August 22, 2011

Collateral Damage

One Wrong Move

by Corey Dawkins and Ben Lindbergh

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Brian Wilson, SFN (Right Elbow Inflammation) [AGL: 36, ATD: -.037] (Explanation)
Wilson's beard may be a natural wonder of the world, but unfortunately, his elbow might not be. Back soreness last week may have altered his mechanics just enough to cause elbow inflammation and a trip to the disabled list this weekend. The move, retroactive to August 16th, came early enough that even if Wilson does not return in the minimum, he can still see a few weeks of action before the playoffs start.

Wilson hasn't suffered any major arm injuries since undergoing Tommy John surgery performed by Dr. Andrews while at LSU in 2003 although there were a few blips along the way. In 2007, he strained his triceps, and an infection in his finger during 2009 spring training sidelined him for a little less than two weeks. Wilson's mild flexor strain and resulting inflammation should clear up in within a month, although San Francisco feels that it may be a matter of about three weeks. In the interim, the Giants are going to have their hands full trying to keep the antsy Wilson from going crazy on the bench sitting alongside the MASH unit in San Francisco uniforms.

Carlos Quentin, CHA (Left shoulder AC sprain) [AGL: 8(55DL), ATD: +.005(+.027DL)]
Baseball outfielders make hundreds, if not thousands, of diving catches in their lifetimes, dating back to their younger days on the sandlot or little league field. However, just one bad landing is all it takes to injure a shoulder. On Saturday, Quentin suffered a mild sprain of the acromioclavicular (AC) joint while diving and is considered day-to-day.

The mildest of sprains of the AC joint can be painful for long periods of time. The nerve endings that transmit pain are excited for a longer period of time in partial tears, while they are completely disrupted in ligament ruptures. Quentin's case is more likely to linger, since it involves his front shoulder while hitting. The closest comp actually occurred recently with Brendan Ryan. Ryan's front shoulder also suffered a mild AC sprain, and he ended up on the disabled list, missing 15 games. Quentin is likely going to miss several games this week, with a decent possibility of seeing time on the DL.

Jimmy Rollins, PHI (Strained right groin) [AGL: 3(22DL), ATD: -.011(+.030DL)]
Despite dealing with knee soreness for a substantial part of the season, Rollins has been able to stay on the field for the majority of the games so far. That might change in the wake of a strained groin he suffered yesterday while fielding a ball up the middle. Aside from the requirements of running the bases, middle infielders need quick bursts of speed in either direction to play their positions properly. Between that and the timing of the injury, the Phillies are likely to be cautious as we come down the stretch.

Jason Berken, BAL (Sore right elbow) [AGL: 8(44DL), ATD: +.023(-.061DL)]
Any pitcher who had to go through Tommy John surgery (in 2005 while at Clemson, in Berken’s case) naturally fears the worst whenever the elbow becomes painful again. Berken's forearm and elbow soreness traces back about a month, but it gradually went away, and a few weeks passed by without incident. Unfortunately, his pain resurfaced in the flexor mass part of his forearm and now has increased in radius, coming close to the same area where he remembers hurting back in college.

It's not uncommon for a pitcher to suffer forearm issues before learning the ligament’s structural integrity is not sufficient, hence Berken's concern. When Dr. Yocum evaluated Berken, he had enough concern to order an MRI with the dye injected into the elbow joint. This will allow visualization of the under-surface of the ligament where most partial ligament tears occur, along with other structures. Once the results of the MR arthrogram are available, Berken's prognosis will be much more accurate. He’ll likely be placed on the disabled list today to make room for Zach Britton.

Pablo Sandoval, SFN (Strained left shoulder) [AGL: 3(29DL), ATD: -.004(+.030DL)]
As we mentioned in discussing Quentin’s situation, a hitter’s front shoulder is incredibly important from a productivity standpoint, and any injury to it will cause trouble hitting from that side. Luckily, Sandoval can also hit from the left side, allowing him to stay in the lineup most nights. With all of the injuries the Giants have gone through the last few weeks, it's not surprising that they are trying to balance putting him out on the field and letting him rest and heal. The risks of further injury, such as dislocating the shoulder, increase because of the weaknesses caused by the muscle strain. Sandoval is day-to-day and likely will avoid the disabled list, if only out of necessity.

