Under the Knife: MLB Injury Analysis on McCutchen, Tanaka, Lee and More

Will Carroll@injuryexpertSports Injuries Lead WriterAugust 7, 2014

San Diego Padres' Milton Bradley is attended to by trainer Todd Hutchinson after Bradley was injured while being restrained by manager Bud Black during an altercation in the eighth inning of the Padres' 7-3 loss to the Colorado Rockies in their baseball game in San Diego, Sunday Sept. 23, 2007.  (AP Photo/Lenny Ignelzi)
Lenny Ignelzi/Associated Press

A.J. Preller is the new general manager of the San Diego Padres. He's a great pick in my opinion. He's the consummate scout with the ability to find and manage international signings in the new limited environment, as well as a snappy dresser.

Preller obviously has the scouting background but also has a scouting mandate in his new position as well. The Padres were focused on people with similar backgrounds, with Billy Eppler and Mike Hazen the other finalists for the position. The Padres are obviously looking to build through the draft, which Preller should be well set up to do. 

However, the Padres should focus on one other area, one that could pay more immediate results. The team has some of the worst team health results around. Only the Yankees are worse over the last three years at keeping their players on the field. The Padres have lost over 4,000 days to the disabled list, something they can't absorb the same way the Yankees accept. (Data is from my proprietary Injury Database.)

Finding and developing players can take years to pay off. Even with top Preller finds like Jorge Alfaro and Nomar Mazara making it to Double-A more quickly than many expected, it's still a timeline that is tough to sell to a fanbase. Fixing team health can be done quickly. We've seen several massive turnarounds with renewed focus around the league.

Preller is bound to surround himself with some very smart people. He should definitely make sure he has the same with the medical staff. He's seen this year that bad luck and injuries can combine to tear down a talented team quickly in Texas. It's the easiest and cheapest path to improvement the Padres have. I'm sure Preller doesn't need my advice, but he knows how to find me if he wants more suggestions. For now, let's look at the injuries around the league...

Ross D. Franklin/Associated Press

Andrew McCutchen

It's impossible to say that Andrew McCutchen's avulsion fracture is a direct result of the pitch that hit him in roughly the same area. Then again, if you see a guy in a ski mask standing outside a stereo store that's just been robbed holding a bunch of boxes, you might want to check on him. 

But that's about assigning blame, as many are doing including this insightful look by Joe Starkey. I can look at an injury and wonder, but when I asked how an avulsion fracture might have happened, things get pretty technical but seem to circle back to the hit. One team physician told me "the avulsion is easy to explain. He twisted too hard, but that normally doesn't happen. Normally the muscle or cartilage gives, but if the back was in spasm at same time he swung, well, that's a bidirectional pull that might just create the avulsive force."

This kind of injury has a standard recovery of four to six weeks, but the Pirates are holding McCutchen off the DL so far. They're waiting to see how his body reacts to the injury and treatment. If they can keep him functional and the pain manageable, there's little chance he could do significant damage. "The bone is already pulled, but it's hardly the only point of contact like you would see with a ligament," said the team physician.

There's little harm in wait-and-watch for the Pirates. Maybe McCutchen comes back and they save 10 days he could have been stuck on the DL. Maybe they're just waiting for Starling Marte to return from his rehab assignment. A retro DL move is in place if needed, so McCutchen's immediate future remains unclear. 

Julie Jacobson/Associated Press

Masahiro Tanaka

Playing catch doesn't seem like much, but for Masahiro Tanaka, it was huge. Tanaka made it through two throwing sessions and will now start to amp things up carefully but not slowly. The Yankees have outlined a rehab throwing program that could have him on a mound as soon as next week, according to the New York Post.

This accelerated timetable is still cautious. Any pain or problem with recovery will send Tanaka back, perhaps to a shutdown or even surgery. There's always going to be a risk that his healing UCL will snap, but as baseball pitchers have shown us this year, they're all at risk. 

