August 5, 2011

Collateral Damage

Shoulder Woes

by Corey Dawkins and Ben Lindbergh

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Johan Santana, NYN (Left shoulder fatigue—rehabbing from anterior capsule surgery) [AGL: 7 (39DL), ATD: +.027 (-.057DL)] (Explanation)
When Santana started reporting that his shoulder was still sore several days after a three-inning rehab start, the Mets became concerned and wondered if there was any damage to the repaired sections. He was evaluated at The Hospital for Special Surgery and was diagnosed with shoulder fatigue on Thursday, alleviating some fears for the time being (wait until they see his contract over the next few years). The rest of the shoulder checked out, including the capsule that was repaired last year. Treatments for fatigue are as simple as you would expect: rest and limited exercise. He is going to stop throwing until he is pain-free but will continue conditioning in the faint hope that he will be able to return in 2011.

The problem with shoulder fatigue is that it's not simply a loss of velocity or a matter of not being able to throw as many pitches. When the structures of the shoulder begin to fatigue, stability becomes compromised. The small rotator cuff muscles help keep the head of the humerus centralized during motion, so when they become fatigued, the humeral head migrates towards the edges of the labrum, which can cause tearing. This begins the downward spiral toward instability, rotator cuff pathology, and weakness.

It's not uncommon to suffer fatigue as much as a few times during rehabilitation following major surgery. It usually takes a week or two for the fatigue to resolve before the throwing program can resume. The clock is ticking on 2011 for several pitchers who are hoping to return this year, even for a start or two. Santana is several weeks away and is increasingly likely to miss the remainder of the season.

Scott Rolen, CIN (Left shoulder surgery removed bone spur fragments) [AGL: 93, ATD: +.067]
Rolen has been down this road before, since this strain of his left shoulder was his second. Considering Rolen's history, it's no surprise that he would end up needing surgery. Rolen had surgery on his shoulder twice in 2005 for labrum tears and once in 2007 to remove scar tissue and a chronically inflamed bursa. On Wednesday, Dr. Kremchek went into his shoulder arthroscopically and removed bone spur fragments from the acromioclavicular joint.

The AC joint is a very common location for bone spurs, and these spurs are often  associated with arthritis. They limit the available space under the AC joint and lead to impingement, which in turn puts the rotator cuff and biceps tendon at greater risk of injury. By removing these fragments and smoothing out the joint surface, proper space is restored, allowing clean motion of the tendons within the shoulder. Rolen will be out for approximately four to six weeks, despite the AGL suggesting three months. In this instance the AGL includes all shoulder surgeries.

Dustin Moseley, SDN (Left shoulder surgery labral tear and capsule) [AGL: 115, ATD: TBD]
The writing was on the proverbial wall as Moseley's shoulder began to dislocate with less and less force. He dislocated the shoulder twice while swinging this year and suffered a torn labrum and torn capsule. Moseley ended up having surgery on the left shoulder on Wednesday in order to preserve the long-term health of the shoulder. With the labrum torn, the shoulder lost some of its valuable stability, allowing the humeral head to migrate, which can end up causing injuries to the rotator cuff or other structures. In order to allow the labral repair to take hold, he was placed in a brace for the next four to six weeks. Rehabilitation will begin at that time, and he should be ready for spring training.

David Freese, STL (Concussion) [AGL: 3 (29DL), ATD: -.002 (+.012DL)]
In another frightening scene, Freese was hit in the helmet by a pitch and went down immediately. As he was lying face down, the athletic trainer and Tony La Russa rushed out to see how bad it was. After a few minutes, he was able to walk off under his own power to be taken for further examination. Diagnosed with a mild concussion, he will be progressed through the new concussion protocols as tolerated, taking the ImPACT test and comparing it to his baseline test. Freese may not require a move to the disabled list, but how he feels today will give us a good idea.

Omar Infante, FLA (Right middle finger fracture) [AGL: 6 (30DL), ATD: -.011 (-.052DL)]
When Infante dove for a Skip Schumaker groundball last night, the last thing he expected was to fracture his middle finger. Replays show that as he dove, the ball hit off his fingers and hand before bouncing into the outfield. Even though his fingers appeared to be subjected to a pretty solid force direct straight onto the bones, he stayed in the game for a time before eventually coming out. Depending on the severity of the fracture—i.e., displacement and location—he may be able to continue playing in a few days. Further information should be forthcoming today.

Flesh Wounds: An MRI confirmed the initial diagnosis of a sprained left shoulder for Hanley Ramirez. Rumor has it he may be able to return over the weekend... Derrek Lee sat out Thursday's game with a bruised left hand after being hit by a pitch. We'll see how long this lasts and whether he’ll need a CT scan... Carlos Villanueva was placed on the disabled list with a right forearm strain... Mark DeRosa was activated off the disabled list, hopefully putting his wrist troubles behind him... Chris Leroux (calf) and Justin Morneau (neck/wrist) are both going to start rehabilitation assignments... Carlos Gonzlaez (wrist) and Alex White (finger) also began their rehabilitation assignments... Ivan Rodriguez suffered a setback in his recovery from an oblique strain. He will return for further testing... The plan for Stephen Strasburg involves making four rehab starts before possibly making his return in September.

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
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