June 10, 2011

Collateral Damage

Pennant Race Pains

by Corey Dawkins and Ben Lindbergh

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In many areas of the country, the thermometer is nearing 100 degrees, making it the perfect time to watch baseball with beverage of choice in hand. However, a number of teams are feeling some heat that has nothing to do with the temperature, as injuries threaten to affect pennant races across the league.

Joba Chamberlain, NYA (Right elbow sprain)
The bodies of relievers and starters face dramatically different demands over the course of the season, although the physical act of pitching is the same in both cases. Relief pitchers don't have as long to warm up, can approach 70 or more appearances in a single campaign, and often rely on two offerings to get them through their outings. Starters, on the other hand, have more time to warm up, appear in fewer games, and often have several types of pitches at their command.

Differences in usage patterns and approaches may contribute to the injury profiles typically seen with each type of pitcher. It has been shown that glenohumeral internal rotation deficit (GIRD) worsens for relief pitchers over the course of a season while it improves for starting pitchers, and it has also been shown that an increased GIRD can be tied to UCL injuries.

GIRD is the term for a difference in internal rotation compared to the non-dominant shoulder, which can be detected by a measure as simple as putting one’s hand behind one’s back. A pitcher may feel completely fine and reports no symptoms, but this deficit is still an adaptation that occurs over the course of the season. Biomechanical changes must therefore occur in concert in order for a pitcher to continue to pitch consistently and effectively, causing other structures to compensate for the changes in motion of the shoulder.

If a pitcher is not used to sudden changes in the demands placed upon him, his chances of injury increase. With ulnar collateral ligament (UCL) injuries in pitchers, the pattern that pushes the ligament to the breaking point often begins a long time before the pitcher actually notices anything amiss. These harmful patterns may also have been present when the pitcher was younger and only exacerbated by recent changes in workload or role.

It’s impossible to state definitively that switching from relief pitcher to starting pitcher and back to reliever caused Chamberlain's injury, despite the studies mentioned above. His UCL could have been injured in high school. Alternatively, its demise could have been the result of his strained oblique this spring.

Regardless of the reason, Chamberlain is likely facing Tommy John surgery after being diagnosed with a torn ligament in his elbow, putting him out for the rest of 2011 and a good chunk of 2012. Even if he were to take the conservative route and successfully rehabilitate the elbow, it would be at least a few months before we see him back in action.

Dustin Moseley, SDP (Left shoulder subluxation)
For all of the fretting about pitchers getting injured during interleague play, not much is mentioned about the injury risk posed by the other 89 percent of the games in which NL pitchers have to bat. On Wednesday night, Moseley partially or fully (depending on the source) dislocated his left shoulder in the process of popping up a pitch. The shoulder reduced on its own and did not need to be yanked back into place, much to Moseley’s relief. In hitters, this injury most commonly occurs as the front arm is moving into its follow-through and externally rotating the shoulder, which was the case with Moseley.

Since his non-throwing shoulder was the one affected, Moseley should be able to return fairly quickly, despite the evident pain he suffered at the plate. He suffered a similar injury in 2004 and missed minimal time. Results of the MRI are not available, but the Padres are waiting until he can attempt a side session today or tomorrow before making a decision about a DL stint.

Brett Lawrie, Minors (Left hand fracture)
Just as it appeared that Lawrie was about to be called up, he was plunked in a minor-league game and put on the disabled list with a wrist contusion. (The injury came in a matchup with the Tucson Padres, clearing the AL East Triple-A affiliates of any suspicion.) The news got even worse after a recent CT scan, which showed a small non-displaced fracture of the third metacarpal on the back of the hand after the swelling went down.

Early in the injury process, swelling can mask a very small fracture on both x-rays and MRIs. A CT scan can be ordered once the swelling decreases, which gives a much higher-definition image of the bone's architecture and allows medical professionals to see these small fractures. Considering he's now a little over a week removed from the injury, Lawrie is at least two to three weeks away from resuming baseball activities and a bit more distant from in-game action.

Dustin Pedroia, BOS (Right patella contusion)
Pedroia has long been known as a gritty player and someone who is willing to play through the normal aches and pains accrued while playing baseball, so when an injury takes him out of the lineup, it’s usually more than a minor complaint. The condition of Pedroia's knee has worsened since he landed on it while fielding a ball on May 16. The second baseman has also been dealing with some cartilage damage since last season, although if it were something major, the Red Sox would have taken care of it earlier.

When the patella becomes bruised there is always a chance that some of the cartilage underneath could be damaged, but team medical director Dr. Tom Gill ruled out any need for surgery after inserting a needle with a miniature camera attached into Pedroia’s knee. This is a much less invasive procedure than an arthroscopy and causes little loss of time. Pedroia should be back with the team today and will likely return to the lineup in the next few days.

Chris Snyder, PIT (Herniated disc surgery)
Catchers are more prone to herniated discs because of the constant crouching that comes with the job, and Snyder is no exception. He had surgery on his lower back as a member of the Diamondbacks in 2009, and today he will have another on the L5-S1 disc. The L5-S1 and L4-L5 discs are the most commonly injured and are located at the base of the lumbar spine before the sacrum.

Snyder’s previous surgery cost him 43 days, but that time off brought him to the end of the season, and he needed more days over the offseason to recover fully. The best comp we have for a player who underwent a similar surgery and returned in the same season is Brad Ausmus, who lost 100 days to disc surgery last year. At the very least, Snyder is looking at a two-month absence.

Ryan Dempster, CHN (Right hip strain)
After seeing how well he pitched on Wednesday (6 IP, 1 ER, 3 H, 1 BB, 8 K), we’re almost inclined to say that Dempster should try pulling a muscle before every start. While warming up on Wednesday, the righty felt soreness in his right hip, but he went on to throw one of his better games of the year. It may not have been the best idea to risk a cascade injury, but so far all appears to be well. Dempster ran before the team's game yesterday and reported no problems in his hip, easing the Cubs’ minds about his scheduled start on Monday.

Flesh Wounds: Russell Martin had an MRI on his low back that ruled out any disc injuries. He's day-to-day for now... A recent MRI revealed that Justin Morneau has fluid in his wrist but no structural damage. He is cleared to play as tolerated... Jim Thome will have an epidural after further tests revealed that his quad pain is related to a previous back injury... Luke Gregerson joins the 2011 strained oblique club... Jarrod Saltalamacchia spent Wednesday afternoon at a hospital but was diagnosed with a viral infection.

Now, back to that beverage of choice…

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