Under the Knife: Braun's Thumb, Harper's Knee, Pitcher Protection and More

Will Carroll@injuryexpertSports Injuries Lead WriterJune 18, 2013

Under the Knife: Braun's Thumb, Harper's Knee, Pitcher Protection and More

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    The best is the enemy of the better, and in some cases, the better seems to be the enemy of common sense.

    Once again this week, the bigger story in sports medicine is not Ryan Braun's thumb, Bryce Harper's knee or even the continuing saga of the New York Yankees falling apart at the seams. Instead, it's a pitcher taking another ball off the head.

    Alex Cobb will be OK after the ball dropped him to the turf. Unlike Brandon McCarthy and J.A. Happ, there was no skull fracture this time. That's hardly victory; it's luck. A bit more force, a bit worse location and Cobb suffers a worse injury.

    (It's also worth noting that Ron Porterfield, the Rays' head athletic trainer, got to Cobb inside of 10 seconds and immediately called for a stretcher. That's the arms out gesture he made before even bending down to tend to Cobb.)

    The issue is bigger than any one pitcher, and as the mainstream picks up on this, it could quickly become even more of an issue about the general safety of baseball. Football may have a concussion problem, but they're not above reminding parents that at least they have helmets.

    Baseball's continued inaction on this is bad, but what is worse is that the pitchers themselves are doing nothing. There are solutions out there. Perfect? No, but as I said, the best is the enemy of the better. Pitchers are out there now with a glove that's doing them little or no good in these situations and...well, hope and luck.

    If I can put together a kevlar lined hat in an afternoon, I'd hope that there's someone out there somewhere, that could assemble something significantly better. It's time that MLB helped find that someone and got that product out there before something is mandated.

    There's a lot of other injuries around the league, so let's take a look: 

Ryan Braun (Thumb)

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    A few days off didn't help Ryan Braun's thumb, so the Brewers were forced to push him to the DL. The current plan, according to the Milwaukee Journal-Sentinel, is to give his hand a complete rest for a week in hopes that the soreness and inflammation subside. 

    With a problem ligament, the question is less about healing and more about function. Other players, such as Dustin Pedroia, have played with similar injuries. But as Braun showed as he tried to play through it, keeping the symptoms static is a constant battle and comes with some cost.

    Braun isn't expecting to be fully healthy when he comes off the DL, so temper expectations for his return. What worries the Brewers is that he seemed to lose power. The normal concern with any grip issue is bat control, but over the past couple weeks, Braun hit over 300. That indicates that grip isn't the problem, but the pain when he does make solid contact. 

    The Brewers can be a bit patient here, so watch to see how Braun responds when he starts swinging a bat again. The first time he gets in the cage next week won't be as telling as whether he comes back to it the next day. 

Bryce Harper (Knee)

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    Rehabs are generally boring. Some of the hardest articles I have to write are about the long process an athlete goes through in getting back. Detailing the rehab protocols is mind-numbing, and for an athlete, it's worse.

    Bryce Harper is someone who plays hard, so "rest" is anathema to him, but it's necessary.

    After visiting Dr. James Andrews last week and having the knee braced up to prevent as much movement, protecting the inflamed bursa sac, Harper has seen some progress. He's worked with the medical staff on range of motion and strengthening, with the Washington Times noting that things are going about as expected. 

    Harper should progress to baseball activities rapidly, perhaps even by the weekend. The Nats medical staff tends to be conservative, so any slight delay or days on the DL past the minimum shouldn't be a major concern as long as there's no notable setback.

    It's slow and frustrating, more so for Harper than for fans, but the result is well worth it. If he can just stay away from walls, the results will come, and a healthy Harper is one of the most valuable resources in baseball. 

Everth Cabrera (Hamstring)

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    There might be no player with a bigger delta between his real baseball value and his fantasy value. Coming into the season, it looked like steals were returning to the game, but instead, it's gotten even tighter,, with only a few players even into double digits.

    Everth Cabrera is one of them, fighting with Jacoby Ellsbury for the overall steals lead, but a hamstring strain might derail that quest.

