Under the Knife: MLB Injury Analysis on Harper, Puig, Wieters and More

Will Carroll@injuryexpertSports Injuries Lead WriterMay 7, 2014

Los Angeles Dodgers right fielder Yasiel Puig is unable to catch a ball at the fence hit by Miami Marlins' Jeff Baker for a double, during the ninth inning of a baseball game, Sunday, May 4, 2014 in Miami. Adeiny Hechavarria scored on the play as the Marlins defeated the Dodgers 5-4. (AP Photo/Wilfredo Lee)
Wilfredo Lee/Associated Press

Every week, it seems like I'm writing about more and more injuries, but in the decade-plus I've been doing this, there's been so much progress. That's why it gets frustrating when people treat a cluster like an epidemic and do more talking about a problem than trying to fix it. 

I once asked Dr. James Andrews what he hoped his legacy would be, and he said that he wanted to put himself out of business. He hoped his research overtook the need for his surgical skills. That hasn't happened, largely because baseball let itself down in this regard. 

Take, for instance, one particular type of injury, a mysterious shoulder injury called thoracic outlet syndrome. While sports medicine is now better at diagnosing it, over half the cases have been found among Texas Rangers players. This isn't a fluke. It's that one of the top specialists in the condition, Dr. Greg Pearl, is located in Dallas. That sure sounds like there could be many more cases out there.

The most recent case is that of Josh Beckett, who is coming back from his own bout of TOS. The surgery has gotten him back, but it's still a complex condition. Dr. Clark Fuller, the director of thoracic surgery at Providence St. John's Health Center in Santa Monica, California, has been researching the condition and believes it's a perfect storm for baseball pitchers.

"It's overgeneralized," he explained. "What we have is a complex combination of anatomy, repetitive stress and difficulty in diagnosis."

The main problem is that the infraclavicular tunnel is difficult to see, and with a known inflammatory process going on each time a pitcher works, the tunnel is changing in shape and size.

"I can take an MRI, but I can't see how the shoulder moves or is firing or changes," Dr. Fuller explained.

The surgery is successful, but Dr. Fuller hopes that more research can help detect and arrest the problem before it gets to that. Here's just another place where MLB's money could help save it lost time and salary, yet not much is being done inside the game.

There are plenty of other injuries around the league, so let's get to it:

Nick Wass/Associated Press

Bryce Harper

Bryce Harper had his thumb surgery last week in Cleveland, and all went as expected. Nationals fans will have a while before we get any new indication on a return timeline, but the first sign will be when he gets out of the cast. That could come as quickly as next week.

Once the cast is off, grip and strength for the whole hand will be addressed. The thumb will need to be stable for this, so the Nats are sure to be a bit conservative, as they usually are with medical cases.

Given the similarities, Nats fans would be better off watching Josh Hamilton, who is coming back from an identical injury. Hamilton has been swinging a bat and is scheduled to take batting practice late this week. Hamilton is on track for a return right in the six-to-eight-week expectation, which is a good sign for Harper as well.

Mark J. Terrill/Associated Press

Hyun-Jin Ryu

The Dodgers got Clayton Kershaw back on Tuesday (and wow, he looked like a world-beater!), but they lost Hyun-Jin Ryu to the DL earlier this week. It ends up essentially a straight swap for now, but Ryu's sore shoulder doesn't look to be a long-term problem. While Ryu is resting, Paul Maholm and Josh Beckett are pitching for their jobs. Ryu hasn't had an MRI, so he shouldn't be out too long. For more info on Ryu's injury, click here.

Tony Dejak/Associated Press

Michael Bourn

Michael Bourn is having more trouble with his surgically repaired left hamstring. Whether the new issue is in the same location as the surgery or not, it's still troubling. Bourn is showing signs already that there's been an affect on his speed, but continued hamstring damage brings this to a chronic problem. Jose Reyes is a similar case—good when healthy but requiring a lot of maintenance (and a Plan B). The Indians hope they can keep him off the DL, but Nyjer Morgan is in place if they can't. For more on Bourn's injury, click here.

Don Boomer/Associated Press

Matt Cain

So Matt Cain is so fancy that he's ending up with triangular crustless sandwiches and trying to catch knives. That sounds more like a circus act than a starting pitcher. Next time, eat the crusts and let the knife fall, Matt. Cain's finger cut is healing, and with a retro DL move, he could be back in the starting rotation by the weekend. He won't have lost stamina, so Cain should be right back in your rotation as soon as he's back in the Giants rotation. For more info on Cain's cut, click here.

Wilfredo Lee/Associated Press

Yasiel Puig

Yasiel Puig plays the game hard. People may not always like some of the showier moves, but the commitment to dive into an unprotected fence has to be admired. Of course, the Dodgers wish he wouldn't do things that push him to the bench, but Puig's in the no-win area of being called out for too much hustle as well as too little.

The team is taking his post-concussion symptoms, mild as they are, quite seriously. While Puig told Jon Morosi that he could be available on Tuesday, the Dodgers elected not to use him. He's expected to be in the lineup on Wednesday, but that's subject to him having no symptoms through batting practice. 

Once back, Puig shouldn't have any issues, nor should this be taken as some indication that Puig is injury prone. I told someone today when discussing the play that The Wall is undefeated, especially when it's unpadded areas like where Puig hit. I'm always stunned that there are so many exposed and unpadded areas in MLB stadiums. Puig's a bit lucky and still very talented.

