May 30, 2011

Collateral Damage

A Wing and a Prayer

by Corey Dawkins and Ben Lindbergh

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Today marks Memorial Day in the United States, the occasion when we honor those brave souls who lost their lives serving our country. Do your part to honor those lost by thanking those still here. The next time you see a soldier, ask to shake their hand.

On to the injuries.

Joe Nathan, MIN (Right forearm and elbow inflammation)
It's not uncommon for players to end up back on the disabled list within a year or two of returning from Tommy John surgery. The surgery requires a long recovery, and there are often bumps in the road both during the rehabilitation process and even once the player is activated. In many instances, the newly-healed body isn't ready for the grind of the season. The typical throwing program accounts for fatigue and restores the body to its former strength, but it can't prepare every player for factors like travel and getting out of the ballpark after midnight.

Looking into the database, we see 173 players who have missed time at the major-league level due to Tommy John surgery. Within one year of returning, a little over 28 percent of the 173 players suffered some sort of injury that caused them to miss time. That figure does include all injuries, so you might think it sounds a little misleading, but almost 20 percent involved injuries to the upper extremities and torso. In fact, nine of the 173 players had another surgery on an elbow or shoulder within a year.

In light of those numbers, it's not too surprising that Nathan finds himself on the disabled list again. Inflammation such as his is very common because of the fatigue factor, but it does tend to resolve with rest and proper rehabilitation. It will likely keep him out for three to five weeks, depending on how long it takes to get the inflammation under control.

Wandy Rodriguez, HOU (Left elbow swelling)
The body doesn't swell without a reason. That reason may not be a major structural issue, but it’s always something. The swelling inside Rodriguez's elbow has been persistent to the point that it required a move to the disabled list. Earlier in his career he suffered from multiple oblique injuries, but this year it's been the shoulder and elbow that have given him problems.

A recent MRI revealed no major structural issues, but it must have missed something. Often there can be damage to the cartilage, which can certainly cause swelling inside the joint. Rodriguez hasn't had any major elbow injuries before, but the Astros would be smart not to push him back too early and risk causing a cascade-type injury.

Joe Beimel, PIT (Left elbow inflammation)
Tony Pena, CHW (Right elbow inflammation)
Tom Gorzelanny, WAS (Left elbow inflammation)
Continuing the trend of elbow injuries, Beimel, Pena, and Gorzelanny all ended up on the disabled list with elbow inflammation. All three have suffered from at least one injury to an arm before, so it's not surprising that we see them here again. We’re also reaching the point in the season where the grind is starting to takes its toll on the players’ bodies; starting around the second week of May, fewer off-days and longer road trips become the norm.

Beimel will undergo an MRI tomorrow, at which point we should find out more about his condition, but Gorzelanny expects to make only a short stay on the disabled list. Pena had an MRI a few weeks ago when his elbow first started acting up, and it came back showing no structural damage, so the length of his DL trip is still undetermined.

Matt Maloney, CIN (Broken rib)
What was first described as an oblique injury for Maloney ended up being a broken rib, conjuring memories of Sammy Sosa's sneezing injury. Small fractures of the ribs can be difficult to assess, especially without any evidence of trauma. In some instances, there isn’t much difference between a bad bone bruise and a small fracture, and in many cases they take about the same amount of time to heal. Maloney was placed on 60-day disabled list, which puts him on the shelf until mid- to late July.

Gordon Beckham, CHA (Left eye contusion)
Even though Beckham wasn't at the plate when a ball hit him in the eye—he was struck by a throw from the outfield that took a bad hop on the Toronto turf—he was still lucky that it didn't cause any fractures or serious damage, since there are several small bones around the eye that don't take a lot of force to fracture. Beckham's eye was swollen, not to mention about three different shades of black and blue, but his vision was normal. Once the swelling subsides enough for his peripheral vision to return, he should come back without any difficulties.

Bronson Arroyo, CIN (Low back pain)
Word came out that Arroyo had an epidural injection for his back pain, which tells us a lot about what’s going on. Epidural injections have many uses throughout medicine, but in sports medicine they tend to be used for disc injuries, such as bulging or degenerative discs, and stenosis, a narrowing of the spinal column.

These injections often contain an anti-inflammatory similar to cortisone as well as pain-relieving medication, and they can make all the difference when physical therapy has failed. They can be very effective at relieving pain and inflammation in both the short- and the long-term, but they don't heal the herniation or create more space in the spinal column. What's more, they're not guaranteed to work.

Flesh Wounds: Kenley Jansen became the Dodgers' 15th visitor to the disabled list in 2011 (three more than any other team) thanks to right shoulder inflammation... Reed Johnson was placed on the disabled list with back spasms, extending his long history of back problems... John McDonald strained his right hamstring a few days ago, and he hit the DL after it failed to improve... Steven Pearce will have an MRI on his right calf on Tuesday and is expected to move to the disabled list... A few days after Buster Posey's injury, Humberto Quintero was lucky to come away with just a high ankle sprain on a similar play... Speaking of Buster Posey, Giants head athletic trainer Dave Groeschner confirmed that he will be out for the season following his recent surgery. He will need at least one other surgery in two to three months to remove two screws.

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