June 1, 2010

Under The Knife

Tuesday Update

by Will Carroll

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Kendry Morales (fractured tibia, ERD 9/1)
Morales didn't have surgery on Sunday as expected. His ankle/lower leg was still swollen and the doctors decided to wait until that swelling was down before going in and fixating the leg. That's reasonable and shouldn't affect the return time for the first baseman significantly. Examinations the last couple days have the Angels thinking that Morales will be back around the end of August or early September. The chance to get some at-bats at the minor-league level is key, as is the Angels' record at that point. Many have asked if this is a reasonable return time, so we look to the comps. The most recent comp is Scott Sizemore, the Tigers' second baseman who snapped his leg at a similar point during the 2009 Arizona Fall League season. Sizemore came back for spring training and the time period doesn't look good. Remember that there was no baseball three months after the point where Sizemore injured himself. A better comp might be Angels center fielder Torii Hunter, who went through a similar process when he had an ugly encounter with a wall. Two injuries that aren't good comps but came up in discussions were Robin Ventura and Jason Kendall. In both those cases, the player dislocated the ankle, which had ligament and tendon issues on top of any fractures. This injury should heal cleanly, especially once it's fixated, with few long-term consequences.

Jorge Posada (fractured foot, ERD 6/2)
It appears that things are moving fast in the Bronx. Posada was throwing over the weekend then made the big step—no pun intended—of running and then sprinting on Monday. The Yankees' catcher has had no residual soreness in his foot, and reports from the team indicate that the hairline fracture appears to be both stable and healing completely. That's not to say that he'll go back to catching immediately. In all of this, Joe Girardi has been very careful to avoid saying that Posada will go back behind the plate just yet. It appears that Girardi is on Posada's side when it comes to avoiding a rehab assignment. A decision on that could come as early as today, and if so, Posada should be activated no later than Thursday with the possibility of an immediate roster move. Part of that depends on who the Yanks decide to send down.

Aramis Ramirez (bruised hand)
The Cubs continue to try and find a way to get Ramirez comfortable with a bat in his hands. The third baseman has a deep bruise on his hand, in between his thumb and index finger, exactly where it presses into the turn of the bat. Ramirez has been dealing with this for more than a week with mixed results. The worrisome part here is that despite rest, it hasn't dissipated. Ramirez has used padding and changed his grip, but the bruise remains. He has had only two hits since May 17, watching his already low average plummet into sub-Mendoza territory. At some point in the very near future, the Cubs are going to have to see marked improvement or Ramirez is going to have to take some real time off to let this heal. The lingering nature of this is a bit worrisome and is leading many to think that there's more to this than just a bruise, though sources insist this is one of those unlucky situations where it's something in precisely the wrong spot that's exacerbated by the necessary activity.

Brad Lidge (inflamed elbow, ERD 5/31)
Lidge is back in the Phillies' bullpen, but not the closer role. That's likely not far behind, though Charlie Manuel seems comfortable with letting Lidge get comfortable. While we often talk about the confidence of the man in the closer role, it's often the manager who decides things. As we saw last year with the slow draw that Manuel had during Lidge's struggles, Ol' Cholly is perfectly happy to move at his own pace. Lidge came back Monday in Atlanta in the bottom of the eighth with the Phillies down big. He showed all his pitches, good velocity, and went after Jason Heyward with four low sliders that seemed effective and of the same shape as the "good Brad Lidge." We'll need more evidence, but one player at the game said that "[Lidge] looked like he had some confidence in his [stuff] for the first time in a while." Jose Contreras will likely get a couple more save chances, but a few more outings like this from Lidge will have him back in the closer role.

Jason Bartlett (strained hamstring, ERD 6/4)
As Bartlett left last Friday's game with a strained right hamstring, the shortstop was called "day to day" publicly while sources told me that he'd miss a day or two, largely because the Rays had several options at the position that could buy him some rest without having to DL him or hurt the team's lineup. It looks like "day to day" will go until Friday, though a decision on the DL could come before then if Bartlett doesn't make more progress. That's not expected to be necessary, but Bartlett was still sore on Monday. The team has Reid Brignac, Ben Zobrist, and Sean Rodriguez, so it can take its time on this decision. It's very unlikely that Bartlett would need the full 15 days and Joe Maddon doesn't mind playing a man down, especially given the flexibility he has with two multi-position players available.

Homer Bailey (inflamed shoulder, ERD 6/8)
"Wonderful." That's how Bailey described how his arm felt after a session of long toss on Monday. Eligible to return in a week, the right-hander is slowly building back toward a start. The shoulder doesn't appear to be an issue just yet, but there's some question about how the Reds will progress him. The short stint shouldn't have cost him significant stamina, so a rehab start isn't necessary. But at long toss with just a week to go, the Reds will need to see some quick progress to the mound by later this week if he's going to come back next Tuesday, which would be his slot in the rotation as well. The one worry here is that no one seems sure of exactly what the underlying problem was for Bailey. I still go back to the image of him shaking his arm and twisting his elbow, the motion that would open up the front of his shoulder. Something tells me Reds trainer Paul Lessard and doctor Tim Kremchek are taking a special interest in this return.

