Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterMarch 26, 2013

Under the Knife: Latest MLB Injury Updates

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    By this time next week, MLB will have thrown their first pitch. Before that, they'll pitch several players on to the DL. Injuries often become the deciding factor in many of those last-minute roster decisions. A player may be healthy now, but might have missed opportunities to impress the coaching staff earlier in the spring due to even minor injuries.

    We'll begin the season with a number of big-name players on the DL, but remember that at the start of the season, there's a bit of a loophole. Teams can put players on the DL with a "retroactive move," in essence post-dating the start of the DL stint. This year, it means that a player that has not played in a major league exhibition game from March 22 can come off early, as soon as April 6. 

    To do this, the players have to be held out of games, and you can see several teams doing this around the league. A player can play in minor league games and preserve the retro move, so as with Derek Jeter and others, they've essentially already started the process. Look for a number of these moves to happen this week, giving a short-term roster relief that will allow a team to bring a 26th or 27th player north, delaying that hard final roster decision a bit more.

    There's a lot of injuries to check out around the league, as there will be every week of the season, so powered by Yasiel Puig, let's get to it:

Derek Jeter (ANKLE)

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    INJURY: post-surgical ankle inflammation


    Derek Jeter almost assuredly won't be ready for Opening Day (via Daily News), but this isn't a huge setback. The Yankees will put their captain on the DL to start the season using a retroactive move, allowing him to come back as soon as April 6. The soreness in his repaired ankle simply made it impossible for him to play shortstop on a normal basis, but he's not far off.

    The Yankees were very conservative with the rehab from the fractured ankle suffered in last year's playoff run. The image of Jeter laying on the turf after breaking his ankle is an enduring one. Jeter had surgery to make sure that the ankle healed properly and up to mid-March, everything was going to plan. 

    Expect Jeter to come back as quickly as possible. He may need to DH occasionally, but it would be a surprise if that was a regular spot for him. The best use would be on days with extreme ground-ball pitchers, though the Yankees only have a couple that lean that way at all. His batting shouldn't be affected, though we could see significantly less running from him. 

    For more on Derek Jeter, click here.

Mariano Rivera (HEAD)

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    INJURY: headache, non-concussion

    ERD: No Missed Time

    The Yankees expected to have the same old Mariano Rivera back this season after losing much of 2012 to a fluky knee sprain.

    While Rivera has pitched well and the cutter appears to be as effective as it has been for the last 18 years, he's had some problems with headaches during spring training. The headaches were severe enough that the Yankees had Rivera tested to determine if these were migraines.

    The worry is first and foremost a quality of life issue for Rivera, but the Yankees also need some certainty about his availability. A closer for any team is needed night in and night out, and the uncertainty that something like this can create really undermines a bullpen.

    Ballplayers are creatures of habit and like to know their role. While one of the other pitchers could easily step up and take the ninth, as last year showed, it's tougher to make things work in front with the day-to-day uncertainty.

    The tests came back as expected and Rivera has said this is not a big deal. The doctors will huddle and try to come up with an effective treatment plan. While these kinds of situations can be very unpredictable, there's little reason to think that Rivera will be anything other than a dominant closer. 

Hanley Ramirez (THUMB)

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    INJURY: sprained thumb, surgery

    ERD: May 10

    Hanley Ramirez had surgery on his thumb after injuring it on a defensive play during the World Baseball Classic. The injury, popularly referred to as a "skier's thumb," is a tear of the ulnar collateral ligament. The surgery to re-attach the ligament was performed at Kerlan-Jobe in Los Angeles by Dr. Steven Shin, one of the top sports medicine hand specialists in the world.

    Ramirez will miss at least two months of the season. The worry is that he will lack some grip strength and bat control when he returns. While Ramirez has returned well from previous injuries, he has never had a similar problem with his hands or wrists.

    In his absence, the Dodgers will use Luis Cruz and perhaps Dee Gordon (once he gets over an ankle sprain) at shortstop, leaving third base to Juan Uribe. It's a big drop-off, but the Dodgers should have plenty of offense in that expensive lineup. 

    There was also an interesting note that came out of the injury. Since it occurred during the WBC, the insurance taken out on players that participated will compensate Ramirez during his time off. This was expected, but that it covers 100 percent and takes any salary obligation off the team is something we've never seen before and that could have some consequences for calculation of benefits and luxury tax.

