August 31, 2011

Collateral Damage

See You in September?

by Corey Dawkins and Ben Lindbergh

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Pedro Feliciano, NYA (Left shoulder capsule sprain) [AGL: 145, ATD: +.081] (Explanation)

Feliciano has spent the season on the disabled list trying anything possible to avoid undergoing a surgery whose previous recipients include Chien-Ming Wang, Scott Elarton, Johan Santana, and Dallas Braden. The shoulder capsule plays a role in the joint’s tensile stability during rotational movements, and it also creates a negative pressure inside the shoulder joint, further stabilizing it.

Injuries to the capsule can be difficult to describe in terms of pain patterns, but generally, symptoms arise in the front and/or armpit area. Surgery would involve tightening the capsule through incisions and plications of the tissue. Another technique involves tightening the capsule through thermal shrinkage, which is very successful in the short term. There have been some studies that have shown that this method is not as successful in the long term with pitchers, who often end up needing another procedure. Given that Feliciano has failed rehabilitation and PRP injections, he is likely looking at surgery sooner rather than later. Out of the 14 cases with specified shoulder capsule injuries, only three—including Felciano—have remained non-surgical.

Nelson Cruz, TEX (Left Hamstring Strain) [AGL: 27, ATD: -.005]
Sunday evening saw the reemergence of Nelson Cruz's injury demons, namely the hamstrings. Cruz was placed on the disabled list with a left hamstring strain yesterday.  He missed significant amounts of time last year with multiple strains of the left hamstring, and this year he began having problems with his quads. His recent hamstring injury will likely keep him out about three weeks and continues a trend of musculoskeletal injuries plaguing him in the middle to end of the year.

Darren O'Day, TEX (Right shoulder inflammation) [AGL: 37, ATD: -.037]
O'Day added to the Rangers’ injury woes when he joined Nelson Cruz on the disabled list with right shoulder inflammation. O'Day was diagnosed with a torn labrum in his shoulder back in 2009 but was able to avoid surgery at that time. Once the labrum it torn, it's never the same, even if it becomes asymptomatic. The tissue will degrade over time, which diminishes the viability of a direct tissue repair. If the labral tear is the cause of his renewed inflammation, he will likely need to have it trimmed out. O'Day still has a good chance of coming back this year, especially if the old labrum tear is not the root cause of his inflammation.

Brennan Boesch, DET (Partial ligament tear—right thumb) [AGL: 27(27DL), ATD: +.006(-.020DL)]
Boesch first injured his thumb earlier in the year but then aggravated it in August. He was diagnosed with a Grade II (moderate) sprain of the ligament and unsuccessfully tried to play through it. He's almost certainly going to need surgery to repair or reconstruct the ligament, but he and the Tigers are trying everything possible to delay that until after the season. Unfortunately, that may not be possible, because the medical staff is still having problems getting the area stabilized enough for Boesch to swing a bat. Any surgery to repair the ligament in his thumb would end his season, but he should be completely healed in time for spring training.

Justin Morneau, MIN (Left Shoulder Soreness) [AGL: 2(46DL), ATD: +.011(+.083DL)]
There have been differing reports about what has been keeping Morneau out of the lineup for the past few days. Some reports have Morneau being held out because of left shoulder soreness after diving on Sunday night, while another pinpoints the reason as mild concussion symptoms. The last few years have been difficult ones for Morneau between the stress fracture in 2009, the concussion last year, and the neck surgery this year. The most concerning of the reported injuries would be the recurrence of his concussion symptoms.

These symptoms can be so debilitating in everyday life that it's almost impossible to understand fully unless you've witnessed or lived through them. If his problem is truly just mild symptoms related to a concussion, it should clear up within one or two weeks. If it is just shoulder soreness, then he should be back in a few days.

Hanley Ramirez, FLO (Left shoulder sprain) [AGL: 36, ATD: -.023]
Hopes of Ramirez returning to the lineup without a hitch quickly faded when he left yesterday's game after two plate appearances with renewed left shoulder soreness. When the Marlins diagnosed him with a sprain after that diving play earlier in August, it was assumed that it would be a day-to-day issue. Now almost a month later, the soreness is concerning because it could very well push him back another week, if not more.  Ramirez underwent surgery on the shoulder back in 2007 and has had some occasional soreness since. Unless the Marlins win out, they won't make the playoffs, so the risk of his worsening his shoulder injury should outweigh the benefit of his returning for a few weeks.

Flesh Wounds: Cameron Maybin's wrist MRI showed inflammation in the joint... Juan Gutierrez will undergo Tommy John surgery on September 6th... Jason Donald was scratched from Monday's lineup with a right index finger contusion... Damaso Marte suffered a setback in his comeback from shoulder surgery... Alex Rodriguez's thumb is still bothering him after he aggravated it during Sunday's game and received a cortisone injection earlier this week... Shin-Soo Choo is likely going to miss the next 7-10 days with left side soreness... Ronny Paulino's toe is broken after all... Ryan Raburn missed Sunday's game with a jammed right finger... Kevin Jepsen will have surgery on his right knee to clean out the joint today... Jordan Walden admitted to being tired now that he's thrown more this season than he has in any other season... Manny Parra underwent surgery yesterday to clean up the elbow and deal with a screw that was inserted when he was younger... Alexi Casilla aggravated his right hamstring during his rehabilitation start on Monday. This will likely push him back about a week or so.

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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