September 2, 2011

Collateral Damage

Marlin Maladies

by Corey Dawkins and Ben Lindbergh

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Hanley Ramirez, FLO (Left shoulder instability) [AGL: 16, ATD: +.030] (Explanation)
The full extent of Ramirez's problems have come to light, and as we expected, he was dealing with more than a simple sprain. It's now been reported that the MRI has shown shoulder “instability,” and Ramirez will be meeting with team physician Dr. Lee Kaplan to discuss the options from here. One thing needs to be cleared up, though: shoulder MRIs don't directly show instability. They reveal injuries and findings consistent with instability, such as sprains of certain ligaments or tearing of the capsule.

The reports of Ramirez not having any structural damage are also somewhat misleading, given the anatomy and lack of bony stability in the shoulder. There can be soft tissue injuries that don't allow a baseball player to function, but they aren’t considered structural issues. The diagnosis of instability relates to symptoms associated with abnormal looseness of a joint and is somewhat dependent on subjective reports of popping out of the shoulder, pain, and other symptoms. It's not like looking at a knee MRI and seeing a torn ACL.

In the same report, we finally got the full timeline of what has been going on with Ramirez. As we initially feared, Ramirez did suffer at least a partial dislocation of the shoulder on that diving play on August 2nd. Later, we discovered that he also suffered a subluxation right before being placed on the disabled list on August 10th, and then he suffered at least a third subluxation more recently in a rehabilitation game. It's becoming more likely that Ramirez will require surgery in order to stabilize the shoulder, especially considering that he has partially dislocated his shoulder three times in one month. He's not completely ruled out for the season yet, but we would not be shocked if an announcement is made soon with the Marlins having no chance of making of the playoffs.

Josh Johnson, FLO (Right shoulder inflammation) [AGL: 37, ATD: -.037]
Johnson has basically been ruled out for the rest of the season, since he just was not able to progress quickly enough through the throwing program that was laid out for him. It's almost unheard of not to at least have a slight setback or repeat of the throwing stages at some point, so Johnson is hardly the first pitcher to follow such a progression.

Unlike other pitchers with longstanding shoulder inflammation, Johnson does not have a significant history that makes us fear further problems down the road. He has complained about shoulder fatigue in previous years, but the majority of his injuries involved the elbow. The timing of his progression through the throwing program might allow him to pitch during the last week of the season, but his return wouldn’t change the standings enough to warrant the risk. Johnson could also throw in mini-camp in a few weeks, but he still has not thrown off the mound yet, a key milestone in the recovery process. He should be ready for spring training, assuming there are no more setbacks.

J.D. Drew, BOS (Right middle finger fracture) [AGL: 5(28DL), ATD: +.007(-.058DL)]
Drew just can't seem to shake the injury bug. Already on the disabled list with inflammation from left shoulder impingement, Drew caught his right middle finger on the knob of the bat Tuesday night and pulled a sliver of bone off when he sprained the finger. He's considered day-to-day, but it becoming more difficult for Drew to remain on the field. These types of injuries almost always heal without a loss of a significant amount of time, but anything could happen when it comes to Drew.

Jair Jurrjens, ATL (Right knee soreness) [AGL: 2(29DL), ATD: +.000(+.014DL)]
Since he off the disabled list after suffering right knee inflammation over two weeks ago, it has been clear that Jurrjens has not been as effective as he was before. Renewed soreness in his right knee is leading Jurrjens to fly out to Vail, Colorado to see Dr. Richard Steadman for a second opinion. During his last trip to the disabled list, an MRI showed bone bruising, which is not an uncommon finding, but Jurrjens’ visit to Dr. Steadman suggests that there is likely some sort of injury to the cartilage or underlying bone of the knee that may or may not require surgery immediately.

Dr. Steadman has performed surgery on multiple players, including Carlos Beltran and Grady Sizemore, and he was one of the innovators of microfracture surgery. There are very effective non-operative treatments for small cartilage injuries if they are stable and do not break off to become loose bodies. Once Jurrjens has met with Dr. Steadman, we will have a much clearer idea as to whether he will pitch again this season.

Laynce Nix, WAS (Strained right groin) [AGL: 3(22DL), ATD: -.008(+.031DL)]
Washington outfielders are having a difficult time staying away from the athletic trainer's room. Last week, Jayson Werth strained his groin, and now Laynce Nix is following in his footsteps. Nix was forced from yesterday's game because of a strained right groin, although it was not apparent how he injured it. Being listed as day-to-day at this point does not mean as much as it might have earlier in the season in light of expanded rosters, but Nix is still expected to miss only a few games. Nix doesn't have a history of groin issues like others on his team, so he may not miss as much time as some are projecting.

Flesh Wounds: Troy Tulowitzki is dealing with a sore left wrist and was scratched from the starting lineup yesterday. He did manage to pinch-hit, however, so the injury appears to be a day-to-day issue at this point... Josh Thole has been diagnosed with a left wrist contusion after he took a foul ball off his wrist, and he is day-to-day... Tommy Hunter was sent to the hospital with an illness, possibly related to dehydration... Freddie Freeman is battling some minor quad soreness and remains day-to-day....George Sherrill was placed on the disabled list with left elbow inflammation... Casey Blake will undergo neck surgery next week for a pinched nerve that has been bothering him for a few months... Shin-Soo Choo did have to be placed onthe disabled list because of his strained left oblique, retroactive to August 28th... Mark Teixeira is day-to-day with a bruised knee after being hit by a pitch last night... Red Sox prospect Ryan Kalish will have surgery to repair a bulging disc in his neck... Ruben Tejada left yesterday's game with a left hand contusion and is day-to-day... Rehabilitation for Juan Uribe's hernia has been unsuccessful in relieving his symptoms. The likelihood of surgery increases each day... Numerous players were activated from the disabled list yesterday, including Adrian Beltre, Carlos Guillen, and Geoff Blum.

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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