June 11, 2009

Under The Knife

For Better and Worse

by Will Carroll

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Carlos Quentin (60 DXL)
A tendon injury? Where the heck did this come from? In the news that Quentin would be out for the month and possibly until the All-Star break, the White Sox let slide into several beat reports that he has a strained mid-foot tendon. This isn't something that's been discussed publicly, and it wasn't in the whisper stream either. In fact, my best sources told me, clearly and forcefully, that the plantar fasciitis was the real issue, while the face-forward reports were saying "heel pain." (I should note here in light of the Raul Ibaņez Anti-Speculation Rule, that "heel pain" isn't a lie, so just stop before you send the e-mail. It's more along the lines of "lower body injury", describing a symptom instead of a diagnosis.) So is this a change in diagnosis, new information coming to light, or something else? I'll admit that I'm not sure yet. My best guess, based on information I have at this point, is that what's being described as a "tendon" is the fascia itself. It's a fine difference to be sure, but a significant one. The biggest note here isn't on my medical version of angels and pins, but that Quentin will be out until mid-July, no matter what the specifics are.

Brad Lidge (20 DXL)
Speaking of the specifics of injuries, the original reports that went out when Lidge went to the DL all said "sprained knee." As medheads here know, "sprain" is by definition a tearing of a ligament. This surprised me, given the symptoms and the lack of trauma. If forced to guess, I would have thought that Lidge was having some inflammation from a torn meniscus, or from the grinding due to his lack of a large piece of meniscus after last year's surgery. Just a few hours later, Mike Ferrin from XM got the scoop: Lidge has synovitis, an inflammation of the synovial capsule that surrounds the knee. Again, this is more symptom than diagnosis, but it's significant enough to necessitate some time off. Once the Phillies got J.C. Romero back, they'd been talking about giving Lidge a few weeks off to see if that would correct things, and that's exactly what has happened. If the problem truly is limited to synovitis, it should help, but it will come back unless things change structurally. The Phillies' medical staff will have to manage this one closely and hope that a couple weeks of rest gets them far enough ahead of it to make it to October. Don't be surprised if he goes past the minimum if Ryan Madson is solid in the closer's role in the meantime.

Josh Hamilton (30 DXL)
Hamilton had surgery on Tuesday to repair an abdominal wall tear (and not a sports hernia, as was originally feared), and he's already back with the team. That's just one of the reasons I'm optimistic about his coming back from surgery at the low end of the suggested range. He does have some injury issues that no one else has had, detailed wonderfully by Gordon Edes. I don't disagree with anything Edes says in his piece, or with the people he interviewed, but one thing bothers me-none of Hamilton's injuries have anything to do with past drug use or any possible effect from it. Do crackheads have hernias? Maybe, but I doubt they got it the way that Hamilton got his. That wrist injury in '07? His ribs this year? There could be some effect in his healing response, but there's absolutely no evidence, and even if there were, it would be nearly impossible to separate those effects from the others acting on any individual's healing response. I mean, Mike Hampton isn't a crack user, is he? To me, Ron Washington has the telling quote in Edes' piece, saying that Hamilton plays with reckless abandon and is likely to run into some other wall down the line. It's that attitude, one that might come from having stared demons in the face and living to tell about it, that might be the biggest effect of Hamilton's past upon his present.

Edwin Encarnacion (50 DXL)
The "major setback" must not have been very major, though my source on that continues to insist that Encarnacion's wrist is not stable and will not hold up. Wrist fractures are tough to read, so this one was going to bear close watching even before this issue arose. The team says that Encarnacion will be swinging a bat again by the weekend, with a rehab assignment soon after. The concern that I have at this stage is that the root cause of the inflammation that shut him down this week doesn't seem to have been addressed. Is it simply that he "overdid it," or is there something else underlying this issue? Rest and treatment can heal many things, but until Encarnacion is actually making it through games without trouble, I'm going to be a little dubious. Wrist injuries linger, my friends.

