May 25, 2011

Collateral Damage

He's Not a Machine, He's a Man!

by Corey Dawkins and Ben Lindbergh

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Even the biggest, baddest machine you can find on display at Home Depot is simple compared to the human body. It’s true of both machines and bodies that each component part has to fit and engage in a certain way for the whole to operate as intended. However, when a machine breaks down, a technician can swap out the faulty parts and restore normal function immediately, with no rehabilitation required. Machines: simple and effective. Humans: not so much. Just ask Duke.

Injuries always require rehabilitation and continuing treatment of some sort to heal fully. Of course, when surgery is required, even that relatively quick fix goes right out the window. It’s almost enough to make one wish that Skynet had become self-aware on schedule.

Jorge De La Rosa, COL (Torn UCL left elbow)
Another one bites the dust. Tommy John surgery isn't as dreaded as it once was, but a torn UCL certainly isn't a diagnosis that a pitcher looks forward to hearing. De La Rosa completely tore his ulnar collateral ligament on Tuesday, according to the team, but a surgical date has not yet been determined.

The timing of surgeries depends on several factors, but surgeons often like to wait until there is minimal swelling and some range of motion returns, if possible. De La Rosa's elbow reportedly hasn’t swollen significantly, so there is a chance that he could have the procedure done sooner rather than later, which would also leave open the possibility of a strong push toward returning at the end of the 2012 season.

Tommy John surgery now comes with a very good prognosis, although nothing is guaranteed. De La Rosa’s previous injuries likely did not play a major factor in Tuesday's tear, but his overall injury history has to be a concern going forward. Contrary to some reports, De La Rosa did have elbow and shoulder issues prior to blowing out his UCL. In 2007 he was placed on the 15-day disabled list with a strained elbow—costing him six weeks—and he was placed on the minor-league disabled list with left shoulder tendinitis in 2004. This past spring training he missed about two weeks with shoulder tightness.

In light of all of those ailments, in addition to a major injury to his middle finger in 2010, it’s natural to question whether he will be effective or at all durable after he returns. De La Rosa will be done for the remainder of 2011 and at least the first month of the 2012 season if everything goes well.

Adam LaRoche, WAS (Left shoulder labrum and rotator cuff tear)
Suck it up. Rub some dirt on it. It's just soreness.

Professional baseball players are paid quite handsomely to play the game, so unlike child and adolescent athletes, they can judge for themselves what risks they are willing to take by playing through or ignoring injuries. The biggest risk is that they can aggravate the injury or even cause a new one, which happened to Adam LaRoche. Earlier this season, a small labrum tear was found in LaRoche’s shoulder, but he played through it until the pain began to worsen.

Tests were repeated, which showed a larger tear of the labrum and partial tearing of the rotator cuff. Still trying to avoid the surgeon's table at all costs, LaRoche will pursue a conservative course. He's going to be restricted from throwing or hitting for approximately three weeks before being re-evaluated, but it's important to note that these injuries won't just heal on their own. They may become less painful and inflamed, but the tears will not go away, and LaRoche can only make them worse until he has them addressed surgically.

Matt Garza, CHN (Right elbow contusion)
Garza was placed on the disabled list with a bony contusion. On its own, that isn't too severe an ailment if it was caused by an impact injury, like a fall or a rendezvous with a batted ball. If no such event occurred and the act of pitching itself actually caused the bony edema, then there’s cause for greater concern. A bone contusion can arise from the bones of the arm literally banging into each other if the pitcher is suffering from instability or difficulty in controlling the acceleration and deceleration of the arm. There doesn't need to be a significant instability for this to happen, nor does the arm have to be hanging at the pitcher’s side from fatigue.

The tiniest change can make all the difference, and a May 11 outing following a rain delay may have been the start of it all. The overall prognosis for the bony contusion is good, but if there is any mechanical instability in the elbow—i.e., ligament damage–then this issue will likely crop up again. If the bony contusion was the result of fatigued muscles, the chances of further injury are somewhat lower, but still elevated compared to those when the culprit is a line drive to the elbow.

Dustin Pedroia, BOS (Left foot pain and numbness)
Pedroia had to leave Monday's game because of pain and numbness in his surgically repaired left foot that didn't respond to treatment. In 2010, a pin was inserted into the navicular bone of the foot to stabilize a fracture that wasn't healing. This bone is important because it acts as a keystone of the medial arch of the foot. It also has many structures passing by it, including the medial and lateral plantar nerves. Sensations to the bottom of the foot are controlled by these nerves, and those are likely the ones irritated by the screw.

He suffered a similar injury in April, but his symptoms resolved after a minute or so. On Monday, it took much longer. Two likely causes of the nerve being stressed include scar tissue buildup and a loosening of the hardware itself. If the fracture has fully healed, then the hardware can be removed easily, but that does require an operation and takes at least some time to recover from. If the fracture is not healed, there is the chance that the fracture will have to be addressed again, with new hardware implanted.

The numbness Pedroia has been experiencing doesn't appear to be consistent, so he has that going for him. He and the Red Sox will continue to monitor the state of his foot and ankle throughout the rest of the season.

Joe Blanton, PHI (Right elbow impingement and inflammation)
Blanton's elbow hasn't been responding to treatment, and repeated MRIs have come up clean, so the Phillies sent Blanton for ultrasound examination and a second opinion by Dr. James Andrews. Results of both are still pending, but the use of ultrasound as a diagnostic tool has paid increasing dividends in sports medicine clinics.

One of the major advantages of diagnostic ultrasound in the clinic is its ability to assess the injured area dynamically. In the case of the elbow, stress can be placed across the UCL to see how much opening or looseness of the joint there is. Ultrasound can also be used to assess the integrity of the tendons in chronic inflammatory conditions, something MRI can do but which often requires at least some wait for the machine to become available.

Flesh Wounds
Erick Almonte was hit in the face by a thrown ball during practice and had a recurrence of his symptoms. This is one of those gray areas where it's difficult to determine if this is a new concussion or not... Jason Bay left Tuesday's game with a stiff right calf. He's day-to-day for now... Phil Coke was placed on the disabled list after tripping down the dugout steps and spraining and bruising his right ankle... Kevin Slowey is going to have more tests and seek another opinion for his lower abdominal pain. There is growing concern that it might be a hernia... Tendinitis rendered Sam Demel's right shoulder painful enough to require a move to the disabled list… Padres prospect Everett Williams will miss the rest of the season after undergoing ACL surgery on his right knee.

Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP
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Ben Lindbergh is an author of Baseball Prospectus. Follow @benlindbergh
Click here to see Ben's other articles. You can contact Ben by clicking here