Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterApril 30, 2013

Under the Knife: Latest MLB Injury Updates

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    Just look at the names in this week's UTK and you'll see the issue. Giancarlo Stanton, Zack Greinke, Troy Tulowitzki, Stephen Strasburg—these are big-time stars, with most making big time money or carrying the hopes of a franchise on their back.

    Instead of being on the field, these players and more are in the training room or worse. The inability of Major League Baseball to keep even their biggest stars healthy is a true indictment of the last decade. Some can't be helped, but some can, and those opportunities to save money and keep the talent on the field are often being missed.

    Let's take a look around the league to see what's going on with the biggest names and biggest injuries in another week of Under The Knife:

Giancarlo Stanton (HAMSTRING)

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    Giancarlo Stanton went down in extra innings against the Mets and his posture said it all. He laid face down on the turf, frustrated and in pain, a feeling that Marlins fans know all too well. Stanton is once again waylaid by injury and could miss significant time.

    This time, it's a significant hamstring strain on the same right leg that cost him part of last year. There's no real connection between the minor knee surgery from last season and this strain, the result of a clear trauma on a hustle play, but it is his power leg. Stanton may have power to spare, but there are concerns that with enough injuries chipping away at his young legs, he may end up with old-player skills sooner rather than later. 

    Stanton was pushed to the DL quickly and is headed for an MRI Tuesday afternoon. That image will help determine how long Stanton will be out, but it's clear this is going to be more than the minimum for the Miami slugger. 

    For more information on Stanton's injury, click here now.

Stephen Strasburg (ELBOW)

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    Mike Rizzo says that Stephen Strasburg's arm is "structurally perfect." This depends on how you define the terms, which makes Rizzo's phrasing downright Clintonian, perfect for the inside-the-beltway crowd. 

    Of course, Strasburg's arm does have a reconstructed ligament, likely a hamstring or wrist tendon that was re-purposed in surgery two years ago. With his most recent forearm issue, Rizzo appears to be using the common non-medical definition that a muscle is not a structure. 

    Strasburg was unable to get loose on Monday night, repeatedly shaking his arm. The Nats say that it wasn't an elbow issue but was "tightness in the forearm." This recalls the flexor mass issue that Dylan Bundy is dealing with (more on him later). 

    Strasburg is taking anti-inflammatories to deal with the issue, meaning this is more than cramping. While Strasburg and Davey Johnson insist that Strasburg is not going to miss a start, the organization has been ultraconservative with him at every point, with poor results to boot. 

    While it's impossible to say "don't panic" to a population used to panicking over any small thing with their star pitcher, there's no facts to support that this is anything more than what the Nats say. Then again, it's a reminder that all their previous precautions and limitations haven't worked.

Hanley Ramirez (THUMB)

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    The Dodgers surprised many by activating Hanley Ramirez before Monday's game. Ramirez was expected to miss two months after his thumb injury that he suffered in the World Baseball Classic. Instead, Ramirez passed all the physical tests and was able to return to the Dodgers lineup in just over a month. 

    Thumb injuries are usually tough to come back from, lingering a bit and showing up in terms of fine bat control. Any deficit in grip strength makes it tougher to adjust to the dips and dives that MLB pitchers put on the ball. It shows up and increases in swing-and-misses and strikeouts. It's often very easy to see. 

    Ramirez looked comfortable in his one at-bat Monday, but he did strikeout. It's too early to know anything, but now you know what to look for. Ramirez should have no real problems in the field, though he may have some mental reservations until he gets a bit more comfortable. 

Troy Tulowitzki (SHOULDER)

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    Rockies fans can exhale a bit. In the thin air, that can be dangerous. Troy Tulowitzki escaped serious injury and significant missed time after straining his rotator cuff on a play at the plate. It's an unusual mechanism but one that is thankfully minor.

    The strain is on the non-throwing side for Tulowitzki, causing him issues at the plate. Tulowitzki, like many players, finishes with a Lau/Hriniak one-handed follow through. His Monday batting practice session showed that he could take his normal swing without issue. That means he could be back as soon as Tuesday, though the Rockies are likely to be conservative with him.

    The Rockies got some nice defensive work from Jonathan Herrera on Monday, giving the team some additional confidence on top of their NL West lead to keep Tulowitzki out if needed. It's unlikely that will be very long, given the nature of the injury and Tulowitzki's Dirtbag mentality. There should be no long-term issues with this shoulder as long as Tulowitzki is able to avoid contact or any other sort of traumatic setback.

Brian McCann (SHOULDER)

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    Things are taking a positive turn for Brian McCann. The Braves catcher is looking to hold on to that latter designation, showing signs that he'll be able to stay behind the plate and not be a massive defensive issue. 

    McCann started his rehab assignment last week in Low-A Rome and is hitting, putting two balls in the seats in his first game. Of course, hitting homers off Low-A pitchers isn't that big a deal and the focus was much more on what he did behind the plate, not at it.

    It's a small sample, but the first game was solid. The Grasshoppers only had three baserunners, with one of them reaching base on a double. It's going to take a lot more to know just how big an issue this will be, but take the positives where they come.

