Under the Knife: Latest MLB Injury Updates

Under The Knife has always been about more than just listing the injuries around baseball. Sure, the focus is explaining the injury status of players like Albert Pujols, Derek Jeter and Ryan Howard, among others. But, it's also been about updating the injury status of MLB in general and taking opportunities to find ways to reduce or prevent injuries. 

I like to take the intro to highlight some larger concept or an article from the last week that caught my eye on the topic of sports medicine. Today, you won't get that here. I started work on it, but when it gets close to 1,000 words, it's not an intro—it's another article.

So later this week, I'll show you what I was working on. The focus of the article is innings limits for young pitchers, specifically Matt Harvey, who is likely to add an inning of work at the All-Star Game (probably the first inning!) and how the Mets could handle him in the second half. With the counter-example of Stephen Strasburg and the attack on the Verducci Effect out there, this is something I've been discussing all season, but we're no closer to any big answers for the game of baseball.

For you panicking Mets fans, I'll ease your mind. They seem to be doing things the right way, using more of a checklist approach to when they'll shut Harvey down. Again, I'll have lots more on this later in the week. 

Until then, let's take a look around the league at some big-name injuries as we head into the All-Star break.

Albert Pujols (Foot)

Bill Shaikin of the Los Angeles Times had the news that Albert Pujols is considering offseason foot surgery. Pujols has been dealing with plantar fasciitis for almost his entire career. While the painful condition hasn't always been present, Pujols and the Cardinals medical staff did regular maintenance to make sure it didn't flare up.

Since Pujols came to the Angels, the doctors have done the same things, but haven't had the same results. This is odd and certainly a huge negative. While there's always some loss of knowledge and trust when moving from one location to another, this was a known problem for Pujols and had to be a focus. Instead, his condition has gotten worse in his second year, largely limiting him to DH duties.

Pujols hasn't changed anything but his location, and there's nothing about Angels Stadium that should be an issue any more than Busch was. He is wearing the same cleats and doing much the same things physically that he always has. He's put on no significant weight and had no major injuries that would change how he walks or moves.

With a 10-year contract in his back pocket, the Angels always knew that Pujols was likely to shift to DH sometime during the deal. No one, especially the team, thought it would be this early in the process. Surgery may give him a bit more freedom and a bit more time at first base, which would be a major positive for the Angels' roster flexibility.

Pujols at "33" is still just a handful of homers short of the magic 500 mark that will all but assure his ticket to Cooperstown someday. Yes, the age is in quotes because it's always been a question mark. His rapid decline over the past two years is going to make it even more of an issue as his aging curve starts to clarify.

Ryan Howard (Knee)

Ryan Howard is heading for knee surgery, but it's not the doom that many Phillies fans are making it out to be. In fact, the meniscus tear is about the best-case scenario for Howard. It's a simple surgery that will cost him six weeks or so and shouldn't have much of a long-term effect on him. 

Players have this kind of injury all the time in sports, and for a younger player, a meniscus repair is becoming more and more of an option. Salvador Perez, the young Royals catcher, had this at the beginning of last season as the team traded the first half of his season for a better long-term prognosis.

Phillies catcher Erik Kratz, a big guy like Howard with more stress on his knees due to position, is ahead of schedule from a similar surgery.

For Howard, he's neither young nor particularly reliant on his legs. Removing the damaged part of the meniscus may cause some trouble down the line, but that's more likely to mean he limps when he comes out on Old Timers' Day than has knee problems while in a baseball uniform. 

Howard did have some serious issues with his Achilles over the last year, though the tear itself was the least of it. The infection and resulting issues may have contributed to this knee injury, though with meniscus tears, it tends to be much more of a traumatic thing, as simple as taking the wrong step.

I'm not putting too much credence into how many surgeries Howard has had and am focused on whether or not he's able to come back normally from this one.

The Phillies will have plenty of options for taking up Howard's at-bats, as detailed by Bleacher Report's Tyler Brooke, but the more interesting question is whether Charlie Manuel will be able to cobble together something of value out of the various pieces while trying to keep the Phillies in contention.

While Howard's value is a bit overrated due to his reputation and power, his overall value should be relatively easy to replace. If Manuel can't do it, it might well be time for the first change on this Phillies team to be the manager.