    Cabrera is a pure speed player, with almost all of his value tied to his legs. Both on the bases and in the field, Cabrera is lost without his speed. Even with that, his bat hasn't been enough to lock down a position in the past, though he's shown significant development this year, jumping from a .645 OPS last season to a current value over .800, as detailed by Corey Brock of MLB.com

    Some of his bat may be fluke, but his speed flourished with the increased opportunity. Cabrera's hamstring strain is mild, so the team is taking a couple days to see whether it will heal up enough to avoid the DL. The team is playing shorthanded to keep the retro move in place, so expect a decision before the weekend. 

    The Pads are surging in the tight-but-mediocre NL West race, but to keep close, they'll need to get healthy. They have a ton of players on the DL, and along with Cabrera's DL wait and see, they are doing the same with the oft-injured Carlos Quentin. Bud Black only has so much smoke and so many mirrors. 

Mark Teixeira (Wrist)

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    Setbacks come in many varieties. None are good, but some are much worse than others.

    Mark Teixeira's is somewhere in the middle. The inflammation in the wrist is not indicative of significant damage to the tendon or tendon sheath, but it sounds as if Brian Cashman wants to put Teixeira back on the DL, per ESPN. 

    There are probably some further issues in Teixeira's wrist. Tendons don't have this kind of inflammation without some kind of underlying issue, and a recurrence this soon after extended rest is certainly a major negative. Cashman wouldn't rule out surgery, and it does appear that this is headed in that direction. If so, the surgery would cost Teixeira about six months as he recovers. 

    As before, the Yankees will try to calm the inflammation and get Teixeira back to function, but this is going to be difficult given what we know of his previous rehab. It's unlikely that the Yankees would give him another 30 days to get better without exploring surgical options. 

    Teixeira had an anti-inflammatory injection over the weekend. If he's not back and swinging by the weekend, he'll go to the DL and the Yankees will go back to the pasted-together roster that they used through the season's first couple months.

    While Alex Rodriguez and Derek Jeter are making progress toward a July return, the team isn't going to have a chance to play with their expected roster until after the All-Star break and now, potentially not at all. 

Anibal Sanchez (Shoulder)

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    Pitching injuries linger. For the Detroit Tigers, the injury to Anibal Sanchez carries a shadow of the 2007 campaign that nearly cost Sanchez his career. The former Marlin was used heavily and inconsistently by then-manager Joe Girardi, ending up with Sanchez having a labrum repair.

    The Detroit News had the details as Sanchez went on the DL. 

    Not many pitchers come back from this kind of injury, but Sanchez not only came back, he cashed in a big free-agency contract. Now, he's having soreness, some inflammation and a reduction in velocity, something that can't help but worry the Tigers after he signed a long-term deal with them. 

    Detroit is saying that there's no structural damage, which tends to be a nothing statement. In Sanchez's case, it's unclear if the repaired labrum counts as a structure or whether this is a muscular injury. The worry here is that the biceps may be involved, as the biceps and labrum interact in ways that orthopaedists disagree on. 

    As of now, Sanchez will miss a couple more starts, but watch to see if there's any more clarity on what structures are involved and if he's able to show normal velocity in a couple starts—not just one, since there may be a fatigue factor here—once he does return. 

Alex Avila (Forearm)

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    Some injuries just hurt to watch. Some hurt just to think about. The last couple weeks have been reminders that the ball itself is quite the weapon, between Alex Cobb, Brandon Phillips and now Alex Avila. It's not just a pitcher problem. 

    Avila took a ball off the forearm in much the same manner as Phillips. Avila hits the DL, while Phillips avoided it, but it's less about the injury as the roster. It was easier for the Reds to replace a middle infielder than it is for the Tigers or any team to play a catcher down, even with Victor Martinez on the roster. 

    Avila was hit near the wrist, so even though images showed no fracture, the Tigers are being cautious. Simply put, the risks of this kind of injury for a catcher are worse than for any other position. They just take more hits back there as part of the job, complicating any return.

    Avila shouldn't be on the DL much past the minimum, but it does leave the Tigers very shorthanded at the position in the interim. Bryan Holaday is a glove guy first and foremost, but even he was outhitting a scuffling Avila so far. We'll see if a couple weeks away can help with that as well as healing up the arm.

