March 12, 2012

Collateral Damage

Battle of the Bulge

by Corey Dawkins and Ben Lindbergh

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Chris Carpenter, St. Louis Cardinals (Bulging disc in neck)
Carpenter has been dealing with stiffness and pain in his neck for about a week and was sent for further tests that revealed a bulging disc. That wasn’t the worst diagnosis in the world, but it could have been better.

There are multiple ways in which a bulging disc can cause pain. The muscles and tissues around the neck can become painful as they strain to stabilize the area and take pressure off the injured disc, and the bulge can be so big that it puts pressure either on the nerves exiting the spinal cord or on the spinal cord itself. By all reports, Carpenter does not have a disc that is bulging to the point where it presses on the nerves. In cases like this, physical therapy focuses on decreasing pain and inflammation as well as strengthening the area. An epidural injection may also be considered to relieve the inflammation, but that does not appear to be in the works quite yet.

Considering he hasn’t thrown since March 3rd, it’s unlikely that Carpenter is going to get right back out there and start throwing again now that he has a diagnosis. He still has to wait until he is pain free and recovers full range of motion before he can start pitching again without risk of reinjury or injuring other body parts. As a result, Carpenter may not be ready for Opening Day, which places additional pressure on Adam Wainwright to be ready. Wainwright has looked good so far, but he’s coming back from Tommy John surgery, so he still has to exercise caution. Carpenter is supposed to discuss his injury issues more with the media today, and hopefully we’ll hear a firmer timeline for his return.

Eduardo Nunez, New York Yankees (Right hand contusion)
Nunez experienced a considerable amount of pain and soreness late last week, so he underwent a CT scan to rule out any small fracture that x-rays wouldn’t pick up. MRIs aren’t very useful in these situations. Although they can show a lot of swelling in the bone, they cannot distinguish between a bad bruise and a small fracture. The CT was negative for any fracture, so treatment will focus on recovery from the contusion.

After trying to take batting practice over the weekend, Nunez continued to suffer from soreness, so he will have to shut it down for another few days. A fine line exists between healing from severe bone contusions and healing from tiny fractures, so total healing time can be approximately the same in both cases. Right now, Nunez will take a few more days off and see where he stands mid-week.

Kenley Jansen, Los Angeles Dodgers (Rapid heartbeat)
When you have a known irregular heartbeat, you’re especially attuned to any little changes in its rhythm. Jansen felt that he had a rapid heartbeat, so he checked into the hospital on Friday. He missed three weeks last year because of an irregular heartbeat, so it had to be scary to feel anything out of the ordinary. Luckily, this time the heartbeat was only rapid, not irregular. He received medical clearance to resume all activities and ended up throwing a scoreless inning on Saturday. It’s something to keep an eye on, but there is no way to predict whether it will happen again.

Giancarlo Stanton, Miami Marlins (Left wrist contusion)
Stanton asked to be called by his birth name rather than “Mike” at the beginning of spring training, but we had to wait over a week before having to type “Giancarlo.” On Sunday, Stanton was hit by a pitch on the left wrist and left the game to get x-rays. They were negative, but the Marlins are obviously going to play it safe with their young star. He should be out for only a few days while he waits for the pain and swelling to subside.

Nolan Reimold, Baltimore Orioles (Chipped tooth)
In a frightening scene on Friday, Reimold was carted off the field and taken to the hospital after being hit in the face by a pitch. Amazingly, he was diagnosed with only a chipped tooth after fractures were ruled out by CT scans. Concussions are also a major concern after an injury like this, but he checked out without any symptoms of concussion. He will be out for a few days and should get back into game action soon.

Matt Lindstrom, Baltimore Orioles (Low Back inflammation)
Lindstrom has been prevented from throwing for about a week now because of inflammation in his lower back. The right-hander has a history of low back problems going back several years, spanning spasms, stiffness, and inflammation. When issues come and go for this long, there is always concern about other conditions, such as disc-related injuries. Right now, Baltimore is saying he’s out indefinitely, which adds a little more credence to the notion that this might be disc-related and not normal soreness. Each day he misses makes it more likely that he’ll start the season on the disabled list.

Flesh Wounds
Kendrys Morales is making progress and recently ran the bases without pain. He will have to do that for several days in a row without pain in order to be considered ready for game action… Jose Iglesias has a sore groin and likely will miss a few more games… Mike Trout is continuing to battle flu-like symptoms and likely won’t be ready for about another week after losing 10 pounds. It is important to note that he has not been diagnosed with Valley Fever or a thyroid imbalance… Maicer Izturis is battling soreness in both legs… Brandon Short suffered a torn labrum in his left shoulder after running into the outfield wall and dislocating his shoulder. He will have surgery and miss all of 2012… Bobby Wilson hasn’t stolen a base since 2007, but he decided to try to go for one over the weekend. He suffered a mild left quad strain because of his miscalculation… Another catcher, Taylor Teagarden, is dealing with low back inflammation. X-rays were negative, but when dealing with low back injuries, x-rays don’t really reveal that much. MRIs would be much more helpful in ruling out conditions that could cost him significant time. He’s expected to miss about four to five days…

Paul Konerko fouled a ball off his left knee and is day to day… Casey Kotchman is also dealing with low back tightness and is day to day… Ian Kinsler was scratched from yesterday’s lineup because of a tight lower back… Chris Perez has been increasing his throwing distances and has an outside shot of making it back for Opening Day… Denard Span suffered a stiff neck in Saturday’s game, but according to reports, that’s all it was… Dallas Braden is not expected to complete his recovery from shoulder surgery until early May… Mike Napoli is dealing with a sore left groin and is day to day… Arodys Vizcaino recently had an MRI on his elbow that revealed inflammation. Even though it doesn’t appear that the Braves are concerned, Vizcaino did have a partial ligament tear in that elbow at the end of the 2010 season, and this will need to be monitored closely… Tommy Hanson recovered from his concussion and pitched an inning yesterday, reaching the low 90s. He should have enough time to prepare for the start of the regular season… After receiving an injection for a bulging disc last week, Humberto Quintero will start hitting early this week… Andre Ethier is battling mid-back stiffness for the second time so far this spring after tweaking the area while batting… Mark Reynolds dealt with some back stiffness of his own over the weekend but was able to make his start on Sunday and should be safe from here on out… Jason Berken suffered a setback on Friday during his recovery from a strained hamstring, and his return may be delayed by a week or so. Sometimes it takes longer to heal a hamstring than it does to kill the villain in a slasher film.

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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