Under the Knife: Latest MLB Injury Updates

Will CarrollSports Injuries Lead WriterMay 14, 2013

Under the Knife: Latest MLB Injury Updates

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    There are a lot of pitchers close to comebacks. With Zack Greinke making a quick comeback from his collarbone fracture and Jered Weaver not far behind him, not to mention Johnny Cueto's return, we will see a lot of pitching coming back to the mound. The problem is that there are just as many heading out with injury. 

    It's been 15 years since Pitcher Abuse Points was debuted by Dr. Rany Jazayerli, and it may be the most influential piece of baseball research in the history of the game.

    When it came in, 150-pitch games were a regular occurrence—not common, but regular—and today, the media freaks out when Yu Darvish goes 127. Managers, even the ones that say they're not sabermetrically minded, are managing by a stat, just like they are handling their bullpens by the save. 

    The issue is that while Jazayerli's research was intended as a warning against regular overuse and gave teams a tool by which to measure the risk of an extended outing, teams decided against measuring and largely abandoned the practice. Adding to the issue was the contemporary La Russization of bullpens, increasing the size and changing the usage of the pen. It allowed managers to pull their starter at 100 pitches or less.

    I'm not advocating a return to the days of complete games and huge pitch counts. Those aren't coming back. Pitchers have to throw too hard to today's power-filled lineups and don't have the ability to "coast." (Though I do think they have the ability to try and force hitters to act more quickly in counts, but that's a story for another day.) 

    I do think that another shift in pitching usage could help—a progressive approach to development and usage, a data-driven approach or maybe something I haven't thought of. There are a full complement of smart people inside the game and more pitching wisdom than I can catalog. Plus it's impossible for these people to say that change isn't possible since the game has changed drastically already

    It's going to take one smart team with the guts to take some risk that wins with a new plan before everyone else will follow. We'll see who wants to be the kind of team the Cardinals were over the last decade. You know—winners.

    For now, let's get to the injuries... 

Zack Greinke (Collarbone)

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    When Zack Greinke was initially injured, the standard line was that this would be a six-to-eight week injury. Instead, we're looking at a month, with a couple weeks of Greinke's seasons added by a smart and aggressive medical plan. 

    Greinke had his collarbone fixated. That rod inserted by Dr. Neal ElAttrache allowed Greinke to throw almost immediately.

    In most cases, a pitcher would have to wait a few weeks for the bone to heal enough to handle the jostling the throwing motion creates. By having the collarbone fixated, Greinke didn't lose any time, any arm strength or any stamina. 

    Greinke threw 80 pitches at Single-A Cucamonga, showing no issues at all with his pitching, and will go again on Wednesday. The Dodgers haven't decided if it will be another rehab start or if they'll go along with Greinke and bring him back to Los Angeles. It seems as if they're leaning to bringing him back, given their sudden lack of pitching depth and their record.

    Greinke shouldn't have much issue once returning. The pitching arm is fine and the collarbone seems to not be an issue either. At five weeks post-injury, it shouldn't be, even without the fixation. Three weeks could mean four starts, a value that could mean a lot to the Dodgers come October. 

Jered Weaver (Elbow)

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    With Zack Greinke back, Jered Weaver shouldn't be far behind. They didn't have similar injuries, but both were to the glove-side, making these quick returns possible. 

    Weaver is throwing off a mound, but the word out of the Angels is that Weaver is "working on some things." Those things are command and control. The Angels hope to see them return over the course of his next few bullpen sessions. Once he's done that, he'll have a similar rehab plan to Greinke with one or two minor league starts.

    The question many are asking is why Weaver is having command issues. The injury was to the glove-side, but it appears it may have had some effect on his mechanics. Weaver is a very long pitcher with a lot of moving parts to his delivery, so even the glove-side is going to have an effect. 

    The command should return, and the control shortly after. Weaver has never had a problem like this before, so the evidence suggests it's simple rust and finding his release point consistently. When he does head out on rehab, watch to make sure that he's finding the strike zone and missing bats. 

Bryce Harper (Face)

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    Bryce Harper needs to stop running into walls. 

    No, I'm serious. Harper is one of the most talented players I've ever seen, with the ability to do everything on the baseball field. What differentiates him in many ways is his flat-out hustle and drive. He dives, he slides and yes, he'll track that fly ball right back into an unpadded wall—on a sprint, too.

    Stop it, Bryce.

    It took 11 stitches to close up the gash on his neck, something that will keep Harper out of the lineup for a couple days. The worry is not that he'll do this specific thing again, but that the next one will be worse or that the sum total of all these minor injuries will take away some of his physical gifts.

    It's going to be hard for him to slow down. It defines him, internally and externally. Inside the game, almost to a man, Harper is regularly compared to Pete Rose for his style of play. The thing is, Rose never had any of Harper's gifts, just the hustle.

    Maybe Harper could be that kind of player if forced, but if he could just slow down a bit—one less dive, a bit less wall—we could see him more like another player: Mickey Mantle. 

B.J. Upton (Shoulder)

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    We can't blame this one on Bossman Senior.

    B.J. Upton left Monday's game after being hit on the left shoulder, the same one with which he's had chronic issues. He had surgery on the shoulder in 2008, repairing a significant tear in his labrum. That injury has seemingly cost him some power. 

    What's interesting is that his brother and now-teammate Justin Upton had a very similar issue a few years back. Instead of having surgery, Justin was able to rehab through it and has kept the power. It certainly suggests some genetic element to the issue.

    Getting hit by a pitch won't cause major issues, but the Braves had to take the tightness seriously and get him out of the game.

    Upton—B.J. Upton, that is—won't miss significant time and shouldn't have any real issue once he returns. It's just a reminder that the Braves know what they got when they signed Upton and that Jeff Porter is determined to be proactive with both Uptons. 

