having all sorts of trouble keeping their relievers healthy. Now Jonny Venters is dealing with left elbow soreness. He underwent Tommy John surgery back in 2005 and has done well since then. … Drew Storen will be shut down from throwing for several more days in order to rest his sore elbow. An MRI was negative for ligament damage, so once the inflammation calms down, Storen will rehab again. … Matt Hobgood will undergo rotator cuff surgery today and miss the entire 2012 season. … Pedro Alvarez is day-to-day while he deals with knee inflammation. … Joakim Soria will have Tommy John surgery on April 3.

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Now that we seem to have sufficient critical mass, I'd love to see an analysis of how well Tommy John surgery pitchers have done. I seem to recall something in the distant past about pitchers being able to throw better after TJ surgery than they could before. It made me wonder if every pitcher should have it, whether they need it or not. Now that steroids are out, is surgery the new PED?
It's not necessarily that they throw better than before, it's more of a slow gradual decline over the previous months to years. The surgery returns them to their baseline, although having the player focus on strength and mechanics means they could theoretically be improved.

Surgery as a performance enhancing method is a whole other issue, something we may see in the not too distant future.