Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterApril 23, 2013

Under the Knife: Latest MLB Injury Updates

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    The NFL draft is this week, as you might have heard. The NBA playoffs have started, a two-month second season that will soak up a lot of attention if we get the expected LeBron James vs. Kevin Durant matchup. The NHL is getting ready for its postseason as well.

    Late April is the part of the baseball season where people look away, and that's a mistake. The games here count just as much, and injuries happen just as quickly. Three or four starts is enough to show us which pitchers are making their normal recoveries. We're starting to see rehabs that took a bit longer to come together.

    We're also getting a solid look at depth. Traumatic injuries will happen. Players will strain an oblique or a hamstring, and at that point, we get to see how a manager can handle the situation. Late April might be the best time for that, and it gives some real insight if you know where to look.

    Let's take a look around the league at all the injuries, the comings and the goings, and I'll see if I can guide your eyes to the right spots and your fantasy team to the right moves.

    So, on to the injuries.

Albert Pujols (Foot)

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    Sometimes it's fun to wonder just how good Albert Pujols could have been.

    Oh sure, he's had a Hall of Fame-caliber career already, but he's put up those numbers, including 477 homers, while never being fully healthy. Pujols has dealt with back, hip and elbow injuries, as well as a long-standing issue with plantar fasciitis. It's the latter—the painful foot condition—that has him hurting now, stuck at DH and missing his power stroke. 

    The pain has gotten worse for him lately, but there's no real answer here. Pujols and the Los Angeles Angels medical staff are trying to maintain the foot, but if he's "dying," the only solution is going to be rest. Pujols does not seem inclined to go on the DL for a time, nor is surgery an option yet, so we're stuck with the status quo. The downside here is that a DL stint wouldn't necessarily make things better, so they need to have a feel for where rest will get him and how it will change things.

    Pujols will stay at DH while the team tries to find ways to rest him. One possibility is for the Angels to bench Pujols over a period of time built around off-days, weather and opponent matchup. The medical staff should get an idea over five or so days as to what a DL stint could do. It's a very tough position and limits the roster flexibility that Mike Scioscia cherishes. 

    Pujols once looked like he would break Barry Bonds' home run record, but he may finally be felled, or at least hobbled, by the injuries he fought through when he was younger. The Angels might be financially protected from the contract, but there's no way for them to replace Pujols' production if he's forced out for an extended period. 

Jason Heyward (Appendix)

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    UPDATE: Tuesday, April 22 at 8:34 p.m. ET: Heyward was placed on the 15-day DL by the Braves on Tuesday afternoon, according to ESPN.

    ---end update---

    Appendectomies aren't what they used to be. A lot of us carry a three-inch scar on our lower right quadrant from an old scalpel-based appendectomy. Kids today have the fancy laparoscopes and almost no internal issues just days after removing the vestigial organ.

    Jason Heyward had a laparoscopic appendectomy (warning: link shows surgery) on Monday night in Denver and is recovering comfortably. The Atlanta Braves are watching his recovery over the next day to see whether or not he'll need to go on the DL.

    In the past couple years, we've had some players who did this. Matt Holliday returned in just 11 days after a similar procedure. Adam Dunn famously came back after just six days, but he struggled and admitted later he came back too quickly. 

    The Braves don't like to play shorthanded, and with Dan Uggla dealing with a mild calf strain, it's likely the Braves will push Heyward to the DL. It should be a minimum stay, and we have to hope that Heyward's experience is more like Holliday's than Dunn's. 

Ryan Zimmerman (Hamstring)

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    Ryan Zimmerman has struggled since returning from his offseason shoulder surgery. While things looked decent during the spring, he hasn't regained his normal swing and has had throwing issues as well. A hamstring injury isn't related, but it does give Zimmerman a chance to rest and regroup while the Nats look at Anthony Rendon to decide if he's the future instead.