Paul Maholm, PIT (Left shoulder strain) [AGL: 48, ATD: -.028]
Shoulder soreness is nothing new to Maholm. He has dealt with it in the past, including the end of the 2006 season, when he skipped his last few starts because of rotator cuff inflammation. Maholm said that ever since then, he has intermittently felt similar symptoms, although less severe and shorter in duration.

It's rare for a pitcher not to experience shoulder inflammation at some point in a season, to say nothing of his career. Usually, this dissipates quickly enough, and the pitcher can avoid the disabled list. With repeated bouts of inflammation or strains in the shoulder, concern rises for another cause of symptoms. Under-surface tearing of the rotator cuff or a small tear of the labrum that can't be found on clinical examination or MRI can both cause these symptoms in pitchers. Maholm will pay a visit to Dr. Andrews to determine the true cause of his first trip to the disabled list in his major-league career.

Freddy Garcia, NYA (Right index finger laceration) [AGL: TBD, ATD: TBD]
While people expect a certain number of pitchers to go on the disabled list, most of them don't expect the stints to stem from “kitchen accidents.” Over a week ago, Garcia cut the side of his index finger near the nail in one such event and eventually needed to be placed on the disabled list. Garcia could not grip the ball properly because of the laceration, which led to the move. He's been able to throw splitters recently in bullpen sessions so the area appears to have healed in nicely. The move to the disabled list was retroactive to August 8th, which should allow him to return in a few days and use September to get ready for the playoffs.

Rafael Furcal, STL (Sprained right thumb) [AGL: 2(27DL), ATD: +.004(-.025DL)]
It's been a rough few weeks for NL shortstops, but Saturday added insult to injury for Furcal. Furcal tripped over a rope at Wrigley Field during batting practice and tried to brace his fall. Unfortunately, his right thumb took the brunt of the impact and suffered a sprain. Earlier this year, Furcal broke his left thumb sliding while with the Dodgers, but x-rays have shown no fracture of his right thumb. Unlike other injuries, if there is a fracture associated with the sprain, it almost always seen on x-ray. Furcal is not expected to go on the disabled list, but there is always that chance, especially given his extensive injury history.

Flesh Wounds: When we talked about Jason Kipnis last week, we were going by the most-up-to-date information at the time, which was that he was suffering from hamstring tightness. Little did we know that the internal—as in team's—diagnosis was a mild/moderate strain of the right hamstring. That makes quite a difference in the database projections, and also in real life. Kipnis was placed on the disabled list retroactive to August 13th and will miss at least one more week of games...As we continue to chronicle the Giants’ medical troubles, Eli Whiteside was placed on the 7-day disabled list on Friday with a concussion after a hard slide, and Orlando Cabrera has missed the last few games with a strained right groin. There’s a small chance that it might lead to the disabled list. The Giants must have the most creative roster management team in the game at this point... Chris Denorfia aggravated his right hamstring while on a rehab assignment Thursday... Jack Wilson stepped on first base—something he doesn’t do often—on Wednesday and suffered a bruised left heel. He was placed on the disabled list on Friday... Rod Barajas has been battling a strained right groin since Friday... Nick Blackburn left yesterday's start with a strained right forearm. The combination of the strained forearm and his complete lack of control both inside and outside of the zone—he's allowed fewer than two baserunners per inning just once in his last six starts—has us concerned that he could end up on the shelf for a while... Adam Lind was diagnosed with a bruised right wrist after being hit by a Gio Gonzalez pitch. X-rays were negative... Chris Davis (torn labrum, right shoulder) has decided against surgery at this point and will try to rehabilitate the shoulder and return this year... Mark Reynolds suffered a mild sprained left ankle on Saturday and missed yesterday's game... Justin Morneau fouled a ball off his foot on Saturday and missed yesterday's game... Frank Francisco was scratched on Sunday because of a sore right shoulder. More tests to follow... Alex Rodriguez was activated from the disabled list and appeared in yesterday's lineup... Jacoby Ellsbury missed the last two games after being hit in the back by a pitch on Friday... Philip Humber (facial contusion) has passed all of his concussion exams, according to the White Sox, and he was placed on the 15-day disabled list as a precaution... Jose Reyes has passed another important milestone and run at close to full speed, tolerating it well.

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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