David Price (Triceps)

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    The Rays are very conservative with injuries, especially with pitchers, but I'll admit that the drastically conservative pace that they're taking with David Price is surprising me. Some are using the timetable to speculate that Price's triceps strain is worse than the team is letting on, but there's no evidence to support it. 

    Price has made all his sessions and will do so again on Tuesday with a side session scheduled. If that goes well, the expectation is that he'll have a rehab assignment set, but the AP detailed that normal soreness is still a problem for Price. If Price is not somewhere in the minors by this weekend—likely at nearby Charlotte (A)—the Rays may not have their ace back until the All-Star break. 

    The team has indicated that they want Price to make three rehab starts, even with Alex Cobb on the seven-day DL. (Remember, the seven days is a minimum, not a maximum.) The goal is to have Price completely healthy and not end up back on the DL, but the pace they're taking lends itself to speculation to fill in the gaps. 

A.J. Burnett (Shoulder)

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    I won't belabor the point that A.J. Burnett is key to the hopes of the Pirates as they try to find the right side of .500 for the first time in two decades. Even with Gerrit Cole up, Burnett is still the clear ace of the team, which makes his calf strain a bigger problem for the Pirates than it would appear. 

    Surprisingly, Burnett has also been pretty healthy over the latter phase of his career. He's been over 180 innings for the last five seasons, a sharp contrast to the early phase where he had Tommy John surgery and was regularly on the shuttle from Toronto or New York to Birmingham. 

    As anchor of the staff, Burnett is not only the team's best pitcher, but most consistent. The bullpen has been solid for the team, but also not overused, something that it could face if the young and inexperienced pitchers that are filling in the back of the rotation could push onto the pen if they can't shoulder the starter's load.

    Burnett will be on the DL a couple weeks while the strain heals and could need a rehab start if it goes much longer than the minimum. It could go as long as six weeks, and with the All-Star break in there, it wouldn't surprise me to see the team use that as a return goal.

    The Pirates are playing well, but have collapsed in the second half of the last two seasons. Don't expect there to be a long leash on anyone if signs of that happening again show up, up to, and including, Clint Hurdle. 

Nick Swisher (Shoulder)

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    Nick Swisher is another player with the "no structural damage" label, according to MLB.com. There's something wrong in the shoulder, leading the team to shut him down and put a spike in him. Swisher will miss at least the rest of this week and that could mean the DL. 

    Swisher has definitely been struggling over the past few weeks, and if the root cause was the shoulder issue, we should see major improvement. Injuries like this, with a clear pattern of problems that extends prior to aggressive treatment—I say aggressive treatment here because I have no doubt that Lonnie Soloff and his staff were working on the shoulder all along—can sometimes show a dramatic swing once the action is taken. 

    Swisher is expected to return on Friday. Again, watch to see if his swing is freer and if his normal numbers show up as a result. If not, this is a chronic issue and everyone should check the waiver wire for options. The Indians will have to be more patient and hope that Swisher can get back to his expected production. 

Clayton Kershaw

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    I won't belabor this too much, but with any long-term contract for a pitcher, there's an element of risk. Pitchers get hurt, especially young pitchers, and it has to be factored into any deal, in ways beyond just buying some insurance.

    Clayton Kershaw is 25—just past the injury nexus—without any major injuries, but he has had some issues and has had a heavy (but not abusive) workload under the nexus. After the guys at Spotrac gave their prediction of a huge deal for Kershaw, north of $200 million, I wondered what the risk might be inside that eight-year deal.

    Using the tools I use for the Team Health Reports, I tried to discern the risk that Kershaw would miss a full season during the term of the deal. Admittedly, this is more specific than what these models were designed to predict, but roughly speaking, there's about a 17 percent chance of a catastrophic injury occurring. 

    We all hope that Kershaw stays healthy and productive, but pitchers are risky. Long-term contracts mean the team owns that risk. The Dodgers under Stan Conte have done their research and know Kershaw better than anyone, so if they're willing to commit, it's a positive sign for his health, but not an imprimatur of invulnerability.