August 3, 2011

Collateral Damage

Dodger Damages

by Corey Dawkins and Ben Lindbergh

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Rubby De La Rosa, LAN (Right elbow surgery—Tommy John) [AGL: 121, ATD: -.004] (Explanation)
The hits just keep on coming for the Dodgers, who have now suffered 23 disabled list entries this season. The injuries haven’t been limited to older players like Casey Blake, and the causes haven’t all been as simple as muscle strains. De La Rosa left the game on Sunday after throwing over 100 pitches in just four innings of work and was almost immediately placed on the disabled list with right elbow inflammation. He had been wild recently, and his elbow was likely contributing to his lack of control. The inflammation was just a harbinger of things to come, as De La Rosa was diagnosed with a sprained UCL, and reports came out yesterday that he was slated for Tommy John surgery. He's going to miss most, if not all of 2012 as a result.

Hanley Ramirez, FLA (Left shoulder sprain) [AGL: 8 (38DL), ATD: -.005 (-.019DL)]
Ramirez came out of Tuesday's game in the sixth inning with a left shoulder sprain, but given his history, there is obvious concern about further injury. It's been four years since he had surgery to fix a torn labrum after partially dislocating the shoulder while swinging. More commonly, a player dives for the ball with his arm extended and out to the side, which puts the shoulder in a prime position to dislocate. As a result, connective tissue and ligaments inside the shoulder (glenohumeral) joint will invariably become sprained in a failed attempt to stabilize the shoulder.

The other main ligaments in the shoulder complex that may be involved are associated with the acromioclavicular (AC) joint. These ligaments are outside the main shoulder joint and are those injured in cases of a separated shoulder. Located at the top of the shoulder, the joint is composed of the clavicle, acromion process of the shoulder blade, and three main ligaments. Physical therapy is usually enough to heal these injuries—with some residual cosmetic deformity present—without surgery, but it can take upwards of one to two months to heal fully, depending on the severity.

We should get more information over the next few days as to the exact structures involved, which will affect our estimate of time lost.

Kyle Davies, KCA (Right shoulder impingement) [AGL: 56, ATD: -.068]
Davies was scratched from his start on Sunday against the Indians because of a sore shoulder. He first felt something against the Red Sox last week, and the soreness didn’t subside. He was subsequently placed on the disabled list for a shoulder-related ailment for the second time this season. From mid-May through early July, Davies was on the shelf with inflammation of his right rotator cuff. Rotator cuff inflammation is a common symptom of impingement, meaning that his current problem was likely present earlier in the year. Last time, he missed 47 games; if he loses a similar stretch this time, he’ll be out until the second or third week of September.

Chone Figgins, SEA (Right hip flexor strain) [AGL: 26, ATD: +.037]
Figgins' rough season took another turn for the worse on Monday, when he strained his right hip flexor diving back to third base in the second inning. This is a common mechanism of injury in cases where the muscle is already stretched out and is forced to contract quickly. Prior injuries, not warming up properly, or fatigue can all contribute to an increased risk of muscle strains. Figgins doesn't have a significant history of hip flexor injuries, so it was likely a constellation of factors, known and unknown, that contributed to his injury. He was placed on the 15-day disabled list last night and will begin his physical therapy immediately.

Cliff Pennington, OAK (Bell's Palsy) [AGL: TBD, ATD: TBD]
Bell's palsy is not a condition mentioned often here at BP, but there is a first time for everything. Pennington was having difficulty closing his eye on Monday, and after undergoing tests, he was diagnosed with Bell's palsy. These cases can be frightening because they often involve relatively sudden paralysis of the nerves controlling the muscles of the face. Usually lasting for a few days, Bell’s palsy affectsover 30,000 people per year in the United States.

Difficulty closing one eye, drooping of the face, and problems smiling are all common symptoms. The symptoms of Bell's palsy overlap with those of more serious intracranial pathologies, so tests are often done to rule out the more serious conditions. It usually isn’t treated directly, and the body is allowed to heal itself. The patients begin feeling better almost immediately, but anti-inflammatory or anti-viral medications may be introduced early in the process. Pennington was placed on medication right away in hopes of limiting any time lost. He's unlikely to require a move to the disabled list, but it’s not out of the realm of possibilities.

Clay Buchholz, BOS (Low Back Stress fracture) [AGL: 78, ATD: .000]
In Monday's Collateral Damage, we speculated that the cause of Buchholz’s continued back pain was a disc injury. While he still may have a disc injury of some sort—many athletes have disc injuries that are asymptomatic—he was diagnosed with a stress fracture of the L2 vertebra along with other stress reactions throughout the lumbar spine. An L2 second lumbar vertebra stress fracture is not as common as one lower in the lumbar spine, but it doesn't necessarily rule him out for the rest of the season. He will follow a very detailed five-tier program to try to get back in time for the playoffs, but it won’t be easy.

Freddy Sanchez, SFN (Right shoulder surgery—labrum) [AGL: 97, ATD: +.022]
Sanchez is done for the season after undergoing surgery on a torn labrum in his right shoulder yesterday. The labrum tear is a result of his dislocation in June and was managed conservatively at first. Unfortunately, rest and rehabilitation were not enough, which became more apparent as time went on. There is no direct rehabilitation to heal a torn labrum; instead, it is focused on regaining full range of motion and decreasing inflammation. Once these goals have been accomplished, shoulder stabilization exercises are initiated into the physical therapy program and progressed accordingly. By undergoing surgery now, Sanchez could return in time for spring training.

Flesh Wounds: This may be the end for Justin Duchscherer,who was released by the Orioles on Monday. He's going to have his fourth surgery on his hips, which clearly ends his season... Marco Scutaro left Monday's game light-headed and with a slightly racing heartbeat but passed all the tests. Scutaro believes the culprit was an energy drink… Chris Ray was waiting for Chone Figgins on the disabled list with a right latissimus dorsi strain, retroactive to July 30th… Scott Linebrink was also placed on the DL retroactive to July 30th with a lower back strain... Aaron Cook left yesterday's game with neck spasms... Bud Norris left his start on Monday with a blister and may have to miss his next start... Scott Rolen is having his left shoulder looked at by Dr. Timothy Kremchek today. He's currently on the disabled list with a strain... Mitchell Boggs finally discovered a bulging disc in his back that had been causing his back pain for over a year... Barry Zito was put back on the disabled list with soreness in the area of his previous mid-foot sprain... Alex Rodriguez is ready to resume baseball activities tomorrow as he progresses from a torn meniscus in his right knee... Josh Johnson is set to begin his throwing program today, giving some hope Marlins fans that he will return in 2011.

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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