July 25, 2011

Collateral Damage

Overextended

by Corey Dawkins and Ben Lindbergh

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Zack Cozart, CIN (Right elbow hyperextension) [AGL: 26, ATD: +.025] (Explanation)
It seems like everyone is having difficulty staying healthy nowadays, veterans and rookies alike. With Nate McLouth bearing down on him, Cozart reached for a throw, only to catch his glove on McLouth's left leg and body, painfully hyperextending his elbow and leading to a trip to the disabled list. After an injury with a major fracture or neurovascular compromise was ruled out, Cozart walked off the field with assistance and was later diagnosed with a hyperextended elbow following x-rays and MRIs.

The elbow is actually composed of three different joints, but the major joint is a hinged joint that forms between the humerus and ulna. The main movements of the humeroulnar joint include flexion and extension, although there is some circumduction motion as well. When the elbow hyperextends, several structures—the biceps, brachialis, joint capsule, and other structures—stretch and can tear, leading to dislocations in severe cases.

For right-handed hitters, hyperextension injuries of the left elbow can be slower to return from than one would expect. With every swing, the momentum of the bat carries the elbow into extension, often moving into slight hyperextension for a brief moment. The risk of re-injury if Cozart were to come back at less than 100 percent is fairly high. Cozart was placed into a metallic brace that limits his range of motion, along with a sleeve to help deal with the pain and swelling. He will use the next few weeks to calm down the inflammation and swelling with modalities and limited range of motion before progressing to strengthening exercises.

J.D. Drew, BOS (Left shoulder impingement) [AGL: 29, ATD: +.113]
Apparently, at least one of the reasons why Drew has not been in the lineup is atroublesome left shoulder. Drew required surgeryto clean out his left shoulder in 2009,andit now appears that he is suffering from impingement in his shoulder. There are two main types of impingement in the shoulder—internal impingement and subacromial impingement—but it is unclear which one Drew is suffering from.

Internal impingement is a difficult injury to deal with because of the contributing factorsand the nature of the sport. It's a complicated condition to fully grasp, even for medical professionals, but summing it up briefly:during the late cocking phase of the delivery,the postero-superior labrum gets pinched between the humeral head and the rotator cuff, specifically the infraspinatus and some of the supraspinatus. Anti-inflammatory medication and physical therapy are prescribed,but the injurycan be slow to respond.

In subacromial impingement, the supraspinatus tendon—one of the rotator cuff muscles—and bursa becomepinched between the humeral head and the undersurface of the AC joint. Poor posture is often a major contributor to the pain,as is overuse of the shoulder. This is much easier to treat with anti-inflammatory medication and physical therapy than internal impingement.

Drew will be on the shelf for a few weeks, and given how the Red Sox are playing right now, it appears that they can handle his absence.

Adrian Beltre, TEX (Left hamstring strain) [AGL: 27, ATD: -.007]
When Beltre pulled up lame during the fifth inning Friday night, Texas fans were wondering what else could go wrong from a health standpoint this year. Losing Beltre, one of their leading hitters, for any period of time would be difficult to deal with. The third baseman was diagnosed with a mild left hamstring strain and placed on the 15-day disabled list after an MRI. He is eligible to return on August 7th, and the Rangers expect him to miss two or three weeks.

Kyle Lohse, STL (Right middle finger inflammation) [AGL: 5 (36DL), ATD: +.008 (+.004DL)]
Lohse’s middle finger has been bothering him for a few starts, and he was recently examined in St. Louis, where he was diagnosed with inflammation in the finger. He was placed in a splint and cleared for his start yesterday, managing to make it through five innings. Lohse's history of compartment syndrome surgery in his right forearm last year may have changed his mechanics slightly, causing the flexor tendons to take up a little more force and become inflamed as the season wore on. Lohse will continue with his treatment of anti-inflammatory medication, modalities, and splinting in between starts. He is not completely out of the woods yet and may need a move to the disabled list if the inflammation becomes too severe.

Luke Scott, BAL (Right shoulder labrum tear) [AGL: 73, ATD: +.026]
After three at-bats on Friday, it was clear that Scott could not continue playing with his shoulder in the shape that it’s in. He's goingto miss the rest of the season, whether or not he undergoes surgery, but he will see Dr. Andrews for another opinion. Scott may still choose to rest and rehabilitate the shoulder, but that would still require at least eight weeks of recovery time, putting Scott into October at the earliest. If he chooses surgery, a six-month recovery will likely be in store, so if he wishes to be ready for spring training, a decision needs to be made sooner rather than later.

Cameron Maybin, SDN (Strained left hip flexor) [AGL: 2 (27DL), ATD: -.031 (+.023DL)]
Sometimes, the manager has to protect a player from himself, and Padres manager Bud Black appeared to do that yesterday by taking Maybin out of the game before the outfielder could injure himself further. In his second at-bat, Maybin hit a ground ball to Phillies second basemen Chase Utley and lunged at the last second to try to beat the throw. Maybin managed to stay in the game for a while longer, but Black took him out against Maybin's wishes. Maybin's reaction suggested that his injury wasn’t too severe, so he should be back within a few days.

Flesh Wounds: J.J. Putz and his inflamed right elbow should be activated on Tuesday... Geoff Blum fractured his right pinkie finger fielding a ball yesterday. No word yet on whether or not he will end up on the disabled list... Angel Pagan left Sunday's game with dehydration. Once he replenishes his fluids, he should be able to return to the lineup... Orlando Hudson was available off the bench yesterday, two days after being unconscious for a period of time. He still has lingering headaches and sore shoulder/neck muscles, but he cleared neurological testing... Jose Contreras was given a PRP injection on Friday to complement his other non-surgical treatments. He will be out for several more weeks... Placido Polanco is feeling much better following his epidural injections... Jed Lowrie has increased his hitting intensity recently and is progressing nicely. He is still a few weeks away at the earliest, however... Joe Blanton will be checked out for nerve damage on Tuesday... Gerardo Parra was hit by a pitch on the left wrist on Saturday and did not start on Sunday. He may need a few more days to recover.

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