    McCann is scheduled to do five games at Rome, then shift to Triple-A Gwinnett for another five games. That puts McCann back on the Braves roster on May 6th.  

Jason Heyward (CORE)

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    Jason Heyward confused a lot of people, including myself, when he talked about his return from an appendectomy last week. Instead of a quick return, Heyward tossed out a late May return date to Dave O'Brien. 

    Heyward's operation was done laparoscopically, which normally gives a very quick return due to the small incisions and limited disturbance of internal structures. Matt Holliday returned in days, not weeks, without complications, as have others, including Curt Schilling. There's no clear reason why Heyward would need time much beyond the 15-day DL—unless there are complications we're not aware of.

    There was no clarification from the Braves on Heyward's statement, so this is one we're just going to have to watch. This article from MLB.com does show that Heyward is not recovering at the normal pace, which isn't an indication of anything besides a current lack of confidence by Heyward. That's tough to overcome for a medical staff.

    Heyward should be beginning some activities a week post-surgery, so look for those to occur, or not.

R.A. Dickey (NECK)

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    The move to Toronto has been something of a pain in the neck for R.A. Dickey. No, I mean literally. Dickey is dealing with pain in the lower part of his neck and/or the upper part of his back. He can pitch effectively, but he's uncomfortable doing so, which seldom turns out well.

    The Jays sent Dickey for some imaging to try and figure out what the root cause of the issue is. It's not a condition that is going to DL him or even force a missed start yet, but getting him comfortable may help get him on track. 

    The Jays medical staff will take those results and try to find a more effective treatment for Dickey in the coming days. The team has adjusted his workload between starts to try and buy him some rest, though it has had no effect just yet. 

    There's no connection between this injury and Dickey's knuckleball, per se, though it may be that his delivery does have something to do with it. He has a very upright delivery that moves forward sharply at the hips. I'd be curious to see a motion capture that shows whether his head is forced back and has to try and catch up through the delivery, the way Roger Clemens did

Zack Greinke (SHOULDER)

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    It surprised some when news broke that Zack Greinke was scheduled to throw. For the Dodgers, this was the plan all along. Greinke is reportedly throwing up to 90 feet and is making solid progress, though the time line for his return has not changed.

    Greinke is able to throw this early due to the fixation of his collarbone, not in spite of it. Instead of having to wait for the healing to stabilize the bone and make it possible for it to not be set back by the motion, the fixation has it mechanically stabilized. 

    What this doesn't do is change the time line significantly. Greinke is still going to be out until late May at the earliest. The throwing will keep him more ready and keep the rehab from needing to build stamina. Instead of three rehab starts or more to get up to the needed workload, Greinke may need only one or two. 

    The next milestone will be when Greinke gets on a mound. That could come in the next few weeks but is more likely to happen in mid-May. From the point he gets on a mound to the time he comes off the DL should be about two weeks, so if he's floating out there on your waiver wire, that's your signal to pounce. 

Jered Weaver (ELBOW)

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    If Zack Greinke is back early (potentially), what about Jered Weaver? There was plenty of talk after the fracture in his elbow was found that he could be back more quickly than the four- to six-week time frame given initially.

    It seems that Weaver is on the same pace as Greinke. Weaver started throwing over the weekend and will start stretching out his arm to the point where he's ready to get on a mound. That could be a bit more quickly than Greinke, so watch for a quicker progress on the long toss. 

    The fractured arm shouldn't be an issue once Weaver returns, though the team will have to keep a close watch to make sure Weaver doesn't make any subtle mechanical changes as a result. Weaver does not appear to be wearing any sort of bracing or protection while throwing, an indication that he'll be normal (if vulnerable again) once he does return. 

    As with Greinke, the key milestone will be getting back on the mound. Throwing so quickly means little loss of stamina, so Weaver could be back in the Angels rotation sooner rather than later.

Dylan Bundy (ELBOW)

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    Ignore the word "elbow" above. The big takeaway from Dylan Bundy's visit to Dr. James Andrews is that there is nothing wrong with Bundy's elbow. The focus is on the flexor mass, a group of muscles in the forearm that has either a mild strain or a persistent cramp. The elbow itself, including the all-important ulnar collateral ligament, is fine. Bundy had a PRP injection into the affected muscles and will be shut down for six weeks.

    The problem now is that no one really seems sure what the root cause is. There's some speculation about it being the way he takes the ball from his glove, while others focus on Bundy's long toss and workouts. The Orioles strictly limited Bundy last year, took away some of his pitches and still ended up with this issue. 

    The injection will need some time to work, as we saw recently with Jason Motte, and the six weeks of rest will be a challenge for a player like Bundy. Assuming everything is normal in a couple weeks, he'll begin throwing and could be back on a mound by early June, which probably pushes his return to Baltimore past the All-Star break.

    This is also a reminder that a visit to Dr. Andrews is not, as I said on MLB Network last week, like a visit to the Undertaker. For more information on why pitching injuries continue to be such a problem for MLB, click here