April 28, 2010

Under The Knife

Mid-Week Aches and Pains

by Will Carroll

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Justin Morneau (back stiffness)

Hearing that Morneau left Tuesday's game with a stiff back immediately brought up worries that he was having a recurrence of last year's season-ending back problem. That issue, a stress fracture in one of his lumbar vertebrae, was a serious one that carries recurrence risk. Early word out of Minnesota is that Morneau had just had some upper back stiffness and that the initial thought is that it was the cool weather in Detroit that aggravated it. While that's a positive in a relative sense, it does bring up some issues that do have to have Twins fans concerned. Many times, players get a "scare" from an injury that kicks them into gear. Back injuries have a way of doing that, but I'm told that Morneau didn't change much about how he approached the game. Maybe it's that this was hardly Morneau's first situation. He was tagged as injury-prone in the minors after some odd problems, including a career-threatening intestinal condition. He shook that off to establish himself as a star, so perhaps this is nothing more than a small bump in the road. Then again, Morneau is 28 and has the "old player skills" that tend not to age well. Watch to see if this becomes a recurrent issue over the next few weeks. The heat of summer should help somewhat as well. If he misses any time, it will be minimal.

Jorge De La Rosa (strained flexor tendon, 6/15)

Jason Hammel (strained groin, 5/11)

There's nothing that can take a team down faster than an injury stack. A stack is when a team has multiple injuries at one position, forcing them to go deep down the depth chart, causing a talent gap and often a loss of production. Sure, it's possible that someone steps up or that the mythical "everyone picks up the man down" kicks in—and I'd love to see a study on this—but anecdotally, stacks just crush a lineup and force roster moves that can throw a team's plan way off. The Rockies have a pretty nasty one at pitcher right now that's worse if you look a bit deeper. Last year, injuries forced the Rockies to bring in some pitchers to "hold down the fort" while their minor-leaguers closed the gap to the majors. Now it's those pitchers, De La Rosa and Hammel, who are out. De La Rosa and Hammel succeeded in a victory for pro scouting, but now we'll get to see if those minor-leaguers are ready to return the favor. De La Rosa's bruised finger turned out to be a strained flexor tendon. While it won't require surgery, this is an injury that often takes longer than expected to heal. There are similarities to what Indians prospect Adam Miller has dealt with, but his damage was much more extensive. Early indications are that De La Rosa is out at least a month, with re-evaluations along the way. As for Hammel, it's a simple groin strain that will cost him near the minimum. The Rockies are likely to bring up Esmil Rogers, who was still being extended into the starter role at Triple-A, so watch out for the bullpen, one that's already being worked pretty heavily and unevenly.

Nelson Cruz (strained hamstring, 5/13)

Ian Kinsler (sprained ankle, 4/28)

Brandon McCarthy (fractured shoulder, TBD)

The Rangers have their own stack of injuries, forcing the team to be pretty creative with a series of moves. With Cruz hitting the DL with a mild hamstring strain, the team juggled their catchers, sending down Taylor Teagarden and bringing up Max Ramirez. Ramirez isn't a catcher any more, but I'm sure he could play the position in a pinch. He's there to replace Cruz's bat for the 15 days that Cruz will be gone. The team also hopes that Kinsler's return will boost the offense in Cruz's absence. Kinsler has had no issues with his ankle during his rehab. While he has mentioned that it will bother him all season, this is more in a pain tolerance sense than any sort of functional issue. Kinsler's an all-out player with a lot of physical talent, but his tendency to get injured does cost him time and value. He'll have to adjust if there are limitations, though any loss in steals should come back in power and additional opportunities. On the farm, McCarthy has been diagnosed with another stress fracture in his pitching shoulder. His arm simply can't hold up, for whatever reason, over any extended period of time. It's unclear what the next step will be, if there even is one.

