March 30, 2011

Collateral Damage

Disabled on Opening Day

by Corey Dawkins and Marc Normandin

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The time for the optimism of spring is reaching its end, as teams have finalized their rosters in time for Opening Day. This means that a number of clubs have had to accept that some of the injuries that their players have dealt with throughout the spring are not going to heal in time for the games that count. It also means that the disabled list, dormant throughout the spring for even the most injured of parties, is now in use. 

Bronson Arroyo, CIN (Mononucleosis)

Usually seen in teenagers and young adults and known as the “kissing disease,” mononucleosis can affect anyone, regardless of age. Usually associated with the Epstein-Barr virus, "mono" is a member of the herpes virus family, and according to the CDC, over 90 percent of adults between 35 and 40 have been infected at some point in their lives. When this infection of Epstein-Barr virus occurs during the adolescent and college years, infectious mononucleosis occurs somewhere between 35 to 50 percent of the time and is diagnosed by clinical exam and laboratory results.

Commonly spread through the saliva of an infected person, the virus is not easily transmitted through the air or blood. It is often found in the saliva of healthy people who are not experiencing any symptoms. Symptoms usually begin between four to six weeks after infection, and often mirror those of other viral infections, such as fever, sore throat, lethargy, swollen lymph nodes, and possible spleen or liver enlargement. For collision sports such as football, hockey, basketball, etc., it is absolutely a disqualification from participation due to increased risk of rupturing those organs (especially when they are enlarged). For non-contact sports such as baseball, swimming, or softball, it often depends on the current symptoms and the position or sport that the athlete in question is playing. A catcher is certainly at risk for additional injury to these organs compared to a relief pitcher or someone doing a breaststroke.

Despite its frequent appearances, there is no treatment for mono aside from addressing the symptoms. Sometimes physicians prescribe corticosteroids like prednisone if there is any risk of airway obstruction from the enlargement of the tonsils, but this applies only in extreme cases.

Bronson Arroyo's symptoms must not be too severe if he is continuing to pitch even after being diagnosed. One thing that absolutely must be monitored is his fatigue level throughout the game, in order to minimize the risk of other orthopedic injuries. There is a chance that he will tire faster due to the mononucleosis, so special care must be taken when possible. He is not likely to miss any time at this point, but if his symptoms worsen, the Reds may consider putting him on the 15-DL to recuperate.

Clint Barmes, HOU (Fractured left hand)

Clint Barmes will be out four to six weeks with a non-displaced fifth metacarpal fracture in his left hand after being hit by a pitch during last Friday’s game. Typically, non-displaced fractures heal well and simply require a certain amount of immobilization, followed by focused physical therapy after coming out of the cast. Until the bone heals, there is an increased risk of reinjuring the area. Barmes may want to invest in batting gloves with padding on the back side of the hand, very similar to the gloves football lineman use, or even the ones that former Astro Jeff Bagwell was known for after he had his own left hand broken by pitches in three straight seasons.

Tommy Hunter, TEX (Right groin strain)

Groin strains for any player can be bothersome, but that goes double for pitchers. Tommy Hunter suffered a Grade II (moderate) right groin strain and is expected to miss approximately six weeks to recover fully. He has strained this groin before—in his last spring training, no less—and it caused him to miss 20 games. He will have to take it easy in the early going to make sure that he doesn't re-aggravate the injury, turning it into a nuisance for the rest of the year. Former Rule 5 selection and converted outfielder Alexi Ogando will take Hunter's place in the rotation in the meantime, cutting into Texas's bullpen depth.

Brad Lidge, PHI (Right rotator cuff strain)

The latest news about Brad Lidge concerns not his biceps tendinopathy, but rather his posterior shoulder problems. Lidge went for a MRI of the shoulder and was diagnosed with an inflamed bursa. These results very well could reflect a cascade-type injury that occurred in the wake of the biceps tendinopathy, which may have thrown off the kinetic chain and changed how the forces were absorbed throughout the shoulder and arm. This is not an ailment that appears to require surgery, but Lidge is expected to miss at least one month. Those of you with fantasy teams might want to look at Jose Contreras in the meantime, as he was handed the closer gig over Ryan Madson in Lidge's absence.

Mat Latos, SDN (Right shoulder inflammation)

Mat Latos is one of many players who will start the season on the disabled list. Latos began experiencing pain in his shoulder last week. His MRI results showed that one of the shoulder’s bursa sacs had become inflamed, which can initiate a nasty cycle of pain, inflammation, impingement, weakness, and eventual instability that needs to be cut short before major injuries occur. He is eligible to come off the DL on April 6 and recently turned the corner in his rehabilitation progress. The Padres' medical staff is happy with his progress, and he is expected to begin throwing shortly.

Homer Bailey, CIN (Right shoulder Impingement)

Arroyo isn't the only Reds starter who is dealing with health issues, as Homer Bailey has been lost to shoulder impingement for approximately three to four weeks. As mentioned above, a vicious cycle of multiple components can feed into each other in a case like this. Pain, inflammation, impingement, weakness, and instability can all begin from something as simple as some soreness that doesn't go away over a few weeks. It is critically important to break that cycle in the pain or inflammation stage, as it is much harder to do so when you've reached the impingement or weakness stage. Bailey was considered a low risk for a significant injury prior to this problem, but it's safe to say that that outlook has changed.

Flesh Wounds: Mike Stanton returned from his right quadriceps strain and resumed hitting home runs like he was never out of the lineup. ... Brian Wilson suffered a mild oblique strain last week and is already improving and throwing. Both he and his beard should be ready to come off the DL as soon as they're eligible. ... Adam LaRoche is reported to have a small tear in his rotator cuff and fraying of his labrum. A corticosteroid injection reportedly helped ease his pain significantly. He returned to the lineup on Tuesday. ... Carlos Beltran reported no ill effects from playing in a minor-league game on Tuesday. ... Jason Bay is suffering from a strained muscle in his left rib cage. He will be reexamined over the next few days to determine whether this requires a DL stint. ... Curtis Granderson strained his right oblique and is questionable for Opening Day. … Todd Wellemeyer will have his right hip examined by a specialist in Chicago.

Lastly, for all the grief that Major League Baseball gets at times, the league deserve some praise for its recent announcement regarding concussions, even if it is technically in the trial phases. On Tuesday, MLB announced the creation of a new 7-day DL intended specifically for concussions and management of their symptoms. Baseline testing will be required and protocols have been created to ensure that proper treatment ensues. While this will not completely solve the problem posed by concussions, it's definitely a commendable step in the right direction, one that other sports haven't yet taken.

Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP
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