    What @buster_espn reported about the WBC being responsible for Teixeira's salary while on DL also applies to Hanley Ramirez, source says.

    — Ken Rosenthal (@Ken_Rosenthal) March 24, 2013

    For more info on Hanley Ramirez, click here.

David Wright (CORE)

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    INJURY: strained core muscle

    ERD: No Missed Time

    It's looking like David Wright will be ready for Opening Day. The Mets could use some good news and getting their captain on the field is nice symbolism if nothing else. 

    Wright isn't back into games yet, but that could happen as soon as Wednesday (via Newsday). He has been able to do everything else, taking grounders at third and making full swings during batting practice. There's really been no deficits or problems during the conservative rehab.

    The worry with any core injury is that setbacks happen and take the player back to step one in a hurry. The Mets medical staff has been able to avoid that so far and are past the point where that usually occurs. 

    Wright should show no real issues once he's returned to full activity. While core injuries are painful and often slow healing, they don't tend to have much in the way of consequences once they've healed up.

    There's usually no loss of power or problems in the field, though certainly extremes or unusual contortions can change that in a hurry. Wright's style of play is not extreme, so he's a safe bet to stay healthy. 

Johan Santana (SHOULDER)

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    INJURY: post-surgical shoulder weakness

    ERD: May 20

    There are always whispers I'm hearing about Johan Santana. "He's done," a scout told me after watching him throw early in camp. Others tried to look on the bright side, reminding me that "it's early" or even reaching for the "Pedro Martinez completely changed and had a second career" card. 

    With Terry Collins saying that Santana will miss six more weeks, starting the season on the DL, those whispers are only going to get louder. What little we've seen from Santana this spring make it tough for me to disagree. 

    The shoulder is two years post-surgery and seemingly hasn't recovered from his no-hitter. Say what you will about having one good day, Santana's arm and body simply broke down after that high stress outing, successful outcome or not. 

    The problem now is that Santana's shoulder is both weakened and having trouble recovering in between work. There's simply no way he could pitch now, let alone effectively, and there's some question about whether he'll be able to make it back to the point where he would be productive. 

    Santana was always a high risk, but at this point, he's nothing more than speculative, the kind of player you draft in the next to last round on nothing but hope. Until we see that he can recover and has something resembling major league velocity, I can't even advise using that kind of late pick on Santana.

Pablo Sandoval (ELBOW)

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    INJURY: bone spur, elbow

    ERD: No Missed Time

    The bone spurs inside of Pablo Sandoval's elbow are causing problems again for the Giants. Spurs are small pieces of bone that stick out. Most of us have small spurs–they can be almost like the bony equivalent of a blister in many cases—but when they grow large enough or point to the wrong place, they cause issues.

    Of course, spurs usually have an underlying causation. There's some sort of irritation or abnormality in the area. If the spur breaks off, it becomes a bone chip, which is just a small piece of bone that is not fixed. They can be a bit more dangerous since they can move and get embedded in other structures, causing both inflammation and even structural damage. 

    The team is hoping that they can keep the elbow comfortable enough that surgery isn't necessary or at the very least can be delayed until the offseason. The surgery is very routine, with one surgeon jokingly referring to it as a real life version of playing the game Operation

    The Giants have seen the purest upside of this kind of injury. Back in 2002, shortstop Rich Aurilia had surgery to remove bone chips from his elbow and he missed the minimum fifteen days as he rehabbed. He had no real problems after returning, showing zero deficits at bat or on the field.

    The Giants can only hope that Sandoval has the same kind of recovery if he needs surgery. They'll do all they can to avoid that and are looking for some treatment or modality to help him along. In the meantime, Sandoval is going to be a risky player who could hit the DL at any point. 

David Ortiz (HEEL)

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    INJURY: Achilles strain

    ERD: unknown

    David Ortiz is finally making some progress. He was cleared to start more baseball activities last week; you know, hitting. He's taking more swings in the cage and could get on the field before the team leaves Ft. Myers. 

    There's still a long way to go before Ortiz is ready to play. He hasn't done any running, at least, not any normal running. At least one report says he's doing some on a SwimEx. It's going to be a tough transition from any limitations to playing.

