Under the Knife: Latest MLB Injury Updates

Will Carroll@injuryexpertSports Injuries Lead WriterApril 2, 2013

Under the Knife: Latest MLB Injury Updates

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    I made it to Opening Day.

    This year, Opening Day meant more than most years, since I was the one that almost went on the DL. Instead, I stood on the field Monday in Milwaukee, looking at the steel roof above the green grass and loving that it was once again baseball season. It was an amazing feeling, talking with so many media friends and having everyone from Doug Melvin to Ryan Braun pausing to ask how I was feeling. 

    Of course, there's a lot of injuries already around the league, which should be no surprise. Almost 20 percent of injuries occur in the spring. Even once Opening Day has come and gone, injuries tend to be a bit front-loaded. The reasons are obvious and inscrutable all at once, but the pattern has held for the decade we have data on and anecdotally for much longer.

    It's a long season, but for too many, the season is already over. Opening Day isn't a new beginning, but the starting line that is sometimes not reached. Teams will begin to make do, to patch holes and to find ways to deal with the injuries that occur. At some point, they'll do something about it, but until then, the doctors and athletic trainers will just put in the long hours they have trying to make a difference.

    Powered by the spirit of Opening Day, on to the injuries: 

Johan Santana (Shoulder)

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    Injury: sprained shoulder, anterior capsule

    Expected Return Date (ERD): Done For Season

    We have likely seen the last of Johan Santana.

    Santana will be undergoing surgery on Tuesday morning at the hands of Dr. David Altchek. The good news is that Santana came back from precisely this kind of surgery before, also done by Altchek.

    The bad news is that it took almost two years for him to be back to level and at age 34, it's going to be harder to come back. He has another year on his big contract, so he'll rehab rather than retire.

    The anterior capsule is a bad area to tear once, let alone twice. The capsule holds the bone of the upper arm (humerus) in place. With the tear, it could move around or create so much external rotation (where the hand is behind the shoulder, as in the picture above), that more damage inside would occur. The tear appears to be in the same or a similar area, so the repair shouldn't be that difficult, but with more scarring, there are less surgical options once inside the shoulder.

    Comparisons here are difficult because there just aren't many. Mark Prior had the surgery in 2008 and while he's pitching, he's not reaching the levels he did before by any stretch. Orel Hershiser had his capsule repaired as part of an extensive reconstruction, so it's not a good comparable either. Bret Saberhagen had a thermal capsulorraphy, which is seldom used in throwing athletes any more but was standard at the time. 

    As before, Santana's rehab will extend beyond this season. The major question is if he can regain the velocity and get control of his slider in time to rejoing the Mets before his contract expires. He could go the Brandon Webb route, though he'd have to show enough to give teams hope that he could help. 

    The Mets did have the contract insured, so they've been shopping for pitching help using some of the money that will come after his elimination period, but the market has been a bit pricey and dry. The Mets would also like to see how new acquisition Shaun Marcum pitches once he's back from his own neck issue. 

Ryan Ludwick (Shoulder)

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    Injury: Dislocated shoulder

    ERD: Unknown

    Opening Day didn't go as planned for the Reds or for Ryan Ludwick. The Angels beat the Reds in a marathon game that won't help either team manage a pitching staff, but Ludwick left the game early with a dislocated shoulder.

    Ludwick, who has been derailed by injuries throughout his career, went for an MRI after the game. Last year's top rated medical staff will work to get the swelling down and the shoulder stable. The key is whether and how much damage occurred inside the shoulder. Any tearing of ligaments, tendons or cartilage is going to add to his recovery period. Some are worried especially about a torn labrum

    UPDATE: As expected, Ryan Ludwick will undergo surgery on Tuesday to repair damaged cartilage inside the shoulder. He'll miss significant time, though there won't be an official timeline until after the surgery. 

    Many will complain about Ludwick's head-first slide being dangerous, but it's more unlucky. Study after study have shown that the injury risk is only slightly elevated and tends not to be as serious (broken finger versus broken ankle), though none of that helps Ludwick right now.

    The Reds should give us more information regarding the damage inside the shoulder, which will help put a timeline on this. Until Ludwick can return, Chris Heisey will get more time in left. The lack of depth the Reds have here puts an interesting situation in play. Shin-Soo Choo's already suspect defense in center could easily shift to left if Ludwick is out for an extended period of time, leaving a quick path for top prospect Billy Hamilton to come up. 

Chad Billingsley (Finger/Elbow)

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    Injury: sprained finger, post-rehab sprained elbow

    ERD: April 10

    Sometimes a seemingly minor injury has to be protected so that it doesn't turn into something bigger. That kind of cascade, a term I borrowed from network science, is one of the toughest tasks for a medical staff. 

    It's that kind of protection that put Chad Billingsley on the DL to start the season. The Dodgers used a retro move to make sure that a minor finger injury didn't change his mechanics and put his elbow at risk. Billingsley has been able to avoid surgery after significantly damaging his UCL last season with a strong rehab program and PRP injections. It's still a risky course that could lead to Tommy John surgery if the ligament doesn't hold, so this kind of conservative protection is smart.

