Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterAugust 6, 2013

Under the Knife: Latest MLB Injury Updates

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    The Biogenesis saga has become the Alex Rodriguez saga. Rodriguez was hit with the oddly-constructed 211-game suspension on Monday and without explanation or evidence, it's hard to have much of a position based on facts, though that hasn't stopped many. 

    What's been most interesting to me is how little people seem to know about the testing program. Referred to as the "JDA" or joint drug agreement, it spells out in minute detail how the program is supposed to work. It's legalese, but important legalese. 

    Few seem to understand "A" sample and "B" samples, collection procedures, location registration, methodology for randomization, but I wouldn't expect them to. I can see why people might gloss over lists of chemicals, appeals procedures and even the precise language requiring secrecy throughout the process, up to and including the wording of press releases. 

    This document, negotiated and re-negotiated by the commissioner's representatives and the players' association was supposed to have governed this process but instead was shattered by it. Whether it was Bud Selig's edict, congressional grandstanding or a public perfectly willing to let both sides make end runs around the letter of the law, the JDA is now not worth the paper it's printed on.

    A few weeks ago, I wrote an article here at Bleacher Report discussing possible replacements for Bud Selig. I ended up with his most likely "replacement" being Selig himself, with the commissioner set up to once again extend his reign. Now, I'm not so sure. This episode has weakened the position of the commissioner's role. The MLBPA will not allow the "integrity clause" to be as unfettered as it has been since the days of Landis and negotiations on the JDA itself will end up more tense. Selig likely doesn't care.

    Selig has instead lashed his legacy to this mast, forever tying himself to the beginning, the heyday and perhaps the end of the so-called steroid era. Selig wishes to be remembered as the commissioner who revived the game and perhaps saved it from an enemy greater than even an angered public after the World Series was cancelled. 

    This was Selig's moment, when he stood at the lectern and pronounced his sentence on Alex Rodriguez. While appeals and who knows what else in this saga awaits us, down to a potential 2015 return, Selig should seal the moment with his own resignation. It is clear that he feels this is his defining act and that nothing after could compare.

    Selig dropped the hammer. Now he should drop the mic.

    But there's still injuries around baseball, so let's take a look around the league:

David Wright (Hamstring)

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    The Mets have had some moments this season. Matt Harvey had a great first half and that nice interview skit on Jimmy Fallon. They had the All-Star Game, and that came off pretty well. Aside from that, there's not much even memorable about this team, though that's not a bad thing for a team that's showing signs of turnaround.

    David Wright is the face of the franchise, not a bad thing in a town where the crosstown icons are either pending suspension, broken or retiring. Wright hitting the DL with a hamstring strain isn't good, but it could be worse. There's no reason to rush him back or push him to stay off the DL. It was on a hustle play. Even if this was worse—and it's not—he's not a speed-reliant player. 

    This is your everyday, garden-variety hamstring strain, a low-to-mid-grade version that should heal up at or near the minimum. A couple more good players and Wright will be back to playing meaningful baseball before he's too old to contribute. These couple weeks off don't affect that plan or his part in Sandy Alderson's grand vision.

Derek Jeter (Calf)

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    Derek Jeter can't stay healthy this season. He's described it as a nightmare and it's hard to argue. The question now, after a mild calf strain pushed him to the DL, is the same as the one we asked a couple years back: Is he done?

    In this case, it's not so much age as it is the pattern of injuries. He started with the traumatic broken ankle and has had a series of muscular leg issues since then. It could be something as simple as a change in his gait or it could be something within that kinetic chain that is throwing off the system. 

    While we don't know the root cause, nor do we have enough information to say how well he'd play over an extended period, Jeter certainly has a track record. He did come back from these same questions, albeit without the physical complications, to have one of his best offensive seasons.

    I'm certainly not going to bet against Jeter. I'm on record as saying that it wouldn't surprise me if Jeter played long enough, even to the point of being a player-manager, to challenge Pete Rose's hit record. That's certainly less likely after a lost year of baseball.

    I think that Jeter, like Mariano Rivera, wants to go out on his terms. He'll get the same kind of victory lap with his own set of gift baskets. What we need now is some evidence that his body is not setting it's own terms and punching the clock against his wishes. Coming back from this calf strain is a start.

Hanley Ramirez (Shoulder)

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    In the eternal struggles of men versus walls, walls have claimed another victory and another victim. Hanley Ramirez hit the wall and injured his shoulder, though it appears he may have avoided the worst of the possible consequences.

    There was a bit of a worry on Monday when the Dodgers delayed an MRI. While the Dodgers aren't commenting on why this was the case, there's a number of reasons that are possible. First, the Dodgers may just be waiting until the team is home, though this is unlikely. Second, the Dodgers medical staff has their hands on Ramirez and the manual testing and their expertise might show that the MRI just isn't necessary at this stage. While teams can certainly afford MRIs, there's not always a medical need for them.

