September 7, 2011

Collateral Damage

Ailing Ace

by Corey Dawkins and Ben Lindbergh

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Josh Beckett, BOS (Right ankle sprain) [AGL: 2 (29 DL), ATD: +.001 (-.000 DL) (Explanation)
When Beckett left his start on Sunday, the initial diagnosis was a right ankle sprain. However, the symptoms he described didn’t sound like those of a typical ankle sprain. In this article, Beckett said it felt like the ankle locked up, then shifted on him, a sensation he had never felt before. By the time they reach Beckett’s level, most athletes have suffered a “normal” lateral ankle sprain and know what it feels like. This was different, and so he was seen back in Boston by Boston’s team physicians and specialists.

If this had been a typical sprain in terms of pain patterns and swelling, he would not have had to rush home and get it evaluated. Red Sox team physician Thomas Gill announced that Beckett did indeed suffer a sprain, and without specifying what structure was injured, he was able to rule out tendon damage to the foot and ankle, including the Achilles.

Something doesn't quite line up. Beckett injured the ankle while pushing off for a pitch. In this position, the peroneal tendons can sublux, and on rare occasions they do so without damage to the tendons themselves. In these cases, a couple bands of tissue that hold the peroneal tendons in place (called retinacula) can become torn and allow the tendons to pop out of the groove. If this continues over time, tendon damage can occur. There are other retinacula around the ankle and foot that hold other tendons in place to ensure proper function. Anytime any of these structures becomes injured, the tendons can shift and give that sensation of something locking up before giving way.

That's not the only thing that could be injured, of course. The same dorsiflexion with external rotation mechanism of injury can also disrupt ligaments around the ankle, specifically the syndesmosis and/or the medial deltoid ankle ligament. Syndesmotic injuries can be severe and are almost always associated with an acute episode of injury where the foot is forcefully externally rotated while planted—a la Buster Posey—or gets caught on a base or another player. These can be extremely difficult to heal and often end up requiring surgery in the more advanced cases.

Deltoid ligament injuries involve a broad ligament on the inside aspect of the ankle and can occur when the foot externally rotates outward. This places a lot of stress on the medial ligament and produces mid-substance failure. Sometimes associated cartilage can arise when the bones rub against each other once the ligament fails to provide the necessary stability. This may have been the locking sensation Beckett felt at first, followed by a pop.

Until we find out exactly what structure Beckett injured, several possibilities remain. We can safely rule out a normal lateral ankle sprain and focus on the other structures potentially injured. Others have said that the sprain was a “bad” one, but that Beckett would miss only one or two starts. Either way, the Red Sox need him to get healthy before the playoffs.

Jose Tabata, PIT (Left hand fracture) [AGL: 6 (32 DL), ATD: -.055 (-.002 DL)]
Tabata's wrist has bothered him for the last few weeks, and he underwent several tests to determine the origins of the pain that caused him to leave Monday's game. The tests showed an avulsion fracture off the base of the fourth metacarpal in his left hand, which will be treated without a cast at this point. He's going to rest the wrist for about two weeks before entertaining the possibility of returning.

Flesh Wounds: Stephen Strasburg was activated from the disabled list and was up to his old tricks... Rajai Davis was shut down after suffering a setback in his rehabilitation from a torn hamstring... Carlos Carrasco will have Tommy John surgery next Wednesday... Paul Maholm (shoulder strain) and Kevin Correia (oblique) were both transferred to the 60-day disabled list, ending their seasons... Jose Lobaton left yesterday's game after aggravating his left knee and is day-to-day... Ryan Spilborghs aggravated his right foot plantar fasciitis and may be done for the year. He already missed almost all of August because of the condition... Blake Dewitt is dealing with minor left hamstring soreness and has been available to pinch hit.

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
Click here to see Ben's other articles. You can contact Ben by clicking here