    Billingsley is expected to make a minor league start on Thursday, putting him in line to return to the Dodgers rotation on April 10. A lot of teams around the league are watching this return, wondering if Billingsley's rehab and injection path is going to offer a real alternative to surgery. 

Jonny Venters (Elbow)

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    Injury: sprained elbow

    ERD: May 10

    Heading to see Dr. James Andrews isn't like seeing the Grim Reaper. In many cases, Andrews doesn't perform surgery on patients he examines, even though most he sees are "second opinions" or consultative checks after another doctor has made a diagnosis. Going to Pensacola or Birmingham isn't a bad thing and shouldn't be taken as such, the way many in the media make it out to be.

    We saw this over the past week with Jonny Venters. The Braves, like many teams, have a close relationship with Andrews and also a geographic proximity. Venters saw Andrews after issues with his elbow, but he won't need surgery—at least not yet.

    Venters will be shut down for a month while they try to calm the pain and inflammation. The key for Venters or any reliever is going to be how he recovers from game to game. If the Braves medical staff can figure out a way to make sure that Venters is available, even with some limitations such as no throwing three days in a row, he'll be a big add to a strong bullpen.

    We still don't know exactly what is going on inside Venters' elbow or how the Braves intend to treat it, at least not publicly. It wouldn't surprise me to find out that Andrews used PRP injections, something he's discussed using in many cases he now sees. Once Venters starts throwing again, likely mid-month, we'll get a much better idea of what to expect from him and when he'll be back.

Darwin Barney (Knee)

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    Injury: lacerated leg

    ERD: April 12

    Some injuries are simply bad luck. In the database of injuries I keep, I divide injuries into two very broad categories—traumatic and chronic. Bad luck is traumatic, even if there's an element of preventability to it. Running into a wall and hurting yourself is bad luck, but you knew the wall was there. 

    Darwin Barney was in the wrong place at the wrong time. He got spiked on his knee, resulting in a very deep gash that required five stitches. It's not a long-term problem, but it was just enough that Dale Sveum and the Cubs needed to make a move. Barney was placed on the DL to start the season, but he won't miss much time.

    Once the laceration is beginning to heal, Barney should be back out quickly. Like most cuts that require medical attention, the healing is predictable. They'll watch for that and for signs of infection, which is really the major danger. Once Barney is back, he might have some slight limitations, but he's going to be fine at second.

    While he's out, Brent Lillibridge will handle second, which is a big defensive drop-off that ground-ball pitchers will notice.

David Ortiz (Heel)

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    Injury: Achilles tendonitis

    ERD: April 20

    Things seem to be turning to the positive for David Ortiz. The Boston DH ran for the medical staff and could be in line for a rehab assignment as soon as next week if all goes well. It sounds as if the treatment for his Achilles tendonitis is paying off. 

    One note that did come out this week is that one of the major complications that has held Ortiz back is the development of Achilles tendonitis in his left leg as well as the previously affected right. This is very common and almost always a cascade issue. The gait change and even the protective boot can cause more weight and stress on the non-affected leg, leading to problems there. This has been confirmed in Ortiz's case, so the rehab likely had to back off a bit during the process.

    Ortiz will do his rehab at Triple-A Pawtucket if the weather is solid or could head back to Ft. Myers where the weather is a bit more predictably warm.

    Expect to see a very short rehab start over the next two weeks, though with Ortiz leaving the team to go back to the Florida complex, news on progress may be harder to come by. 

    John Farrell will juggle the DH slot while Ortiz is out, likely using a platoon of Jonny Gomes and Mike Carp until Ortiz's return. This could also be a good time to ease Mike Napoli into the season, protecting his hip with a bit of DH time here and there, though he's had no problems through spring training.

Dylan Bundy (Elbow)

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    Injury: elbow stiffness

    ERD: May 1

    It's hard to stop the panic for Orioles fans and prospect mavens when they hear that Dylan Bundy is having elbow stiffness and has been shut down.

    Of course, the facts of the situation should assuage some of the concerns, if not all. 

    The Orioles are already very conservative with their pitching prospects, something that has been a hallmark of Rick Peterson's tenure. The O's pitching coordinator is closely involved with the medical side and understands developing pitchers as well as anyone. With Bundy ticketed for Double-A to start the season, he was already going to have his innings and workload managed.

    There was an MRI performed on Bundy's elbow, but there was no noted damage and the shutdown could be only a matter of days. Then again, the O's could use this as a way to limit the innings Bundy throws on the season. Assuming that he'll be healthy and productive, losing five starts off the front of the season could save him about 25 innings, which could be important as the team gets into September. 

    Expect Bundy to work on a throwing program once he's cleared to begin throwing. His history of long toss should have him back to normal strength and stamina quickly. There have been some low-level Luddite rumblings about that program. With poster boys Bundy and Trevor Bauer not living up to expectations just yet, those rumblings will only get louder. 