    Comments from Don Mattingly indicate that Ramirez could be back in just a couple days. The term "jammed shoulder" is meaningless; it's a description, not a diagnosis. If it amounts to a sore shoulder and maybe some bruising, that's a couple days, some treatment and ice. If there's soft tissue damage or structural issues, that's far more. We'll have to wait and see, though the signs on Ramirez are positive.

    All that said, I once again have to raise the issue that padding is an area that really needs to be investigated. What we have and how we have it simply isn't working. Again, I'd flat out order my players to not run into walls. In fact, I wonder if Wrigley Field's lack of outfield padding actually is more effective, since players know and seldom slam into the bricks and ivy, this case excepted. 

Miguel Cabrera (Abdominal)

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    Miguel Cabrera missed four games during his latest health issue, one that the team from Hockeytown is trying to treat like the NHL would. The Tigers aren't giving any sort of detail, not even upper or lower body, but reports are that Cabrera is dealing with an abdominal issue. It is a positive that the team didn't protect his retro DL status, letting him pinch hit Monday night.

    Following on a hip flexor issue, we do have to wonder if Cabrera is dealing with something more. The symptoms that we know would match up with a sports hernia or even a hip labrum problem, though we clearly do not have all the details. There are a lot of other possible things, though the Tigers do seem to be worried enough to keep Cabrera on the bench for an extended period.

    Cabrera did take batting practice over the weekend, which was thought to be a sign he'd be back, but the team is being careful with their star. The Tigers will wait as long as they can to make any sort of move, given his value. The team could put him at DH if it would help, though it doesn't appear that mobility of any sort is the real problem. Instead, this is one of comfort and productivity, things Cabrera has provided for Detroit since he got there.

Yadier Molina (Knee)

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    Yadier Molina was a candidate for MVP last year and while I can't make a statistical case for picking him over Buster Posey, those softer definitions of value certainly tip toward Molina. With his good friend Albert Pujols heading west, Molina stepped into the offensive and clubhouse roles that Pujols left behind. (Admittedly, that latter one was more a perceived role than actual. Pujols was more a valued teammate than a vocal leader.) 

    Molina has continued that this year, though one has to wonder if the workload he's taken on over the last few years and the lack of rest that Tony La Russa and Mike Matheny have allowed him to take on are now exerting their toll. Las Hermanos Molina might be the perfect catcher gene pool, but they are human.

    This is the second time this season that Molina has had issues with the knee. This injury, described as a sprain but also noted as "no structural damage" by the Cardinals, doesn't have a discrete cause, but with the indeterminate time frame, it's reasonable to say that inflammation is once again the issue. That's tough to work through while catching, so the Cards are going to not only have to give Molina the time to heal up but figure out how to keep him productive once he does return to catching.

    The Cards really don't have the option to go the Victor Martinez route at this stage of the season, especially with weak backups, but they may have to investigate it next year. Of course, no team does better with positional flexibility up and down the defensive spectrum than the Cards, so I'm not too worried about that. Molina could miss a bit more time than you'd expect, but they won't dawdle given the way the division fight is going now.

Matt Moore (Elbow)

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    The Rays have an enviable record with pitchers. They develop them, they get production out of them and they keep them healthy. It's far from that simple, but their holistic approach between scouting, development, coaching and the medical staff has given these results over nearly a decade.

    While situations like what they have with Matt Moore are rare for them, their conservative handling of it shows why they've had success. First, they have the depth available to fill in for Moore, even in a pennant chase. That makes it so they don't have to rush anything.

    Second, they caught this elbow inflammation very early, so there's little if any long-term damage done. Once they get Moore back to a point of health, they'll hand him off to the coaches, who can work with their medical staff to fix any issues that they determined caused this event.

    Finally, they won't panic. Moore might be young and a future ace, especially if they're forced to trade away David Price in coming years, but this developmental machine that they've built was reloaded by the last trade. Moore's long-term prospects and results should get better, in part because his team has the ability to handle things in this way now.

    (By the way, if you looked at that picture above and thought, "Inverted W with short stride length and scapular retraction," I'll remind you that I can find pictures of almost any pitcher, good and bad, that look either way depending on the moment the shutter clicked.)

Melky Cabrera (Knee)

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    Melky Cabrera avoided another suspension for his use of testosterone and involvement in the Biogenesis case, but he wasn't able to avoid a return trip to the DL. His meniscus tear has him on the DL, though as of yet, the Jays aren't going to send him for surgery, which is the normal fix for this kind of injury.

    Cabrera will instead rest and undergo therapy to see whether or not he can come back without causing more damage or more inflammation in the knee. Taking 10 days or so to do that could work, though with the Jays falling behind in the AL East race, it could be said that the team is thinking more to the future and at the same time, hiding Cabrera from the public eye during a sensitive time.

    It won't take 15 days to see where this is going. If Cabrera does need surgery, it would effectively end his season, though there's a good chance he'll at least try to return if they can avoid surgery for now. Look for any sign of Cabrera running or even batting against live pitching, since the twisting of the knee in that motion would challenge the inflammatory response of the knee.