Derek Jeter (Ankle)

Derek Jeter had no trouble during his initial rehab until he started running the bases. Jeter had progressed from ankle surgery to the field and batting, but it wasn't until that last hurdle that he had any issues. When he did, well, we know what happened next.

The Yankees have waited patiently for the secondary fracture to heal up, and now Jeter is back to running the bases in games. He is playing for Scranton/Wilkes-Barre (Triple-A), and in his first game back, showed a burst going from first to third. It's a very good, but early sign for Jeter's ability to play his kind of game once he gets back.

Jeter reported that he is having no problems during his first three games back, and while self-reporting like this always has to be taken with a grain of salt, it does appear that he's back.

Even in cases like Jeter's where there were complications, bones heal. Now the only remaining question is whether he'll need occasional rest or, at the very least, regular time at DH rather than his traditional spot in the center of the diamond.

If Jeter doesn't have any swelling or pain and is able to do the normal parts of a rehab assignment, he'll be back quickly. Thus far, things look positive. With the All-Star break coming next week, it's unlikely that the Yankees will rush things with him.

The Yanks do finish at home, but they also start back in Boston with key series against the Texas Rangers and Tampa Bay Rays following that. Expect Jeter back for all of them. 

And yes, Jeter just looks weird in any uniform other than the Yankees, pinstripes or not.

Curtis Granderson (Finger)

The Yankees shifted Curtis Granderson to the 60-day DL this week. Usually, that's nothing more than a paper move to get someone on the 40-man roster. For Granderson, it is a sign that his recovery from a broken hand is going much slower than expected, as noted by the New York Post.

Since being hit on his hand in late May and having surgery to fixate the bone, Granderson has made some progress. He's doing everything but holding a bat. The downside is that he's of no use to the Yankees until he can do that.

This is at the very long end of the expected rehab period for this kind of injury, so the Yankees are right to be concerned. Even once Granderson is back holding a bat, he'll need to get his swing back and show that the grip strength isn't an issue.

As with wrist injuries, fine bat control does take some time to come back and can create swing-and-miss issues at first. Finger and hand injuries don't tend to linger quite as long as wrist issues, however.

Granderson is at least another two weeks away, and the Yankees are hoping that he can be back before the trade deadline. With Derek Jeter, Alex Rodriguez and Michael Pineda all possibly back in the same time frame, it will make Brian Cashman's job at the deadline even tougher. It's nearly impossible to judge this team right now, and he may not have much time with what he thought would be his core.

Troy Tulowitzki (Rib)

Troy Tulowitzki is out on a rehab assignment. He's not far from a return to the lineup and the Rockies hope to keep him there for the rest of the season. As the team surprisingly fights for a playoff spot in the mediocre NL West, Tulowitzki's health, along with that of Carlos Gonzalez, could be the deciding factor in what could end up decided by a game or less. 

One of the ways that Tulowitzki is helping himself is the use of a rib-protecting layer. Believed to be an EvoShield, like the one at this link, it is similar to one that has been used in the past by Josh Hamilton after a rib injury he suffered a couple seasons back. The shirt can help to protect him from impacts, but he will need to do his part by avoiding lay-out dives and collisions.

Players coming back from rib injuries tend not to have any further problems after complete healing. There is a reason to worry if the player has a history of impacts or needs dives, but Tulowitzki has enough range and baseball IQ to play well without that. However, he certainly could fall back to that on instinct. 

Ryan Braun (Thumb)

The Brewers got some good news and bad news. They pushed Aramis Ramirez to the DL to help rehab his chronic knee issues and, at the same time, brought Ryan Braun back a bit early. It was expected that Braun would be back later this week after the nerve issues in his hand cleared up, but the open roster spot didn't have a better fill than him.

Braun isn't quite 100 percent, and while he was activated, it's not clear when he'll be available for more than just pinch hitting. It's likely still on track for later this week. He has been able to go through several batting practice sessions without issue.

As expected, the nerve problem in the palm of his hand and running up to his now-healed thumb just needed a bit more time to heal up. The thumb sprain healed up concurrently and also gave him the chance to re-focus. Braun does have a tendency to get beat up over the course of a season, though the Brewers do a great job with maintenance. 