Kyle Lohse (30 DXL)
Lohse will miss a month as the forearm problem that's cropped up for him post-HBP hasn't gotten any better. The team is describing it as a strained flexor tendon, so if that's the case, the tendon must have been weakened or affected by the HBP, and then injured when he tried to throw in that state. The worry I have here is that the Cards seem very open-ended on this, as if there's something more going on, or that they don't have a good handle on. Strained flexor tendons are all too common in baseball, and shouldn't be that challenging, especially if they have good images. All the facts aren't out here, so I'll be digging more on this while the Cards dig for more pitching.

Denard Span (5 DXL)
Jorge Cantu (3 DXL)
If femoral-acetabular impingement and anxiety are the injuries du jour, then dizziness wants admision onto the menu. Joey Votto, Cantu, and now Span are all dealing with the symptoms, but all from varying and very vague causes. With Span, the culprit is still unknown, but the doctors seem to be focused on a thyroid condition. This isn't uncommon, and is actually more common among African-Americans; it's easily corrected and managed, so it should have little impact on Span beyond the short term. Span's absence did cause Michael Cuddyer to be pushed over to center field after Carlos Gomez left Wednesday's game, so a short bench becomes an issue for the Twins. For Cantu, the cause is a cholesterol medication, according to Joe Frisaro. He's been on the medication for a couple of weeks to take care of the all-too-common problem, but as with many, the side effects were worse than the cure, at least for now. He'll change medications, and the problem is expected to clear up.

John Baker (1 DXL)
Baker was out of the lineup on Wednesday after a bat to the face forced him to get six stitches. OK, that may be the fact of the matter, but let's face it, there's one little important detail that's been left out. The bat was in the hands of Albert Pujols, who was trying to turn on an inside pitch, and the bat got Baker's face on the backswing. Baker uses the standard mask (more effective against concussions) instead of the hockey-style, which is more effective against bats smacking one in the side of the head. Granted, he probably could have had side curtain airbags and Pujols' bat would have still gotten through. He's lucky that it was "just" stitches, and he should be back soon.

Anthony Reyes (120 DXL)
"Might have Tommy John surgery" is a phrase that confuses a lot of people. It came up in relation to Reyes, surprising many who thought that he was having the lesser ulnar transposition surgery. There's a simple explanation here, and it occurs with most elbow surgeries (and most surgeries, to be honest). Prior to undergoing the procedure, Reyes sat down with his surgeon, Lew Yocum, and Yocum said something like, "We'll get in there and look around. We'll get a good look at the UCL, and if it's damaged, we might as well go ahead and replace it. Is that OK?" Reyes will be unconscious during the surgery (we hope!) and it's not as if Yocum could wake him up to ask the question. The possibility is there, so surgeons ask for permission to take action if necessary. That he asks doesn't mean it will happen, though it usually indicates that there's some fraying of the ligament that they've seen on the images. Reyes is out for the year regardless, but Tommy John would cost him a portion of 2010 as well.

Quick Cuts: Brandon Webb is on track for a return at the All-Star break, but could he be traded? Yes, if he proves to be healthy. ... Roy Oswalt will have his next start pushed back a couple of days, so that he can deal with a sore wrist. ... Jeremy Bonderman will pitch long relief for now, but I bet that doesn't last long; it's a confusing decision by Jim Leyland. ... Aramis Ramirez is taking grounders, but sources tell me that the shoulder isn't yet stable enough for more intense activity. ... It sounds like the Mets are going to hold Jose Reyes back until the All-Star break at the very earliest due to his cascade hamstring injury. ... Isn't Jeff Kent about the last guy you'd expect to see on something like this? ... Torii Hunter has a miild straiin of his groiin. The Angels will hold him out to avoid Tropicana's turf. ... Rich Harden will be limited to about eighty pitches when he comes off of the DL on Saturday. ... Jason Bartlett is taking ground balls and looks close to a return. ... Jesse Litsch will have Tommy John surgery and miss a year or so. ... Charlie Morton's debut didn't last long. His hamstring tightened up early, and they pulled him as a precaution. ... Josh Hamilton is back with the team and has already begun his rehab. ... Don't miss out on the guys who could come back from TJS and contribute down the stretch, like Tim Hudson, Billy Wagner, and Jake Westbrook. Westbrook's return could signal Cliff Lee's departure if the Indians haven't turned things around by then.