Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterApril 16, 2013

Under the Knife: Latest MLB Injury Updates

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    Sean Forman is awesome. His site, Baseball-Reference.com, is one of the crown jewels of baseball research. What happened on this date in 1937? What did Kiki Cuyler do in his first game in the bigs? How did Jason Motte do late in the season during his career? If you can think of the question, Baseball-Reference can probably give you the answer.

    I can go back and look at the first game I ever went to at Wrigley, one where I was sure that Gary Carter hit a walk-off home run, only to find that while Carter did hit a homer, it was in the third inning. Memories fall victim to facts, which is as it should be.

    But then we get to injuries. Even when Bill James was still guarding a bean factory, he had box scores. When someone wants to look to historical injuries, there's almost nothing. MLB simply did not collect this data until very recently, and even that wasn't cataloged. The infamous Redbook of the 1990s was discontinued. 

    I say "almost" because David Neft did a lot of research putting together the best available database of injuries that exists for historical injuries. It's not perfect and it's not widely available, but the work that Neft did is pretty amazing. The effort that is necessary to maintain the injury database that I keep is not insignificant, so I can't imagine what Neft had to go through to come up with his.

    As I said, it's not perfect. It misses a lot of injuries, especially minor ones, and has a hard time dealing with some of the vagaries of the disabled list, like the September problem and the career-ending injury, but it's better than anything else out there.

    One of these days, I hope that I can publish my database, freed from HIPAA concerns, but until then, I'll keep using it behind the scenes as we try to figure out how to reduce injuries and have more good players in the box scores, rather than the DL reports.

    On to the injuries.

Johnny Cueto (Shoulder)

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    Injury: Strained lat

    Expected return date (ERD): June 2

    Johnny Cueto reached for his triceps.

    Now, here's the problem with that. While I often say that watching where an athlete reaches in that initial moment after injury is very telling, certainly much more than when they're asked questions later, it's not perfect. There's a simple answer as to why this one is the issue: location.

    The latissimus dorsi is located in the back and is one of the largest muscles in the body. It anchors near the triceps in the upper arm, so that's one possible cause of confusion. The easier answer is this: Try to grab your lat. I realize I'm not a very flexible person despite my efforts with yoga, but this is going to be an issue for most. Instead, Cueto likely grabbed at his arm to pull it in and guard it, the way many do with shoulder or collarbone injuries.

    A lat strain can be pretty devastating, and it tends to be a kinetic chain injury. It is very seldom the weakest link initially, so in this case, it's not like the situation Ben Sheets had where the forces broke down link after link on that kinetic chain. The average time lost to a lat strain over the last three years is about 60 days, according to the database of injuries that I keep. Another recent example is Matt Garza, which just made Reds fans groan and reach for a bowl of chili.

    Cueto's strain is not thought to be severe, but it's not likely to be a minimum DL stay for Cueto, either. We'll have to look for any signs early in Cueto's rehab for a better timeline, such as when he begins throwing long toss. In the meantime, the Reds are likely to use top prospect Tony Cingrani in those starts, though if the Reds can wait just one start, they'll lock in the 21 days of minor-league time needed to gain an extra year of control. Sam LeCure could take that spot start.

Matt Harrison (Back)

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    Injury: Inflamed back

    ERD: Unknown

    The Rangers are starting to get worried about Matt Harrison's back issue. The key fact that has come out since he hit the DL is that the pain and weakness has tracked down to his legs. That usually indicates a disc problem, where the inflammation has impinged a nerve. In the worst cases, it's called sciatica and is extremely painful. 

    Shifting this from a muscle-spasm issue to a damaged-disc problem really changes the timeline and makes it tougher on the medical staff. Harrison has had two injections in his back without any real change. These are normally done in a series of three, but having two ineffectual injections often causes a shift in strategy. More aggressive measures would be next, and surgery is an option if everything else fails. 