    Zimmerman is only expected to miss minimal time, but he can use his time off to rebuild his game a little bit. It wouldn't surprise me to see him get a rehab stint to do some extra work and gain confidence, especially if Rendon continues to hold his own.

    The longer-term concern here is that Zimmerman's shoulder doesn't appear to be holding up well. If he can't make the adjustment, the Nats have some roster issues. Zimmerman can't shift to first due to the re-signed Adam LaRoche, and the arm issue precludes the outfield. 

    Watch to see when Zimmerman shifts back to swinging and when he goes on a rehab assignment. It will be a bit tougher than most injuries to get a heads-up on exactly when he'll be back, but when (or if?) he starts hitting again at his normal level is obviously the best indicator.

Chad Billingsley (Elbow)

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    UPDATE: Tuesday, Apr. 23 at 4:28 p.m. ET by Will Carroll

    Chad Billingsley will need Tommy John surgery:


    Chad Billingsley will undergo Tommy John surgery tomorrow, April 24. Recovery time is expected to be 12 months.

    Los Angeles Dodgers (@Dodgers) April 23, 2013

    ---end update---

    Chad Billingsley missed the last part of the 2012 season with an elbow sprain. The Dodgers were aggressive, treating him with PRP and a throwing and rehab program that allowed him to avoid Tommy John surgery.

    At the very least, Billingsley should be rested for some time. He is having more issues with the elbow, and the worry is that the sprained ligament did not hold up under usage. Ligaments can scar in and repair themselves, but the UCL—the ligament replaced in a Tommy John reconstruction—can only handle a very small tear before it becomes non-functional. 

    If Billingsley has re-injured the ligament, he could be facing reconstruction and a year off. The Dodgers were right to do everything they could to avoid that, and we'll have to see whether they can hold it off longer.

    Billingsley's elbow was risky before, and this latest episode makes it difficult to expect him to hold together absent surgery.

    The Dodgers' pitching depth seems to be coming apart, but that's why they had so many starters—even risky ones like Billingsley and Ted Lilly—in the first place. 

Brian McCann (Shoulder)

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    Brian McCann had a very minor setback over the weekend as he continues to progress toward a return to the Braves lineup. He developed a sore wrist and went back to Atlanta to be seen by team doctors.

    However, he returned quickly from what seemed to be no more than a minor sprain at worst. 

    McCann is expected to shift his work behind the plate this week. Throwing is the major concern, and the Braves are very eager to see where he is. If he can't throw credibly, the team will have to make some tough decisions.

    The emergence of Evan Gattis helps, but the Braves are unsure whether they can afford to carry three catchers. Gattis can play first, but Freddie Freeman is back and takes that option away most days. The weak spot in the lineup is at third, so Gattis might get sent down when McCann comes up with the idea of getting him some work there. The Braves simply don't know yet and won't until McCann shows what he's got left.

    McCann has Gattis and Christian Bethancourt coming up behind him and is playing out his option year. This could go in any number of directions, making it as difficult to read as any I can remember. The best choice is to avoid McCann as well as any speculative plays on Gattis or Gerald Laird. 

Freddie Freeman (Core)

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    People seem to like conspiracy theories. One of the top ones in baseball is that the DL is often misused as "shadow moves" that are more about the roster than they are about injuries. It happens, but they are few and far between. The paperwork necessary to put a player on the DL is seldom checked, more for fear that teams will start calling each other out than anything. Still, there's a minimum standard.

    However, there are moves that allow a team to do things in the interim. It's possible that Freddie Freeman could have avoided the DL, but the move kept Fredi Gonzalez from playing shorthanded—something he is powerfully uncomfortable with—and gave the Braves the chance to play around with Evan Gattis a bit. That's not a shadow move; it's good roster management.

    Freeman is back from his minor core strain and was in the lineup Monday. Core strains tend not to recur once a player gets to this point, so there's no reason not to have Freeman back in most fantasy formats. It's too early to say that the swing is comfortable and the power is back, but it's easy enough to watch for that if you're keeping Freeman stashed or in weekly leagues.