The Yankees could be creative here. Instead of sending Tanaka down to rehab, why not let him go three or four innings and shadow him with a long man or a returning player like Michael Pineda? Using another starter would be tough because both have normal routines they like to use, but utilizing all their assets as they push toward the end of the season is key if the Yankees want to get into the playoffs.

(Quick note on another Yankees pitcher: CC Sabathia had his knee surgery on Wednesday, and things went well. Dr. Neal ElAttrache found a bone spur inside his knee that hadn't shown up on images. That was removed, he got some cleanup and injections and will start his rehab immediately. It's a very positive report.) 

Alex Brandon/Associated Press

Cliff Lee

The Phillies didn't trade Cliff Lee before the deadline and just after it? Well, they won't be dealing him in the waiver window either. Lee's flexor tendon has been re-damaged, and while this is a similar location, the early indications are that it's not in the exact same spot. It's not clear because as of Wednesday, Lee still hadn't had an MRI, per the Philly Inquirer.

Part of the reason is the team clearly thinks Lee is done for the season. However, it's important to do the normal rehab up to a point, if only to have some clarity about Lee's future. If he needs surgery, it would behoove everyone to do that as quickly as is possible. If he needs rehab ahead of any major decision, that needs to start quickly as well.

A re-strain of the area, regardless of specific location, certainly points to a problem. Lee has a lot of mileage on his arm, and something is breaking down that one area. The Phillies would be smart to have Lee's biomechanics checked once he's back to throwing to see if something could be pinpointed, but the team has done very little with this in the past. 

ST. LOUIS, MO - AUGUST 3: Starter Matt Garza #22 of the Milwaukee Brewers pitches against the St. Louis Cardinals in the fourth inning at Busch Stadium on August 3, 2014 in St. Louis, Missouri. (Photo by Dilip Vishwanat/Getty Images)
Dilip Vishwanat/Getty Images

Matt Garza

The Brewers don't have a big margin for error in the NL Central. While many are surprised the Brewers were ever in first at all, the team is holding on largely because of its pitching. They've gone three deep with Matt Garza, Kyle Lohse and the homegrown Yovani Gallardo, while filling in the back with a variety. 

Garza's oblique strain is mild but just enough to hold him out for a start or two. Because of the uncertainty, the team elected to DL him, call up a replacement and hope that having him healthy for the stretch run will counteract the loss of three starts. 

The team's Big Three has been very healthy this year, as has the rest of the team for the most part. A run of hamstring injuries and the loss of its big bats last year was a fluke, letting the team get back to contention at the same time it gets back to health. That's not a coincidence. 

Garza does have a history of injuries over the past few seasons, including an oblique strain last year. Garza's experience with it helped here. He got the injury checked early, which should keep it from being as serious as he dealt with last year. 

OAKLAND, CA - JULY 05: Edwin Encarnacion #10 of the Toronto Blue Jays is assisted off the field by trainers after sustaining an injury during the first inning against the Oakland Athletics at O.co Coliseum on July 5, 2014 in Oakland, California. (Photo by
Jason O. Watson/Getty Images

Edwin Encarnacion

Edwin Encarnacion is nearly running again. A setback late last month not only cost Encarnacion time in getting back, it's made it necessary for him to head on a rehab assignment. The Jays are hoping it's short, says Shi Davidi, but he's got some hurdles to get past before that happens.

Encarnacion's quad strain has grabbed again on a couple occasions despite it being described as a mild strain. That indicates the problem is in a difficult or weak location. This kind of injury can be very recurrent, and unless the team is willing to simply say "don't run," Encarnacion will need to have the leg healthy. Even at first base, several of the motions require quad involvement, so even an Encarnacion-in-statue mode would be risky.

The Jays have a split personality with team health. They've got terrible results with pitchers but great results with position players. That gives Encarnacion some hope. If he can get back this week, watch for signs that his swing hasn't been affected. Any sign of power—line drives, gap doubles, light tower homers—would be a big positive. 