    All that uncertainty means I'm not ready to put an expected return date on Harrison just yet, though my outlook is not overly negative. If Harrison is out an extended period, the Rangers will keep Justin Grimm in the rotation while waiting on Colby Lewis and Martin Perez to get healthy and compete for that slot. Robbie Ross is another option, showing just how much depth the Rangers have at almost every position. 

Jason Motte (Elbow)

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    Injury: Sprained elbow

    ERD: Done for season

    I was talking to my friends, Dave Cokin and Steve Cofield, yesterday—they do a great radio show on ESPN 1100 in Las Vegas—when Dave brought up a question I get over and over. Why do teams insist on trying to rehab through elbow injuries that often result in Tommy John surgery anyway? 

    The simple answer is that anytime you can avoid surgery, you do it. The more complex answer is that the risk-reward balance is definitely worth losing a month or so in an attempt to save a year or more. The issue is that we don't see this due to the sample size. Jason Motte is one guy, and it's going to take a very broad view to see if the real answer is that one in 10 is successful in rehab (and it's a very interesting question as to what the success rate actually is). Then, win or lose, the effort will have been worthwhile. 

    It would not be surprising if the treatment plan for Motte included a platelet rich plasma (PRP) injection as part of an aggressive rehab program. The decision on Tommy John surgery will be made around May 1, though any setback will push that decision up. Even if Motte makes it back without surgery this time, the sprained ligament is going to be very risky in the short term. I'm not expecting Motte to make it back, as reflected in the ERD. 

Erick Aybar (Foot)

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    Injury: Bruised foot

    ERD: April 25

    The Angels' medical staff did everything it could to avoid pushing Erick Aybar to the DL. He was given several days to try to heal up from what the Angels are calling a bruised heel, but couldn't. The team pushed him to the DL with a retroactive move over the weekend, meaning he could be back as soon as April 25.

    There is some worry that this is more than a heel bruise, but there's no evidence to support that. Aybar started having trouble after hitting the bag awkwardly and hard. He did appear to be making some progress, which is why the Angels held off on the DL shift, but finally they seemed forced into it for depth. 

    The Angels have shortstop depth, but adding Brendan Harris to an already struggling lineup isn't going to help anything. Aybar's injury should be brief enough that the team can get by without looking to the trade market.

Scott Sizemore (Knee)

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    Injury: Sprained knee

    ERD: Done for season

    I'll be honest—I can't remember the last time there was a failed ACL reconstruction in the NFL. Sure, we all remember Adrian Peterson or Wes Welker coming back quickly and showing no real problems, but the players that fade away are tough to remember outside of a database. I asked on Twitter, and the best anyone came up with was Cedric Griffin.

    That makes it all the more strange that baseball has had two such issues this season. First, it was Mat Gamel, which is an odd situation all around; then, it was followed with Scott Sizemore. It's unclear if this was a graft failure or a complete reinjury, but it's very unusual. Sizemore's injury happened on an odd play, but one that does have the classic mechanism for an ACL sprain.

    Sizemore had the knee repaired by Jim Andrews and should be on track to try returning again next spring. The A's have a lot of possibilities at second base, but are trying Andy Parrino first. 

    Maybe it's the name... 

Brett Lawrie (Core)

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    Injury: Core strain (intracostal)

    ERD: April 16

    Let's start with the good news for the Jays. Brett Lawrie is expected back on Tuesday (per MLB.com) after missing the first couple of weeks of the season with a core strain. The question is where he'll slot back in. The Jays had him play second base while on his quick rehab assignment at Single-A Dunedin, but the Jays intend to play him at third after he's activated.

    Toronto appears to have been toying with the idea of shifting Lawrie over to make room for Jose Bautista at third, but the organization has changed its mind about that right now, perhaps due to Bautista's back spasms. Lawrie does offer a bit of flexibility that may allow John Gibbons to shift things around to fill in where necessary and get the best possible lineup out there.