    It's really about 50-50 on whether Cabrera will return, and for the upside of his '13 production, any fantasy team in a race now might be better off to check the waiver wire and see if they can find something not just surer, but better.

    Oh, and if you want to point to Cabrera's lack of production "without the juice," fine. Just don't say that this injury is the result of his use or discontinued use. There's no scientific evidence that cartilage issues have anything to do with PEDs. While Cabrera and Alex Rodriguez have had that problem, it's pretty widespread in sports among non-users as well. 

Salvador Perez (Concussion)

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    The seven-day concussion disabled list is a great tool. It's not so long that players avoid it and not so short that teams make the decision lightly. While MLB has done a nice job with concussions, it also seems to have more long-term consequences. While Salvador Perez is making progress, others like John Jaso need only look into the Cardinals dugout to see how far it can go. (Mike Matheny's playing career was ended by repeated concussions.)

    Perez still has headaches, though reports have them dissipating slowly. The team seems more concerned as to why its young catcher didn't report his initial symptoms. It's hard to blame anyone, player or staff, for this, and I wonder if MLB shouldn't take an opportunity to be more innovative. Since catchers bear the brunt of fouls and collisions more often, small sensors could be placed in the helmets to trigger checks. Even this new innovation from Reebok could be used in baseball to signal an issue, though it was developed for football.

    Perez and Jaso show that MLB is serious about concussions. We can only hope that the best care and the ability to use a short-term DL spot to help the team keeps them and all the others that will inevitably come on the right track. Expect Perez back by the end of the week, though concussions are notoriously difficult to time. 

Steve Delabar (Shoulder)

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    Dylan Bundy was something of the poster boy for the long-toss contingent. While his injury earlier this season doesn't change anything about its efficacy for him, it has raised questions. Steve Delabar is more the sequel to The Rookie, but he's also a proponent of long toss. Delabar wouldn't have even had a chance to get hurt in the majors without the program that got him back there, so don't think I'm knocking it.

    There are some pretty big biomechanical issues with long toss, ones that I haven't heard good answers for. The bigger issue for Delabar and some of his 'pen-mates are that once again, it seems that the Blue Jays simply can't keep pitchers healthy. I can't explain that either, though over a decade, it's a much bigger issue that the Jays can't explain it or correct it.

    Delabar is having some inflammation inside his shoulder and while it isn't considered serious or long term, it is even more difficult for a player like Delabar. Simply put, he's a guy who walks a fine line between being an All-Star and being a fungible pen arm.

    Losing any velocity when he returns is something to watch for, especially if he's asked to go multiple outings. That ability to recover is one of the toughest matchups for any reliever, so we'll see how Delabar responds. 

Rangers Pitchers

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    Nelson Cruz may be gone for the next 50 games and maybe longer, if rumors are true that Nolan Ryan is willing to go to the playoffs and beyond without the long-term slugger. (I wonder what they'll call that big hot dog now if he does leave.) The Rangers are expecting some players back, including a slew of pitchers that could tip the balance of the AL West.

    Colby Lewis will have one more start, likely again at Double-A Frisco, before returning. The team seems very concerned about his stamina and getting him out over 100 pitches. With the depth in their 'pen, it surprises me that the Rangers would be so concerned for one pitcher, but it might indicate more about the 'pen than Lewis. Lewis has had a rough go of rehab, dealing with several setbacks while attempting to come back from flexor tendon surgery. Watch to see whether Lewis loses effectiveness as he goes deeper into games, though velocity isn't a huge concern for the sinkerballer.

    Matt Harrison was thought to be the perfect complement to Yu Darvish (who came back well from his trapezius strain), but early-season back problems led to not one but two surgeries. The surgery and the follow-on weren't overly serious, but any back problem for someone who relies on force coming through their back and flexion of the spine is going to have some issues. Lower back pain fells a lot of people. Early results in rehab look good for Harrison, though again, stamina seems to be a big concern. Harrison will be given the full 30 days of rehab if necessary, though I expect to see him ramp up quickly once he gets some confidence in his back and his delivery. The Rangers will be watching the latter to make sure it's repeated.

    Neftali Feliz is the wild card here. He extends a bullpen that is deep but well used. If his return from Tommy John surgery is successful, he adds to Joakim Soria, Tanner Scheppers and Joe Nathan as hard throwers who can shorten games. (See why I was a bit surprised the Rangers have been focused on stamina with Lewis and Harrison?) Feliz will focus on command during his rehab, as velocity has never been an issue. I'm curious to see if the Rangers have made any adjustments to his delivery during the early stages of the Tommy John rehab. 

    Finally, the Rangers also could get long-man Michael Kirkman back in the near term. His return from skin cancer is just a good story and a reminder to wear sunscreen, get checked and to live life. Anything Kirkman can give the 'pen is a bonus, even if it's just some depth to shuffle out some guys and give them some rest at the end of a hot Texas summer and the start of a desperate chase of the Athletics.