    The hitting isn't appearing to cause more irritation in the Achilles, but the strain is still enough to keep him from playing just yet. It's unclear whether Ortiz will need some time to get his swing right once he does return, which would require a trip to the minors. Pawtucket would be the usual destination, since he could drive down and keep up his rehab at the Sox complex, but weather and the schedule will factor into the final decision.

    At this point, there's simply not enough information to say when Ortiz will be back. Similar injuries to similar players would seem to indicate that he could come back quickly and effectively once the strain is stable, but I'm loathe to put too much weight on those comparisons. Ortiz's age, size and singular focus makes it tough to read.

Wilson Betemit (KNEE)

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    INJURY: sprained knee, PCL

    ERD: June 1 (if surgery avoided)

    Wilson Betemit was set to be the Orioles' DH this season, filling in around the infield as needed. It's a valuable role and one that will be tough to fill for the Orioles at this late date.

    The Orioles lost Betemit last season, which forced them to bring in Manny Machado, a move that helped carry them to the playoffs as Machado established himself as an elite young talent. This situation's different and will be the first big challenge for Buck Showalter in 2013.

    Images showed that Betemit has a Grade II+ sprain of his PCL (via Eduardo Encina of The Baltimore Sun). This injury can take as much as 120 days to recover from, as Matt Diaz did in 2008, or as little as 15, such as Darwin Barney did last season with a very minor sprain. Surgery would likely cause Betemit to miss the entire season, especially if there's further damage inside the knee.

    The current plan is to rehab the knee without surgery, which gives Betemit a chance to return in as little as six to eight weeks. It's a chance, not a certainty, with the very real possibility that the rehab will fail and surgery will be necessary. At that point, he would miss most if not all of the '13 season.

    All in all, it's very bad news for Betemit and the Orioles. The course of treatment will be determined over the next few days, while Dan Duquette and Buck Showalter work to figure out how to fill in for a versatile player with only one roster slot. 

    For more info on Wilson Betemit, click here.

Carlos Beltran (TOE)

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    INJURY: fractured toe

    ERD: No Missed Time

    A fractured toe is both painful and infuriating. The latter is mostly because there is very little that can be done for the injury. Doctors take an x-ray and then say "that must hurt." About all that can be done is a bit of protection, like taping two toes together, or perhaps a cap over the end of the shoe. 

    It's that simple an injury for Carlos Beltran, but it's not a simple situation (via St. Louis Post-Dispatch). Beltran's long-term knee issues could be affected by this, which is leading the Cardinals medical staff to be very cautious with him. Even a small change in how Beltran runs could lead to more problems with his chronic knee. They've been very good at avoiding those problems and keeping him on the field and productive.

    Beltran is scheduled to play again on Tuesday, but the Cardinals have been making sure that a retro DL move is preserved. It wouldn't surprise me to see him shifted to a minor league game if there are any concerns. 

    I was also able to confirm that since the injury took place during the World Baseball Classic, the Cardinals and Beltran were protected by the injury policy. If Beltran is forced to miss time, it won't cost the Cards anything more than the lost time and production. 

    Whether he ends up on the DL will depend on Beltran's pain tolerance and how confident the medical staff is in their ability to keep a small problem from becoming a bigger one. If Beltran does go to the DL, uber-prospect Oscar Taveras may be kept around to open the season, though doing so would start his service clock. It's more likely that he's just being kept at the big league camp since there are major league at-bats available. 

Jason Motte (ELBOW)

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    INJURY: strained flexor tendon, elbow

    ERD: May 1

    "Mild" is one of those words that can confuse people when it comes to injuries. The strain that Jason Motte has in his throwing elbow can accurately be called mild—it is a Grade I strain—but any sort of damage inside the elbow of a pitcher is a major concern.

    The biggest worry is that Motte will have a setback in rehab or shortly after his return—one that will have a more serious tearing inside the tendon—or that the structural weakness will transfer force to another tendon or even worse, a ligament. 

    The Cardinals are seeing positive signs (via St. Louis Post-Dispatch), but he's not yet passed all the physical tests that would allow him to get back to throwing. It's definitely encouraging that that could happen in the very near future, but I'd expect the Cardinals to be a bit conservative with him once he gets to that stage. A closer doesn't need a great deal of stamina, but Mike Matheny will definitely want to see that he could use Motte in back-to-back games before activating him.