Brett Myers (Elbow)

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    Any sort of elbow sprain is bad. Even when teams say a pitcher has a "mild UCL sprain," I start to get worried. For a pitcher like Brett Myers who has plenty of mileage on his arm, even minor issues in the pitching elbow raise big red flags.

    Myers is said to have tendonitis in his flexor tendon, another bad sign, and only very mild damage to the UCL itself. He does have one of the better medical staffs around in his corner, with Lonnie Soloff great at both maintenance and rehab. He'll need it. 

    With elbow injuries, the worry is more about control. The first sign is often that a pitcher begins to be wild in the zone or can't find the right release point, leading to problems with breaking balls and hitting the strike zone. Myers hasn't shown more of that than normal, so that's another positive for him. 

    Myers, Scott Kazmir and Daisuke Matsuzaka were supposed to be placeholders, allowing the Indians to retool and get young pitchers some extra time. If they have to go to Trevor Bauer too early—and they seem powerfully disinclined to do so—they'll end up taxing that same young rotation by the end of the season.

Kyle Lohse (Finger)

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    Dislocations are painful. There's lots of apocryphal stories out there about players doing silly things when they're trying to get the dislocation reduced. They're likely true, as any catcher or quarterback can tell you. You don't see them much in pitchers, but Kyle Lohse had one in Monday's game against the Padres in a bit of a freak fashion. 

    Lohse injured his left pinkie finger as he ran to first base. He got a bit too close to Jedd Gyorko as he passed and caught his finger on his elbow or jersey. It popped out and was put back in to place by the medical staff. Lohse told Tom Haudricort that he'd had issues with it before, which may have contributed to the injury.

    Lohse's injury is on his glove hand, so it will be easy to protect the finger. It should have no effect on his pitching or mechanics when he makes his next start. The Brewers will finalize that he will make that scheduled start after he does his side work, but there's no reason to worry too much. They are on a roll, and the acquisition of Lohse is one of the reasons why this team is playing with confidence now after a slow start.

Colby Lewis (Elbow)

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    The Texas Rangers might have a crowded rotation soon. Even with the loss of Matt Harrison for a couple months, the Rangers' pitching depth is apparent.

    Nick Tepesch and Justin Grimm are holding things down at the back of the rotation for now, but with players like Robbie Ross and Derek Lowe in the pen, getting Colby Lewis and Martin Perez back will provide Jon Daniels with some tough decisions in the next few weeks.

    Lewis is getting close to a rehab assignment. He'll do a couple live batting practice sessions and some controlled innings in extended spring training before heading out, likely to Double-A Frisco or Triple-A Round Rock. Since Lewis didn't have any real spring, he'll need three or four starts to build up his arm strength. 

    Players coming back from surgery on their flexor tendons usually have good results. The time it takes to come back is less than Tommy John surgery, and they don't seem to have the proprioceptive issues either. Watch for Lewis to have good control and movement on his sinker.

Nick Tepesch (HAND)

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    The season is several weeks in, and pitchers seem to be dropping like flies. That's not unusual, but a number of pitchers, including Rangers rookie Nick Tepesch, have been hit on the arm or hand by comebackers. We started this season without any new protection for pitchers, though MLB had been testing head protection after Brandon McCarthy's scary headshot last year.

    Hits on the hand are just odd; I can't find a significant record for them or any reason why they would be up. With batters hitting the ball harder overall, the reaction time is down, so perhaps this is a consequence of that with a bit of bad luck mixed in.

    Tepesch may not miss any time, but all he has to do is look over at Martin Perez, still healing from a broken arm and giving him a shot at the rotation, to know how it could have been worse.

    There's no way to completely protect pitchers, but doing nothing is terrible. If Nick Tepesch or any other player chooses to go out there without protection, fine. I'm more worried about the kids that watch them.


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