Derek Holland (inflamed rotator cuff, ERD 6/30)
If this turns out to be another case of thoracic outlet syndrome for the Rangers, I'm sending the CDC in there. Holland is heading to the DL with what the Rangers are calling an inflamed rotator cuff. Holland came out of his Sunday start complaining of numbness in his hand. Assuming that this is just a rotator cuff issue, that would indicate an impingement impacting the nerves that comes through the shoulder and down the arm. That's reasonable, but with the history of TOS in Arlington, the gallows humor has begun in some circles. There's no indication that's the case here, as Holland will be treated conservatively, though expecting this to be a minimum stay is unlikely. This one's going to be more like a month. The team is expected to replace him in the rotation with Tommy Hunter in what's become a rotation rotation.

Orlando Hudson (sprained wrist, ERD 6/3)
Hudson came out of a nasty collision with Denard Span with the worse end of the deal. Well, Span might argue that a bit. While it looked initially like Hudson had injured his knee, it was his surgically repaired wrist that was the problem. It was made a bit worse because of that history, making it impossible to tell just how much damage had been done with simple x-rays. Hudson was forced to have further advanced imaging done to make sure that there were no new fractures or injuries inside the wrist. After consultation with Hudson's 2008 surgeon, the Twins think the second baseman will need just a couple days then rejoin the team. With Alexi Casilla injured, the Twins were forced to remind Michael Cuddyer that he was once an infielder.

Chris Capuano (sprained elbow)
Contrary to what many seem to think, having two Tommy John surgeries isn't much more significant than having one. It's the same thing that happens—too much force is exerted on the UCL and it snaps over the course of time or occasionally from one traumatic event. It's certainly not good, but there's actually some benefit to knowing the process and having successfully completed it previously. It's rare, mostly because most pitchers don't last long enough to blow it out twice. There's a "honeymoon" period after Tommy John surgery, where the transplanted tendon is "ligamentizing" that seems to last four or five years. In that period, there are very few problems and the new UCL seems to be almost bulletproof. It's new, so it's simple that it wouldn't be worn down or overstressed. Capuano's return from his second time around should be no different, but it also makes sense that not so far down the line, he'll need the same procedure. If the left-hander can win for the Brewers now, they'll take that.

Errata
I made a stupid error yesterday. In a "Quick Cuts" discussion of Ricky Nolasco, I said that I don't worry until a pitcher sees a 10 percent reduction in velocity. That's a big number and very obviously too much... for a major leaguer. Back in 2004, I worked on a project I called "V-Loss" for my book Saving The Pitcher. I was trying to find a way to quantify fatigue using velocity loss in a pre-Pitch-f/x world. Velocity loss was an apparent thing, something that we found that a Little League mom could spot almost as well as a trained scout. We found that fatigue was apparent at 5 percent and notable at 10 percent, the point where a pitcher should get lifted. It was a quantification of Earl Weaver's quote, "When the pitcher is tired, the hitters will tell me." Because this was focused on youth pitching (though we did use all levels for the work), the large variance in their velocity is more understandable. For major leaguers who are much stronger and pitching at higher velocities, that kind of drop in velocity can be devastating. I apologize for the confusion. 

Quick Cuts: Is this the end of flu-like symptoms? ... Steven Strasburg will debut for the Nationals on June 8. In that start and every other start he makes, he'll be on a very strict pitch count. There have been suggestions that there's also a seasonal innings limit in place. ... Andre Ethier is back in the lineup for the Dodgers, wearing a soft splint on his injured finger. ... Derek Jeter was hit in the back of the leg, then was lifted later in the game. He had a marked limp. Don't expect him to miss much time, if any, for the Yankees. ... Diamondbacks third baseman Mark Reynolds left last night's game with a quad strain, but there were no details at deadline. ... Huston Street could start a rehab assignment later this week. The Rockies' reliever could be back in a couple weeks. ... Jesse Litsch will return to the Blue Jays rotation on June 8, a few days shy of one year since his Tommy John surgery. ... Yes, there are a lot of worries when you're a pitcher. This kind of thing is just one of them, but nice article from Ken Davidoff. It's stunning to me though that Andy Pettitte, an admitted hGH user, still gets a pass for that while saying things like "If I can figure out a way to get out there, I do it." .... Miguel Montero is hitting in extended spring training, but is still a couple weeks away from being able to catch. The Diamondbacks considered getting him some work at first base, but don't appear to be serious about a position switch, even a temporary one. ... Mark DeRosa started a rehab assignment. The Giants' left fielder is trying to play through his wrist issues and observers say he appeared to really be struggling, even at the High-A level. ... Awesome.