Kathy Willens/Associated Press

Torii Hunter

Torii Hunter got lucky when a pitch off his hand left him with nothing more than a painful bruise. It's just another situation where an existing technology—a padded glove, like this one—could have prevented an injury. I don't understand why players, especially players who have broken bones in their hand, don't wear them. If I were an owner or GM, I'd put incentives in contracts for players who would wear state-of-the-art protection against them ending up on the DL. 

Michael Wacha

Tanaka wasn't the only one whose game of catch was significant. Michael Wacha is back throwing a ball after time off to let his shoulder heal up from a stress reaction. That's a positive, according to MLB.com, but he'll need to make it through several more steps in his rehab-throwing program before the Cards know if or when they'll get him back. They've been creative with use this season, but with new depth, they could be even more creative with Wacha. 

NEW YORK, NY - MAY 18:  Gerrit Cole #45 of the Pittsburgh Pirates delivers a pitch in the first inning against the New York Yankees at Yankee Stadium on May 18, 2014 in the Bronx borough of New York City.  (Photo by Jim McIsaac/Getty Images)
Jim McIsaac/Getty Images

Gerrit Cole

Gerrit Cole's latest rehab start was a mixed bag. He showed good velocity and got to his pitch count, but he got knocked around some (10 hits) and lost velocity. He'll need to show more in his next time out, which is one more start than the Pirates initially planned for him. The team will be watching closely, hoping that Cole can get back and supplement its NL Central chase down the stretch. 

Allen Craig

Allen Craig's time as an active Red Sox player was brief, but suggestions that his foot has been the reason for his disappointing season strike me as reductive. The Cardinals staff is topnotch, and the team uses extensive video analysis. I have to think one of those two would have detected something, even if Craig wasn't telling them. We'll see if the Sox can get him on track for next year, but being healthy can't do anything but help. 

Joe Mauer

The weirdest thing about Joe Mauer and his rehab is that it's almost a non-story. He DH'd in Cedar Rapids (A) and seemed fine, but Mauer at 31 has become a forgotten player it seems. The Twins have four more big-dollar seasons of their hometown hero, but at this stage, he's closer to becoming Ryan Howard than Harmon Killebrew. The move to first hasn't helped, so the Twins had better figure out what will or suffer the small-market consequences. 

Elaine Thompson/Associated Press

Andrelton Simmons

The Braves are hoping their defensive wizard, Andrelton Simmons, can avoid the DL after spraining his ankle. David O'Brien notes that the early signs aren't positive, but the team will wait on a decision. This is one situation where playing a man down might really help things, but it would go against the pattern of Fredi Gonzalez. 

Ryan Zimmerman

Ryan Zimmerman has a Grade 3 strain of his hamstring, but the Nats insist that the six-week time frame they're giving is real. A near rupture of the hamstring will normally keep a player out for months, so what's the story? Much of the speculation I've heard—and let's be clear, I haven't been able to confirm this—is that Zimmerman's injury is to the semitendonosis.

This muscle's tendon is often used in elbow and knee reconstructions so the body can work without it. The idea is that essentially Zimmerman did a "self surgery," but that once he recovers from the trauma, he could function. We'll see in a couple weeks if he's able to get back out and run. It's unclear what the Nats will get if he does come back, but the possibility they get something remains plausible.

David J. Phillip/Associated Press

George Springer

Another setback for the Astros? Yes, George Springer was close to a return after playing in Quad Cities (A), but the quad appears to have been reinjured while legging out a double. It's tough for players to play "smart" in rehabs. They shouldn't go all out, just get their work in and heal up, but that's not how most are wired. Evan Drellich has the details, but don't expect Springer back for a while as he restarts the process. 

I'll be in Texas next week for a great event. Not only is it great to be on stage with Don Welke and Jon Daniels, both taking questions, we'll be raising money for Richard Durrett's family. If you're near Arlington, come see us on Wednesday. I'll also be doing an event with The Scoop on Thursday in the area. I love getting out and meeting readers and new friends, so hopefully you'll see more of these in the near future.


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