June 25, 2009

Under The Knife

Aces Down

by Will Carroll

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Brandon Webb (160 DXL)
Let's first dispel the myth that Webb is bulletproof. Yes, he's had a nice career so far, with few health issues if any up until this season, but it's no secret that he's been a long-time patient of Dr. Andrews, going as far back as Webb's high school years. Now, on the one hand, I'm rather impressed that he was receiving top quality care at that stage, but on the other, I'm wondering why he needed it. Let's assume that the care kept him in the game and productive, helping him heal up any damage that could have happened at a young age. That said, damage in the body is healed with scar tissue, which is never as strong as the original tissue. That scar can confuse things on an MRI as well, so the idea that Andrews or Craig Morgan might look inside the shoulder with a 'scope is a scary proposition. Getting a visual of the damage rather than trying to decipher an MRI can often tell a far different story. With Webb's season done at the point they do surgery, and labrum or rotator cuff damage costing him nine months of rehab, we have to wonder whether the Diamondbacks will pick up an $8.5 million option on a pitcher who could miss the first half of 2010. (Think John Smoltz.)

Edinson Volquez (50 DXL)
The news is bad for Volquez. Just before it was expected that he would be back up on the mound, he's instead back down. An MRI showed swelling in the soft tissue of the forearm, and he's been shut down for at least two weeks. That makes a return before the All-Star break impossible, and it could push it back as far as August, even before we factor in the possibility of further setbacks. About the only good news here is that this type of injury seldom requires surgery, but the issue even then is that this type of injury comes from fatigue and workload. That's something he's unlikely to avoid in the future, so his long-term health, even if this heals up cleanly, is going to be in question. If I had spidey-sense, I think it would be tingling. Something doesn't feel right here, and for an already risky pitcher like Volquez, it could end up being a tipping point. Has anyone noticed that Volquez was a Verducci Effect guy?

Akinori Iwamura (90 DXL)
Remember what I said about there being a difference between an MRI and having an actual visual of the injury? That's more or less what happened with Iwamura. I speculated that the Rays knew his injury wasn't a complete tear of the ACL, and they elected to work on it for the month between the injury and the scheduled surgery rather than immediately going in. Sources tell me I was wrong: the month was spent on "prehab", making sure that the secondary stabilizers were improved before surgery, a protocol that's aggressive, but being used more and more around sports. Then, when Dr. Koco Eaton went in, he initially intended to both fix the meniscus and to take a look at the ACL. When he saw the ACL's level of damage, he was able to pull the scope out and close the openings, keeping his scalpel on the tray. Why the scope? While I still think that Eaton had some clue this was a possibility, another surgeon told me that many orthopedic surgeons are so comfortable doing meniscectomies with a scope that they'll do them that way even if they're going to open the knee. "I can't remember the last time I did an open meniscectomy," he said. "I remember the steps, but I haven't done one in... years." For the people wondering if the surgery may have been done a couple of weeks ago to get Iwamura back in the lineup earlier, yes, it was possible in theory, but a quicker surgery is no guarantee of an earlier return. The prehab work done on the knee was one of those "pay me now or pay me later" situations, where the time has to be put in, whether it's pre- or post-surgery.

Evan Longoria (3 DXL)
Scott Kazmir (30 DXL)
The Rays pulled Longoria from Wednesday's win and could hold him out longer, depending on how his hamstring responds to treatment. While the injury isn't considered serious, this is the same leg that gave him problems a few weeks ago. Add in the recurring nature of the injury, the conservative nature of the medical staff, and that the team is playing at home on turf, and it all adds up to a few days off for Longoria. He might be available to pinch-hit with a running restriction. The news is better on Kazmir, where it's become a when and how he'll return, not an if. The team watched David Price continue to struggle, and they're working to figure out how to best slot Kazmir back into the rotation. One option is to shift Price to the pen, but in the long term Price isn't going to get as much work on his secondary pitches there as he would in Durham. It's going to be an interesting and important decision for the Rays' brain trust, one that will show us how they balance their long-term plan with winning now.