I've also noticed that in many cases, winning makes Braun feel better or at least distracts him. The Brewers need to pull together, but if the team does end up a seller at the deadline, distractions may be tougher to find.

Then again... 

Yadier Molina (Knee)

If you subscribe to the definition of MVP that says the player that a team couldn't stand to lose, Yadier Molina is definitely near to the top of the list. Catchers that hit are rare, but leaders and inspirational figures like Molina are even more rare. He's the linchpin of the post-Pujols Cards, a team that is overplaying its true talent level yet again.

Molina injured his knee, but should only miss a few days. The Cards were very concerned, but an MRI came back clean and Molina is pushing to be back in the lineup as soon as Tuesday. The team will need to watch him closely and even consider how it can get him a bit of extra rest. There's little discussion of shifting him out of catcher, even with his bat as valuable as it is. 

Watch to see if the Cards start giving Molina more rest. With the All-Star break upcoming, they can be a bit cautious with his return. Going forward, they could look to chain off-days with travel days, keep him out of day-after-night games and other simple ways to keep a catcher rested. The Cards got a bit lucky with this one, but they need to think about the long term with their star as much as they do keeping pace with the Pirates this season.

Chris Carpenter (Shoulder)

Chris Carpenter is more than just a bonus right now for the Cardinals. As they get to the second half of the season and innings totals go up for Shelby Miller and Lance Lynn, the team's brain trust has to figure out ways to fill in some of the innings it will need as well as staying fresh for the playoffs.

If Carpenter becomes the answer for anything north of 50 innings, that's a huge bonus, even at the level they're paying him. (That money is sunk regardless.)

In his latest throwing session, Carpenter went 106 pitches, which is a lot for any session like this and has to be taxing. That the Cards would let him go that deep on just a session is a big indication that they're trying to figure out how his shoulder will hold up to a starting load.

While things are positive, it's the stamina and recovery that are the major issue. The Cards are an innovative team, so something creative, like pairing up Miller and Carpenter in a tandem, should be possible. I know there will be naysayers. People that will say neither of them could warm up properly or something nonsensical.

The key here is that that kind of arrangement would limit innings and be more valuable than what the Cards had to do with Lance Lynn last year after he hit the wall. Innovative or not, Carpenter's possible return is now needed. We'll get a better idea of when that might come in the next week.

Matt Kemp (Shoulder)

Peter Gammons had a great article earlier this season on the difficulties hitters have in coming back from shoulder injuries.

For Matt Kemp, one of the examples in the article is having more trouble with the shoulder. He's headed to the DL, according to Dylan Hernandez, and could be there a while.

Kemp had offseason shoulder surgery, but this recent issue, an AC sprain, indicates that the shoulder is not entirely stable currently. The surgery he had is a simple one, so it's more likely that the strengthening didn't work to get everything in the right place. Shoulders are very difficult to put back together due to the sheer number of moving parts.

Kemp will work to stabilize the shoulder with rehab and more therapy. The sprain shouldn't be a long-term injury, but unless the shoulder gets stable, this is going to become more of a long-term issue for Kemp and could sap both power and control. That this latest problem came on a simple swing is definitely a worrisome development.

Yasmani Grandal (Knee)

An ACL injury is not good for any athlete. It's definitely not good for a catcher.

Yasmani Grandal has had difficulties on and off the field this season, but a collision at the plate has ended it. He will need surgery, and his start to next season is at risk. There is no word on who will do the surgery, though Grandal will do some "prehab" over the next couple weeks while the swelling in the knee goes down before having surgery. 

ACL surgery has made a lot of advances over the last decade, most involving the rehab process, but the best results have come with players that are in very good shape. Grandal isn't built like most catchers, and that athleticism may help him return, though he's also not going to be mistaken for Adrian Peterson.

Baseball hasn't yet had someone reset the clock the way that Peterson, Robert Griffin III or Wes Welker has for football, in part because the injury so seldom happens. We'll see whether Grandal can be that guy and see a return time closer to nine months, which could have him ready for 2014.

At the same time, baseball is missing another opportunity to discuss the needless collisions at the plate. Grandal doesn't have the national profile of a Buster Posey, but until this play is removed from the game, we'll have these occasional injuries that will endanger careers and change teams, as well as showing lower-level players the wrong way to do things.