Curtis Granderson (Arm)

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    The Grandy Man cometh. Maybe as soon as Tuesday. 

    Curtis Granderson has had nothing but success while playing with the new-look Scranton Railriders. The Triple-A Yankees affiliate has seen Granderson hit over .400 and show good power and defense as well. The arm has healed and is clearly not a problem.

    Remember, it's the arm that was injured and not the wrist. In this case, it makes a huge difference. A wrist injury can cause a lack of power and bat control that can linger, sometimes for a long time. A fractured arm, like any bone, simply heals up.

    Once healed, things get normal pretty quickly, which is what Granderson has shown.

    Granderson is the first of a couple returns the Yankees should get in the next few weeks. Mark Teixeira should be back at the end of the month once the 60-day clock expires, and Derek Jeter is something of a mystery right now. With how the Yankees are playing right now despite all the injuries, it's fair to ask if adding talent will actually make the team better. 

Austin Jackson (Hamstring)

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    Curtis Granderson is coming. Austin Jackson is going. That patterns seems to be repeating.

    The two outfielders were once traded for one another, a deal that has worked for both teams. The Tigers will have to see how they play without Jackson for a couple weeks.

    Jackson has a moderate hamstring strain and was retroed on to the DL back to the weekend. The team gave Jackson a couple days of rest and working with Kevin Rand before pushing him to the DL. While Jackson doesn't need the full 15 days, the rest should help him heal up fully.

    Speed players with hamstring issues are a big worry, but while Jackson is a speed player, he's not solely a speed player. His most valuable asset is his ability to get on base in front of the power hitters, but his legs are key to the future of the team. Jackson needs to stay in center to allow Nick Castellanos and Avisail Garcia to stay on the corners. 

    Expect Jackson to miss the minimum and to return to normal quickly. Andy Dirks will pick up the workload in CF, which could make him a decent short-term pickup in deeper leagues.

Johnny Cueto (Core)

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    Johnny Cueto had a nice, if short, first rehab start last week. He went 50 pitches at Low-A Dayton and will go around 75 in his second stint on Tuesday. Assuming all goes well, Cueto should slot back into the Reds rotation over the weekend.

    The core injury, an oblique, didn't show any issues during the rehab start, which is the best indication that it is healed.

    While these types of core strains have a tendency to recur, it usually happens early on before the muscle has healed. As long as the medical staff can keep a player from overdoing things early while balancing the need to stay in shape, it's a relatively simple return.

    The Reds will have to decide how to slot Cueto back in. Tony Cingrani has been a very solid replacement (37/6 K/BB) since Cueto was out, meaning Mike Leake might be on the way to the 'pen. Since Cingrani is unlikely to be able to go deep into the season without fatiguing, Leake might be a good backup.

Bud Norris (Back)

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    The Astros are already 15 games back in the AL West, which shouldn't surprise anyone. With Bud Norris hurting, it may be harder for them to get worse by trading him, which they have been trying to do since before Opening Day.

    Norris' back spasms are not yet serious enough to push him to the DL, something the Astros are loathe to do. The trade prospects go down with a DL stint, even more than the shellacking that Norris took. Scouts I have spoken with may laugh about the Astros, but they'll also admit that it's very tough to judge the team.

    One advance scout told me this week that the team may be the toughest to read that he's ever seen. "They're unorthodox to the point you wonder if it's inexperience, if they don't know what they're doing or whether it's intentional."

    Norris is day to day as the medical staff works to get him ready for both his throw day and the next start beyond. Early signs are positive. The medical staff and the team's injury stats will be what to watch this season, as those can often be leading indicators for future success.

Colby Lewis (Elbow)

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    Colby Lewis had a significant setback in his return from flexor tendon surgery. It's not a recurrence, but it is an arm problem, something that the Rangers will have to be very careful with as he tries to return.

    The triceps inflammation is likely a classic cascade, the result of a minute change in Lewis' mechanics. It could be the layoff or it could be something functional post-surgery, so a team and a medical staff can't take any chances.

    Lewis was shut down, given an anti-inflammatory shot and pulled off the rehab. He'll restart with a throwing program in about a week and could be back on another rehab assignment by June.

    The Rangers will be watching closely and may have to take another look at Martin Perez, who was optioned to Double-A Frisco (just across town from Arlington) instead of being sent on a rehab. It will function the same for Perez.

    In the meantime, Justin Grimm and Nick Tepesch will continue on in the Rangers' rotation. Neither has pitched their way out of it yet, though a healthy Lewis should be able to force his way in. We'll have to wait a few more weeks, which gives Jon Daniels some more time to make that decision. (By the way, Jon, how was that burger?) 

Chris Carpenter (Shoulder)

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    Chris Carpenter is going to give it one more shot. As I expected, Carpenter rested his shoulder for a few months and decided to give it a try here in May. He's a long way off from a return and any return remains quite the longshot, but giving it a try doesn't cost the Cardinals anything extra just yet.

    The hope is that Carpenter can come back enough to contribute to the bullpen. The upside there might be taking over the closer role, something Adam Wainwright has done in the past.

    The problem is that Carpenter's shoulder may never be able to handle pitching on back-to-back days, let alone handle the closer role. 

    There's a chance that Carpenter could act as a long man, perhaps taking some innings off young starter Shelby Miller, whom the Cardinals want to manage closely. That kind of role would be valuable as well.

    As for the cost, yes, it could hurt the Cardinals' pocketbook. The Cards are covered by a standard disability contract on Carpenter, meaning that a comeback would be on their dime and not the insurance company's. Any comeback is likely to be at the end of the season, much like last year.

    If he can contribute, the Cardinals will take it and not penny pinch.