Coco Crisp (100 DXL)
Crisp is just the latest Royal to go down, and he's done for the season. He had surgery on his shoulder to repair a torn labrum and the other assorted damage. I could detail the entire situation and how this went from soreness to season-ender, but Rany Jazayerli has done it for me in far more detail than I'd do in this column. Crisp's shoulder is going to be a big question mark heading into next season. While it's much easier for position players to come back from this kind of injury than it is for pitchers, Crisp is going to be bumping up against spring training in his comeback. The good news, if you can consider it that, is that it was as simple an injury of this type as possible; the labrum was cleaned up and there was no other serious damage beyond "normal wear" according to a source. Crisp should be able to return to level, but we now have to wonder if this was all necessary.

Matt Lindstrom (40 DXL)
Lindstrom had a shoulder problem during the WBC, so I'm sure that the Marlins are going to blame his new elbow problem on the Classic as well. While there is some element of a cascade effect here, it's important to keep in mind that Lindstrom has never been healthy for any extended period during his career; no matter what role he's in, he seems to break down under the workload. That's just how some pitchers are, and it's difficult to just say a guy is "fragile" or "injury-prone," when in fact it's really more a case of reliability. If there was such a thing as MTBF for pitchers, it wouldn't tell you when a breakdown was going to happen, just when it was most likely to happen. It's like driving with the gas gauge on "E"-you know you're low, but when are you out? Lindstrom will miss a month at the least, and will be replaced by a combination of pitchers. With Leo Nuņez still coming back from a sprained ankle, Dan Meyer picked up the save last night.

Josh Outman (45 DXL)
Justin Duchscherer (120 DXL)
The A's are loaded with solid young pitching, but the problem with that is that the associated risk with relying on it can lead you to throw a chair or two. Outman has been very solid for the A's since being slotted into their rotation, but an MRI taken on Monday shows a moderate sprain in his elbow. That's never good news, especially for a guy at the injury nexus. He'll be out for longer than the minimum to make sure that the elbow is healed up, and also because the A's aren't in "win now" mode. Any elbow sprain is bad, but I'm told this is well below the threshold where surgery would even be considered, although remember that the threshold is very low. This is hardly as bad as it could have been, and he is likely to pitch again at level this season. My guess is that he'll be out about a month, then need some rehab starts before returning to Oakland. In the meantime, the A's should get Duchscherer back at some point in the near future, but temper your enthusiasm; while he's ready to throw again, he's probably coming back as a reliever, and even then, he'll have to wait to be back until after the All-Star break.

Quick Cuts: Aramis Ramirez could be sent out on a rehab assignment by next week. He looked good in a workout on Wednesday, and will have another in Chicago on Friday with lots of important eyes watching. ... Carlos Beltran is the latest baseball player to get a PRP injection, this one in his knee. ... Nick Swisher was a late scratch on Wednesday. He did come in to pinch-hit, so whatever it was doesn't seem serious. ... CC Sabathia will make his Friday start for the Yanks. ... Troy Glaus is hitting, but it's just off of a machine in Arizona. It's something, but there's still no solid timeline for a return. ... Asdrubal Cabrera should be back for the weekend. What's up with the Punic naming obsession in Venezuela anyway? ... Manuel Corpas has elected not to have surgery to remove the bone chips in his elbow. We'll have to see how this works out. ... One of the most hilarious things I've ever seen or heard was my pal Ashley Pena (she's on the right) seeing Chad Bradford pitch for the first time. "What the hell is this knuckledragger doing?" she yelled in a near-empty Tropicana Field, back when Bradford was with the Orioles. Bradford will be back Monday, so listen for Ashley. ... In a season where sinkerballers Chien-Ming Wang, Webb, and Fausto Carmona have lost tremendous value, this is an interesting chart. ... Carlos Delgado is doing well in rehab, though he's still at least a month away.