June 20, 2011

Collateral Damage

X-rays for Albert

by Corey Dawkins and Ben Lindbergh

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Albert Pujols, STL (Left wrist)
It seems as though hardly a week of the season has gone by without another event that causes Cardinals fans to hold their breath, starting in spring training with Adam Wainwright and continuing through the collision at first base involving Pujols. Collisions at first base happen all the time, but the ones that stick out in everyone's mind involve injuries similar to Brian Roberts’ in 2005 (dislocated elbow) and Derrek Lee’s in 2006 (broken wrist).

As Pujols was reaching up the line for the throw from second baseman Pete Kozma, he collided with Wilson Betemit. His wrist was bent backward to a disturbing degree, his elbow flexed to an odd position, and his shoulder was twisted. Pujols was clearly in immediate pain, mainly focusing on his wrist, but he also pointed to the shoulder at one point. The athletic trainers left the dugout to examine Pujols for any major fracture and quickly helped him from the field. Following the game, GM John Mozeliak described Pujols’ injury as a sprained left wrist after initial x-rays ruled out obvious fractures, but further tests will be performed on Monday.

Acute wrist injuries can be devastating to baseball players, especially hitters. Hyperextension of the wrist can cause anything from fractures to ruptured ligaments or strained tendons fairly easily. Small fractures might not show up on regular x-rays, so until Pujols has further imaging, we can't completely rule out the possibility. Even if no fracture is present, the gliding mechanisms between all the bones can be disrupted if the ligaments are too loose. For any hitter, especially a power hitter, this could cause a drop in production.

Based on his reaction and the point at which he was holding his wrist, it’s certain that Pujols sprained the wrist and possible that he has a small fracture. As more information becomes available, we will keep you updated.

Tommy Hanson, ATL (Right shoulder tendinitis)
Hanson was placed on the disabled list with right shoulder tendinitis on Friday, only five days after pitching one of his best games of the year. Often in cases of tendinitis we see an increased workload that puts an undue strain on the body, but Hanson really hasn't been overworked this season. He has only gone over 106 pitches three times, and the majority of his starts have been between 94 and 101 pitches per game.

Hanson has said that his shoulder has been bothering him for at least the duration of his last three starts. A recent MRI revealed only inflammation in his posterior rotator cuff and showed no structural damage, but the Braves want to err on the side of caution with their young star rather than have him risk aggravating the injury or hurting something else. Hanson expects to be back in the minimum, which certainly seems possible.

Jed Lowrie, BOS (Left shoulder soreness)
Carl Crawford, BOS (Left hamstring strain)
Clay Buchholz, BOS (Low back strain)
A recent rash of injuries has brought the Red Sox considerably closer to the Dodgers in the race for the most disabled-list moves this year. Lowrie has been battling soreness in his left shoulder for several weeks after colliding with Crawford and was just starting to improve, but on Thursday night, he subluxed his shoulder while swinging (or as he described it, popped it out). This is a classic description of a subluxation, wherein the joint becomes partially dislocated but quickly reduces itself. The MRI showed no significant structural damage, according to the team, but the images are being sent to Dr. Yocum for a second opinion. It is not uncommon to discover tears of the labrum and cartilage damage after subluxations and dislocations of the shoulder joint, so that’s what Dr. Yocum will be looking for. If there is a labrum tear that requires surgery, Lowrie will miss a good chunk of time.

The day after Lowrie suffered his injury, Crawford was sprinting down the line to beat a throw at first and strained his left hamstring. It was a mild Grade I strain, but Boston placed him on the 15-day disabled list the next day, since the Red Sox and Crawford couldn’t take the chance that he might come back too soon and jeopardize his long-term health. He could be back in the minimum, but hamstrings are notorious for being finicky in their recovery.

Buchholz has been fighting lower back soreness for the past few starts, but it wasn't until Thursday night that his delivery started to change, which tipped the balance toward making a move to the disabled list. Diagnosed with a lower back strain, he's going to focus on proper rest and physical therapy without further aggravating the condition by pitching. Buchholz is determined to be healthy down the stretch but also believes he will be activated on July 2nd, the first day possible. His motion and pain will almost certainly be significantly better by then ,and as long as his delivery isn't altered, there is no reason to doubt that he could make that start.

Hunter Pence, HOU (Left elbow sprain)
Hunter's play at first on Friday night wasn't as dramatic as Pujols' injury, but Pence did suffer a sprained elbow trying to avoid a tag. As he reached out with his left arm to tag first, the ground pushed back against his arm, and a valgus force was applied to the elbow, injuring the ligament. After being unable to complete batting practice on Saturday, Pence underwent an MRI that revealed a mild sprain. The Astros do not expect him to be placed on the disabled list, but he may miss the next series against the Rangers.

John Danks, CHA (Bruised head)
Line drives up the middle can do a horrific amount of damage when they strike pitchers, but Danks was lucky on Saturday night. The lefty had enough time to turn his head before the ball struck him and bounced into the third-base dugout. In a little more than two seconds, everyone expecting the worst saw Danks hop up and laugh while he asked for the ball. The athletic trainers came out to perform an evaluation consistent with the new concussion protocol, and Danks was allowed to finish the game. Later, Danks went for a CT scan, and everything was ruled out other than a bruise where the ball struck him. Amazingly, he is expected to make his next start.

Jose Morales, COL (Right thumb surgery)
Very few things hurt a catcher more than taking a foul tip to the throwing hand. On Wednesday, Morales was hit on his right thumb by a foul tip off the bat of Rob Johnson, causing a fracture. Despite clear pain and swelling, Morales finished out the game, only to go on the 60-day disabled list Friday after further tests. Morales will have surgery to insert two pins today to stabilize the fracture and allow for faster healing.

Matt LaPorta, CLE (Mild right high ankle sprain)
On Friday night, LaPorta sprained his right ankle trying to avoid a tag in a rundown. Clearly in pain as he was being helped off the field, the question was how severe the injury would turn out to be. An MRI showed fluid in the ligaments themselves, a telltale sign of a sprain to those ligaments. Luckily, it was only a mild high ankle sprain, and he should be back in about three weeks.

Flesh Wounds: Shaun Marcum left his rocky Friday start against the Red Sox with a left hip flexor strain. An MRI confirmed that there was no structural damage, but he might still miss his next start... Rick Ankiel is back on the disabled list, this time because of a strained left intercostal muscle... Alex Rodriguez has been battling a left shoulder issue for the last several weeks... Rod Barajas sprained his right ankle chasing down a wild pitch on Saturday. The injury was less severe than originally feared, and Barajas is aiming to return around the minimum.

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