March 9, 2011

Collateral Damage

Greinke Goes Down

by Corey Dawkins and Marc Normandin

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In the wake of Milwaukee's imported ace's recently-revealed injury, something tells us that future Brewers will have "No pickup basketball" clauses written into their contracts. Considering newly-signed Rickie Weeks admitted that he also plays pickup basketball during his downtime, the Brewers may want to see if they can sneak the language into existing contracts as well.

Zack Greinke, MIL (Broken rib)

This isn't the first time that a player has tried to hide an injury, and given the competitive nature of the sport, it won't be the last. Zack Greinke injured his ribs shooting hoops during the first week of camp, and after a few weeks without any improvement in his condition, an MRI was ordered. The scan showed a very small fracture of his seventh rib—one that x-rays didn’t pick up—and a bruised eighth rib on his left side.

Rib-cage injuries can take weeks to recover even when the damage is a bruise or a very small hairline fracture, as it is in this case. Milwaukee is planning on being without Greinke for 4-6 weeks, although he may begin throwing again earlier than that once the pain subsides. The key to rib injuries is rest—the two starts he has already made this spring likely delayed his recovery (although how significantly is still in question), so the healing process may as well be beginning now, not after the time of injury.

Rib-related ailments tend to last longer than similar injuries that occur in other areas of the body, especially when it comes to fractures. Josh Hamilton missed four weeks towards the end of 2010 with his rib fracture, and everyone in the Boston area will remember Jacoby Ellsbury’s rib injury party in 2010. The anatomy of the rib cage itself suggests why injuries to the area tend to linger. Twelve pairs of ribs make up the cage; 10 of the 12 originate at the spine and attach to the sternum through strong costocartilage, and the last two are connected to the spine but are not attached to the sternum and are thus called floating ribs. Rib fractures most commonly occur where ribs start to angle back toward the front of the body to connect to the sternum.

Rib injuries are extremely painful because they can never truly be immobilized. They must expand and contract with each breath, making it more difficult for the fracture site to heal and form the necessary bony callous. Rib fractures and contusions also cause painful spasms of the small intercostal muscles that are located between each of the ribs. Many different muscles attach on the ribs: the pectoralis major and minor, both internal and external obliques, the abdominal muscles, and the serratus anterior, which is a major stabilizer to the shoulder blade.

If the ribs were completely rigid, then force applied to them would result in easier fracturing, increasing the possibility of a punctured lung or other damaged organs. Thanks to the ribs' flexibility, they absorb force in much the same way as a car bumper, albeit without the messy exchange of insurance information with a stranger.

The torso is an important component of the kinetic chain and the general biomechanics of pitching. From a force production standpoint, the associated pain can severely hamper some muscles and cause strain elsewhere up the kinetic chain. This may cause Greinke to take a little longer to return, depending on how quickly he can progress through the throwing program and move to game readiness.

Carlos Beltran, NYM (Left knee tendinitis)

Some Mets fans seem ready to show up to Citi Field with torches and pitchforks, but that would be silly (for one, the Mets are at their spring training complex for the next few weeks). Beltran’s tendinitis is on the outside part of his left knee, not his right, which he had surgery on in 2010. Almost immediately after the 2007 season, Beltran underwent surgery on both knees to clean out scar tissue by the patellar tendons situated toward the front, so this isn't his first issue with that particular joint.

Beltran's pain may not have started when camp opened, as he claims: he suffered from left knee tendinitis toward the end of last season along with his right knee pain, according to multiple reports. If this were an isolated incident, it could be chalked up to an inflamed Iliotibial band (ITB), which runs from the outside of the hip to the outside of the knee. But repeated instances of inflammation on the outside of the knee raise suspicions of a lateral meniscus tear, among other things—especially since it has been so painful for Beltran since (at least) the beginning of spring training. Lateral meniscus tears don’t always show up on MRI: this study discusses how lateral meniscus tears are correctly identified by MRI approximately 80 percent of the time, with the remaining 20 percent diagnosed at the time of surgery. Beltran’s situation merits the careful attention given to it, as it wouldn't be surprising if the problem is a lateral meniscus tear that requires surgery.

Corey Hart, MIL (Strained left oblique)

Corey Hart injured his oblique two weeks ago after slipping on the outfield grass. He was slowly progressing in his recovery but suffered a setback over the weekend. One of the better comps out there is the injury Mike Cameron suffered in 2006. Cameron was out for a little over three weeks before returning, so Hart is looking at least another week on the shelf before he can return. That would give him about two weeks before Opening Day to get his at-bats in.

Ryan Zimmerman, WAS (Abdominal strain)

Looks like we jinxed Ryan Zimmerman in our Nationals installment of the Team Injury Projections: word came out afterward that he suffered an abdominal strain. Right now it’s supposedly a minor strain, and manager Jim Riggleman said that his third baseman would be out on the field had the regular season already arrived. One has to be a bit concerned by the nagging injuries that Zimmerman has suffered over the last couple of years, though, including the strained muscle between his ribs that he dealt with at the end of 2010. The Nationals are planning on giving him a few days off, which should be just the ticket if the problem really is as minor as they think.

Joel Zumaya, DET (Right elbow soreness)

Joel Zumaya is still dealing with lingering soreness in his elbow following the surgery performed on it at the end of last season. He had a rare surgery for a pitcher: the bone at the tip of the elbow was broken and needed to be stabilized. This usually occurs when something falls and lands directly on the elbow—it's rare for an adult to suffer this injury as a result of pitching (or, say, Guitar Hero). A recent MRI and examination by Dr. James Andrews ruled out any structural damage, but Zumaya continues to experience lingering soreness following his February 27 appearance.

He’s not going to pick up a baseball until he is pain-free, but no one knows if that will be in one week or three. Zumaya will then realistically need several weeks in order to build up his arm strength again, which puts an Opening Day appearance in jeopardy.

Flesh Wounds: It was good to see Justin Morneau in the batter’s box during his first game action of the spring… Shin-Soo Choo also returned to the lineup today after battling left elbow soreness for the last week and a half... Bud Norris had to leave his start on Monday with a right hamstring strain but does not believe that he will miss much time … Jeremy Hellickson is set to make his spring debut on Friday, albeit with only one inning planned after his right hamstring strain earlier in camp… Derrek Lee will have an MRI on his troublesome left wrist on Wednesday. This follows off-season surgery on his left thumb... Melvin Mora could miss another week or two following neck soreness after his car was rear-ended on Monday... This could be a key reason why Boston’s pitchers are projected to be healthy this season, according to the CHIPPER system. Why more teams don’t do this based on a simple cost/benefit comparison remains a mystery.

Corey Dawkins is an author of Baseball Prospectus. Follow @CoreyDawkinsBP
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