    The next big milestone will be throwing. Once he gets into some long toss, it's a good indicator that a rehab assignment will come shortly after that. May 1 is a best guess for an ERD at this stage, but it could go either way depending on how Motte does through the upcoming stages of his rehab and throwing program.

The Dots

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    Bill Petti has a nice piece of research that contradicts what Bill James said about ground-ball pitchers. James is clearly in the wrong here, oversimplifying a physical issue. What I think is that hard sinkerballers have a hard pronation, moving the humeral head inside the shoulder.

    Go ahead, try this one at home. Make a "thumbs up" motion and then turn your wrist to a "thumbs down." Now do it with the opposite hand on your shoulder. Feel how that bone (the humeral head) moves inside the shoulder. Now imagine doing that hard, a couple thousand times a year, and you can see why I think biomechanical data would answer this question. Too bad someone like James, with precisely that kind of data on hand, didn't look ...  

    Brett Lawrie is going to start the season on the DL, but he's already playing in minor league games. He's allowed to do that under the retro DL rules. Lawrie is making good progress and has had no setbacks with his core strain. He could be back as quickly as the minimum ...

    Shin-Soo Choo was back in the Reds' lineup over the weekend after missing a week due to back spasms. These can recur, but seeing Choo back in the leadoff role is definitely a positive indicator. He should be a big run-scorer for the Reds in that role ...

    The Cubs have lost Scott Baker for at least half the season after he had a major setback in his return from Tommy John surgery. While there is said to be no structural damage (via the team's official site), there was significant inflammation in the repaired elbow. Baker will be shut down for at least a month and will begin a throwing program once he's cleared.

    It's not expected that he will be ready to pitch for the Cubs until at least June, assuming he can stay healthy then. Travis Wood takes the starting slot, along with Carlos Villanueva as they fill in for Baker and Matt Garza ...

    David Freese will start the season on the DL. He's made progress with his sore lower back, but having just had another set of injections, the Cards elected to use a retro DL move on him. They do expect him to be back on or near April 6 ...

    Terry Francona confirmed that Chris Perez will make the Opening Day roster (per Newsradio WTAM 1100's Nick Camino). The Indians' closer has been dealing with a shoulder strain throughout the spring, but is near full strength now and should be ready. He may miss some save opportunities early as they will try to avoid using him on three or more consecutive days  ...

    Lots of questions about Ricky Romero over the last week. He's coming back from offseason surgeries that were supposed to help him get back to where he was. Instead, he's imploded and his rotation spot is in question. The Jays are currently saying that the problems are mechanical rather than physical, but we'll have to keep a close eye on this ...

    Tommy Hanson gave the Angels a scare after he left his last spring game grabbing his shoulder. It turned out to be a minor triceps strain. Hanson looked good in an intra-squad game and appears ready to open the season in the rotation (via Alden Gonzalez of MLB.com)

    Stephen Drew is slowly increasing his activity after missing several weeks as concussion symptoms cleared. He could play in minor league games by the end of the week, though it is unlikely that he will be ready for the start of the season ...

    John Danks got torched in a minor league game, all but assuring that he'll start the season on the DL. Danks reportedly had mid-80's stuff and was lacking movement as well. The Sox seem quite concerned with his slow recovery from August shoulder surgery ...

    The Reds had two pitchers hit by comebackers last week and are fortunate that neither was injured. Mat Latos took one of his ankle, while Bronson Arroyo was hit hard enough that the Reds said that the stitches were visible on his hand. While both were lucky, it's a reminder that pitchers are out there with no protection, including their heads ...

    It's a sprain, not a strain, no matter what this article may say. Adam Eaton has a Grade I sprain of his UCL, the "Tommy John" ligament, and will miss two to four weeks as he rehabs it. Surgery will not be necessary, as the tearing was mild. Eaton should have no trouble once the ligament has healed and he returns, though the Dbacks tend to be conservative with these kinds of chronic injuries ... 

    Add "neck" to the list of things that Shaun Marcum has injured. Marc Carig (Newsdayshowed off quite the list of past problems, but the pain in his neck will cost Marcum at least one spring start and puts his start of the season in question ... 

    Thanks again for all the well wishes and thoughts after I had more heart surgery last Friday. The good news is that I expect to be ready for Opening Day myself. I'll be headed to Miller Park to watch the Brewers take on the Rockies. The challenge will be avoiding those great Klement's brats!