Uncredited/Associated Press

Jay Bruce

Jay Bruce has a minor meniscus tear, but surgery to correct the problem will cost him a month. The Reds should be familiar with this type of injury and its rehab. It's very similar to what Joey Votto went through a couple seasons ago, and they'll definitely want to avoid the setbacks Votto had that cost him extra time and a stable base for the rest of the season. Bruce isn't speed-reliant and should have Billy Hamilton protecting him from having to go too far into the gap. Expect Bruce back near June 1. For more info on Bruce's knee, click here.

Ann Heisenfelt/Associated Press

Matt Wieters

Late word from Baltimore has catcher Matt Wieters heading to see Dr. James Andrews for a second opinion on his elbow. This was first reported by Jeff Passan of Yahoo Sports. Wieters has been dealing with elbow pain, thought to be a flexor strain, for the last few weeks. He's been given extra rest, but the worry now is that there's damage to the UCL. If the damage is severe enough, Wieters would need Tommy John surgery.

Wieters was in the lineup on Tuesday as a DH, which gives us some idea about how the injury is affecting him. If he's able to swing but not throw, he could become a full-time DH. He may still need surgery, but the team could work on the timing. Delaying too much could risk the start of the 2015 season, but the Orioles will cross that bridge when they come to it.

Position players take a shorter time to recover from Tommy John, but a catcher isn't like a field player. The awkward, full-effort throws may force a longer rehab. This could end up as a situation like Albert Pujols had early in his career, where he was shifted to the outfield and then first base due to his elbow sprain. We'll know more after Wieters' visit to the good doctor. In fact, Buck Showalter told the media that Wieters can catch Wednesday!


Chris Sale

Doomsayers have followed Chris Sale since he was first drafted, but the latest batch will have to pipe down for now. Sale is getting closer to a rehab assignment and is showing no significant issues with his elbow. While forearm strains do occasionally become elbow issues, the White Sox medical staff paid particular attention to Sale's ligament during imaging and said that it is undamaged. Sale could be back before May is out, though the Sox will need to see that he's lost no stamina. This could be the latest feather in Herm Schneider's cap if he can get Sale back and keep him healthy.

Patrick Semansky/Associated Press

Chris Davis

Davis is making good progress with his oblique strain, but he's not likely to come off the DL when first eligible on May 11. The Orioles need Davis back, but they need him back with his power. The injury to Matt Wieters complicates things a bit, but the injuries really operate independently. Oblique strains don't have much long-term issue if the player allows it to heal up properly. Get Davis back in your lineup as soon as he's activated, but in weekly leagues, that may not be next week.

Aroldis Chapman

Aroldis Chapman could be back as early as this weekend. Stints in Dayton and Louisville have gone without a hitch, with Chapman showing no issue with his arm or his face. The test will be the next comebacker, though Reds sources tell me Chapman has shown "no flinch" during practices or games. Chapman's fastball is showing normal velocity, so he'll go right to the closer role when he's activated despite Jonathan Broxton's presence.

Mathew Sumner/Associated Press

Yoenis Cespedes

With Puig, Chapman and Cespedes all in UTK this week, it should come as no surprise that some around the game have been asking whether Cuban players are more susceptible to injury. Given the mechanism of injuries to Puig and Chapman being purely traumatic, I'll laugh those off, but there are some worries about Cespedes.

He's very strong and "tightly wound," in the words of one scout. Hamstring strains and other minor problems aren't keeping him out long periods, but there's question about whether it's reducing his effectiveness. The A's watch him closely to make sure that this can be minimized, so I'm not too worried by this latest episode. He was back in the lineup on Tuesday, a good sign.

Jason Grilli

The Pirates have been shuffling players back and forth between Pittsburgh and Indianapolis rapidly for the last few weeks, in part because of Grilli's oblique strain. Mark Melancon is a solid fill in, especially for a team that doesn't much buy in on closer mythology. Pittsburgh is shuffling its roster trying to find the right mix for a team that's struggling on the back end. Its depth will help, and with Grilli already throwing on flat ground, the back of the bullpen is one less thing for the team to worry about. Don't count on an immediate return to the devalued closer role, and don't dump Melancon when Grilli returns, either.

Ryan Zimmerman

Zimmerman is making some progress with his thumb, but he's still about a week away from starting baseball activities, according to Andrew Simon of MLB.com. That puts him toward the five- or six-week mark of the four-to-six-week standard timeline. A fractured thumb is different than the Harper or Hamilton ligament injuries, so he shouldn't have quite as much trouble with grip strength once he does get going. Just remember that a healthy thumb doesn't help his chronic shoulder issues. Expect a rehab assignment in a couple weeks with a return around June 1.

Tom Olmscheid/Associated Press

Joe Mauer

Mauer has had something of a renaissance early this season after moving to first base. However, he has had more problems with his back recently. While Mauer calls it merely stiffness, my worry all along was that the Twins waited too long to make this move and put Mauer into a chronic situation with the SI joint in his back. If that can't be worked out quickly, it might be time for fantasy players to sell high on Mauer.

The Draft

While the rest of the sports world is getting ready for the NFL draft starting Thursday, baseball scouts are really digging in on their work for baseball's draft in early June. Adam Wells had a great mock you can check out, but there's one thing more and more teams are noting: health. While young pitchers are especially risky, they also have a higher ceiling. Teams are doing their due diligence trying to figure out if the reward is worth the risk. Too many times, they have been simply buying injuries.

One other theme you'll see as we get closer to the draft is velocity. While we've seen velocities tick up in baseball, to the point it's changing the idea of "getting into the bullpen", it's even more pronounced in college baseball. There's always some kid, usually from rural Texas, who shows up his senior year throwing 98, but this season, there are two college kids throwing in the mid-100s! 

Amazingly, neither of them made Wells' first round! That tells you just how deep this draft could be. Given the depth, health is going to be as big of a deciding factor as signability and pitchability for the smart teams this year.


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