Brett Anderson (strained flexor tendon, 6/10)

Remember when Brett Anderson's elbow was just a cramp? Yeah, not so much. Turns out that cramp was actually the flexor tendon issue and that strain will shelf him for the next month or so. The flexor tendon isn't significantly torn ... OK, well, let me cue the "a strain is a tear!" speech, since I've already heard one reporter say "It's not torn." What they usually mean is that it's not ruptured and in this case, it's not close to that. This is likely a Grade I tear, though I don't have confirmation on that. There's been no mention of surgery or even a long-term rehab. Tendons are stronger and denser than ligaments and, being attached to muscles, can respond to healing better, but also take longer to heal because of the continued motion and articulation. Short of complete immobilization, it's tough to isolate a tendon. Pitchers with Grade II strains of the flexor tend to head for a surgeon, though they do have a good success rate. Anderson's best case is shutting it down for a couple weeks and coming back in late May. More likely, he'll spend a month on the shelf and take a couple weeks to get back up to speed. The A's have the pitching depth and this does hold Anderson's innings down a bit. In the longer term, we have to watch to see if Anderson backs off on the usage of his slider.

Vicente Padilla (inflamed nerve in elbow, 5/15)

The Dodgers got some more information on Padilla and while it's not good in the short term, it's actually good news. Just a day after Padilla said his arm felt worse than he could ever remember,  the finding that there's an irritated radial nerve in his pitching elbow makes that a very reasonable statement. The inflammation will be worked on with medicine and modalities for the next 7-10 while Padilla is shut down. Ideally, the nerve would be released naturally at that point and stop reacting. If there's a more serious impingement, it could require a surgical intervention, one that would cost Padilla months, if not the season. Usually, this does tend to calm down. Padilla has complained of this pain off and on throughout the spring, though it never approached this amount of pain or loss of function previously. That indication is that the inflammation following pitching is the culprit here and is a positive one for his non-surgical recovery. He won't be back until mid-May at the earliest, but this could have been much worse.

Rafael Furcal (strained hamstring, 4/30)

Furcal missed a second game with a tight hamstring, a big worry for a speed player that has had back problems in the recent past. Low backs and hamstrings are tied together in many cases, almost literally. Furcal had allegedly 'got religion' on a stretching and strengthening program which had kept his back problems at bay so far this season, but this injury, while minor, reminds us that there's a big recurrence risk. Furcal has played very well so far this season, flashing the speed that made him a star, so even a minor leg injury costs him some value. The Dodgers expect him to avoid the DL, but that he could be out until the weekend. I'm definitely keeping an eye on this one.

Quick Cuts:

Best wishes to Bob Uecker, who's heading to the DL for heart surgery. One of my fondest memories of this crazy "career" of mine is an evening at Don & Charlie's listening to Uecker tell stories ... Brad Lidge is expected back in Philadelphia by the weekend. They stretched him out a bit, going two innings and striking out four on a rehab appearances with Double-A Reading on Tuesday night... Newsday is reporting that Carlos Beltran may not be back until the All-Star break. The brace he's been fitted with is something of a red herring, though ... Ivan Rodriguez was back in the lineup on Tuesday after missing Monday with a sore back. Rodriguez has a history there, but hasn't had problems with it for years ... Felipe Lopez is on the DL with a strained elbow. Yes, it's the result of his pitching performance in that 20-inning game with the Mets. He should miss the minimum ... Lance Berkman was in the lineup Tuesday after a scare with his knee over the weekend. This is a very good sign that the swelling is under control ... The Giants think that Aaron Rowand will be ready to come off the DL when eligible on Sunday. They're not sure if he'll need some form of facial protection ... Kerry Wood will head out on a rehab assignment next week. The real news is that he'll be back in the closer role, which is somewhat telling from Manny Acta ... Joel Zumaya's arm is holding up, but not well. He'll need some extra rest despite the ban on using him in back-to-back games ... Koji Uehara looked solid in a quick rehab outing. He'll make one more appearance on Thursday before the O's make a decision. It looks like he could be back in the pen quickly ... The Brewers have to be worried about Trevor Hoffman, who hasn't had the changeup working at all this season. There's no indication of injury here, so some work or rest is likely in order. The team could go with LaTroy Hawkins or Todd Coffey for the short term, but Chris Smith is tearing up Triple-A, though he's no prospect at this stage ... Thanks to everyone that e-mailed or tweeted while I was sick yesterday. I was day-to-day, but played through it to hang out with The Daily Line. My interview with Reese Waters will be up soon at BPR.