Cody Ross (Calf)

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    Injury: strained calf

    ERD: April 10

    The Arizona Diamondbacks will start the season without two-thirds of their expected starting outfield, and that's after the trade of Justin Upton to the Braves. With Adam Eaton out long term, the Dbacks are hoping they'll get Cody Ross back much more quickly. Ross's strained calf has him on the DL to start the season, but he'll do a quick rehab assignment starting at High-A Visalia this week.

    Things get a bit muddled on timing after that. Ross will start out as DH, but Kirk Gibson says that Ross could be back on the active roster by the following Monday. That's going to be one quick progression—or the Monday possibility is less likely than Gibson may be making it appear. 

    The Diamondbacks medical staff will be looking for normal bilateral strength in Ross' legs, for him to run well in the field and on the bases and to be able to play a nine-inning game without issue. Those can all happen quickly, and the Dbacks staff is very good at getting players back.

    Having Ross back next week may be a bit of a speculative play for fantasy owners, especially with A.J. Pollock having a nice Opening Day. 

Alex Rodriguez (Hip)

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    Injury: post-surgical hip labrum

    ERD: July 15

    Yankees fans sound disappointed that they'll be getting Alex Rodriguez back. The polarizing third basemen is on track with his rehab after offseason hip surgery and should, as expected, be back around the All Star break. 

    Rodriguez was in the Bronx for Opening Day answering questions about his recovery while avoiding questions about the ongoing Biogenesis investigation. Rodriguez is still in the very early stages of his rehab and has not progressed to the point where we get any sort of guidance beyond a very general timeline. In this, no news is good news; there have been no setbacks.

    The timeline, absent new information, holds until we get to May, when there will be milestones to check such as more running, fielding and perhaps hitting by the end of that month. It's going to be difficult to differentiate between slow healing and the glacial pace that the Yankees will take with this, so don't read too much into any individual timeline.

    Rodriguez is a good "injury stash" player, since we have a solid idea of what kind of player he'll be once he's back. Rodriguez went through a very similar rehab in his previous hip surgery and played well after. He will be older and there's off-field issues to be sure, but Rodriguez has always seemed better on the field than off it.

The Dots

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    The injury to Johan Santana brought up an interesting note on insurance that is very key in longer-term contracts, such as those signed by Justin Verlander and Buster Posey. Disability companies are more willing to sign deals in 2013 since they can use pre-existing conditions clauses to protect them. Santana's contract reportedly had a clause on his elbow, but not his shoulder. Disability contracts tend to be shorter than the overall deal, but can be renewable.

    Corey Hart wasn't at Opening Day in Milwaukee, but signs remain positive. He's still working on rehabbing his knee in Arizona with Frank Neville, the Brewers rehab coordinator. Temper expectations of an April return, but Hart did avoid the 60-day DL to start the season.

    The Marlins surprised many, including Logan Morrison, when the slugger was placed on the 60-day DL. Morrison has struggled with what the Marlins call a minor knee injury for the better part of two seasons. Since he won't be back until mid-May at the earliest, he's a tough hold without a deep DL in most leagues.

    Sources around the league have sounded cautiously optimistic about the progress Mark Teixeira is making in rehab. Teixeira is out of his brace for all but workouts and could start up baseball activities in the next week. His timeline still has him out until May, but with an injury like this, Teixeira will take the positives as they come.

    Phil Hughes is on the DL, but the retro move could have him back as soon as April 6th. Hughes' disk issue has cleared up and he is supposed to make a normal side session later this week. If he makes it through that, he's likely to get the start and slot back into the rotation. The Yankees do have options since they won't really need a fifth starter over the first two weeks of the season.

    The Red Sox elected to use the seven-day concussion DL for Stephen Drew, despite positive progress at the end of camp. Part of that was concern for the active roster, but Drew remained in Ft. Myers to continue a slow but steady rehab process. He could start a rehab assignment shortly, but the team is smartly being very conservative with Drew right now.

    Brian McCann is making progress, but one scout I spoke with this week wondered how any team, especially the Braves, will assess his value. "Laird is the more important part for them. If McCann can hit, is there a team that will trade for a DH? If he can't throw, do you consider him a catcher, even an emergency catcher? He's basically Mike Napoli now and you saw what happened with his contract." The Braves are going to have some tough decisions towards the end of the month as McCann continues his return from shoulder surgery.

    The A's brought in Hiroyuki Nakajima to give some stability to the shortstop position. Instead, he's going to force the team to play Jed Lowrie at short, giving him more exposure. It's almost a lose-lose for the team this early. Nakajima will miss at least three weeks with the injury.

    Luke Scott strained his calf in one of the last tune-up games the Rays had. It could cost him around a month depending on how his leg handles the rehab. With his absence, some were surprised that Wil Myers didn't get the call, but the team is thinking long term with their prospect, as they normally do.

    Thanks for all the feedback during the first couple weeks of UTK at B/R. If you have any other players you have questions about, drop them into the comments and I'll try to follow up on them for you. Remember, most of the time if I skip a player here, it's because there's no new information. I call it TRIP, for "typical rehab in progress." 

    All quotes in this article were obtained firsthand unless otherwise noted.

    Will Carroll has been writing about sports injuries for 12 years. His work has appeared at SI.com, ESPN.com and Football Outsiders. Google


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