    Core strains do have a tendency to recur, but only early. Lawrie has had almost six weeks to heal up from the initial injury and showed no issues in his minor-league rehab. 

Jose Reyes (Ankle)

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    Injury: Sprained ankle

    ERD: July 10

    Now for the bad news. Jose Reyes will miss at least two months, with the Jays expecting three or longer. He won't need surgery after checking in with Derek Jeter's doctor, Robert Anderson, in Charlotte. The sprain is severe (Grade III), but the ligaments are not completely ruptured or detached from their anchor points. 

    Reyes has already begun rehab for the ankle, but we're weeks away from having any sort of visible milestone in his recovery. Doctors and trainers I spoke with were most concerned with his lateral mobility once he returns, rather than his speed. Second base isn't an option, since Reyes would be at more risk with his back to the turn, but DH is definitely something that might have to be considered, at least initially.

    For more information on Jose Reyes, click here.

Sergio Santos (Shoulder)

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    Injury: Strained shoulder

    ERD: May 10

    More Jays? Yes, and this time it's a recurrent injury to Sergio Santos. Santos made it back this spring from shoulder surgery, but has had continued problems with the triceps. As with Johnny Cueto, you need to think about the full anatomy before understanding how a triceps issue could be interrelated to the shoulder. Go ahead and reach back there and note that the three muscles of the triceps stretch from near the elbow to the shoulder. It's the anchor point that's key here.

    Santos appears to have shifted the weak link in his kinetic chain from the shoulder down a bit. As a converted player, it could be that his arm simply hasn't undergone the anatomic changes necessary to pitch at the major-league level. I won't bore you with a discussion on positive tendon changes or humeral retroversion, but if you want to dig in more on this, I'll just have you do your DuckDuckGo searches for today. I'll also note that the deceleration issues that are apparent in the picture above point to the next problem: his rotator cuff.

    Santos hits the DL in part to give the medical staff time to try some new strategies for maintaining the arm and in part to make room for Brett Lawrie. There's some opportunity in the DL, though it's clear that the Jays are struggling with injuries once again.

Giancarlo Stanton (Shoulder)

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    Injury: Bruised shoulder

    ERD: Unknown

    While teams like the Mets and Rangers are wondering how many prospects it would take to get Giancarlo Stanton into their laundry, the Marlins are wondering what it will take to get him back on the field. He's missed five games with what was thought to be a bruised shoulder, but the complete lack of progress has the team worried that it's more.

    The Marlins sent him to see the team doctor, and while there was no news from that visit aside from the lack of progress, we do know that Mike Redmond seems disinclined to play shorthanded. That Stanton is unable to even take batting practice has to be seen as a major negative. 

    Stanton was unhappy with the team's moves this offseason, but that doesn't seem to be in play here. The slugger has been a bit injury prone throughout his young career, and there's no major gain to the Marlins rushing him back. A healthy Stanton is key to the Marlins' future, whether he's playing there next year or not. Getting him healthy has to be the No. 1 priority, no matter if that costs them a couple weeks in DL time.

Michael Bourn (Finger)

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    Injury: Lacerated finger

    ERD: April 23

    Missing time is never good for any player or team, but some situations are better than others. The schedule can help, as can a flexible roster and a manager who doesn't feel hamstrung playing a man short. The difference between a week and 15 days lost can be pretty valuable and is more of a difference than many think. 

    The small sample size of the season gives us an indication how much the Indians might lose if Michael Bourn were pushed to the DL for his finger injury. In 10 games, Bourn has been worth nearly a win. Assuming similar production and noting that Drew Stubbs was exactly a replacement-level player last season, that's around three-quarters of a win with just one decision. Those Indians decision makers are smart. 

    Bourn had five stitches in his finger and hand, a difficult location since the finger's movement must be limited. He won't be able to play until that area has fully healed, so there's a bit of flex in that return estimate. 


    Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Rotowire.