videoAs the injury news pours in this season, we'll take a quick-hit look at the fantasy-relevant players who are battling health issues. We'll be splitting them up into players who we're keeping a watchful eye on -- players who have sustained injuries recently but have not been placed on the disabled list -- as well as those who have been placed on the DL.

To the DL

Francisco Cervelli, C, New York Yankees (right hamstring): When a player instinctively grabs the back of his thigh as he pulls up while running, then falls to the ground, there is little doubt as to which muscle is injured. When the injured player does not even attempt to move, but instead sits on the ground waiting for assistance, there is little doubt the injury is severe. Cervelli did both of those things as he crossed first base Sunday, leading anyone watching to anticipate a move to the DL with a hamstring injury, probably for a lengthy period of time. On Tuesday the Yankees placed Cervelli on the 60-day DL with a Grade 2 (moderate) hamstring strain, essentially confirming early suspicions. The recovery time for a Grade 2 strain varies widely depending on the degree and location of the tissue damage. Two to three months to return to full function is not unusual. Cervelli will not be back until June at the earliest.

Juan Lagares, OF, New York Mets (right hamstring): Lagares pulled his hamstring Monday, also while running to first base. He too will require a DL stint but his is of the 15-day variety. That’s not to say he won’t require some additional time beyond the two weeks but he has the opportunity to return if the leg cooperates.

Keep a watchful eye on:

Curtis Granderson, OF, New York Mets (forearm/rib cage/knee): Granderson nearly took out three separate body parts in one play Monday, but X-rays of each proved negative. Still, Granderson was moving gingerly after the game and sat out Tuesday. He is considered day-to-day and could possibly return as soon as Wednesday. He also is considered lucky.

Josh Johnson, SP, San Diego Padres (right forearm): Things just are not getting better for Johnson. He opened the season on the DL with a flexor strain in his throwing elbow and has failed to progress to throwing. On Tuesday, the Padres announced that Johnson will travel to visit Dr. James Andrews (Johnson had Tommy John surgery in 2007 and a subsequent elbow scope this past offseason). According to the San Diego Union-Tribune, when Padres general manager Josh Byrnes was asked if Johnson would pitch this season his reply was an unsettling, "Not sure." And so we wait. Given Johnson’s storied health history, this latest news is anything but encouraging.

Nearing a return:

Jose Reyes, SS, Toronto Blue Jays: Reyes is currently on a rehab assignment after starting the season on the DL with a hamstring strain. Well, he didn’t actually open the season on the DL, but he did have tightness in his hamstring during spring training, then failed to get to first base during his first regular-season at-bat before it acted up. Apparently, things are going well enough now that Reyes could be activated this weekend for the team’s series in Cleveland. Jays manager John Gibbons told reporters if the next couple of days go well for Reyes, he should be "ready to go" Friday. Naturally, Reyes is not out of the woods, given his extensive history of hamstring injuries, but the Jays will be happy to have him back.

Casey Janssen, RP, Toronto Blue Jays: Janssen opened the season on the DL with a low back strain but worked his way back to his first rehab outing Tuesday. After one inning, Janssen suffered no apparent setbacks but the next day is always a telltale indicator. Janssen may need a few rehab appearances but could rejoin the Jays within the week.

Video: Red Sox injuries

April, 15, 2014
Apr 15
videoStephania Bell and Eric Karabell discuss injury concerns with the Boston Red Sox's Dustin Pedroia and Koji Uehara.

Video: Phillies injuries

April, 15, 2014
Apr 15
videoStephania Bell and Eric Karabell discuss injury concerns with the Philadelphia Phillies' A.J. Burnett and Cole Hamels.
As the injury news pours in this season, we'll take a quick-hit look at the fantasy-relevant players who are battling health issues. We'll be splitting them up into players we're keeping a watchful eye on -- those who have suffered injuries recently but have not been placed on the disabled list -- as well as those who have been placed on the DL.

To the DL

Adrian Beltre, 3B, Texas Rangers (left quadriceps): The Rangers placed Beltre on the disabled list Sunday (retroactive to April 9), making April 25 the first day he would be eligible to return (Rangers are off on April 24). The move doesn’t come as a huge surprise given the Rangers had made it known they were leaning that direction.

While the injury was classified as a Grade 1 or mild strain, the bigger picture -- as in the timing of this injury relative to the scope of the entire season -- undoubtedly factors into the team’s decision. According to, general manager Jon Daniels acknowledged as much. "That's probably the smarter thing, to err on the side of caution," Daniels said. "The last thing we want is to be without him for an extended period of time." The hope is that Beltre will be able to return when eligible.

Extended absence is a reasonable concern with a player who has a history of soft tissue injuries, particularly on that left side. While Beltre has managed his prior injuries well enough with a few days' rest to avoid the DL, the increasing number, frequency and, well, age elevate the level of concern.

Beltre has primarily experienced hamstring strains in his past, but this quad issue first appeared during spring training. The opposing dynamic of the quadriceps and hamstrings along with increased presence of scar tissue and an overall decrease in tissue flexibility pose a risk.

During spring training, manager Ron Washington had already hinted at increased DH days for Beltre, especially during day games following night games. Not only is that likely to be in place, it wouldn’t be surprising if there were increased days off for strategic rest as the season progresses. For a player who’s averaged 149 games a season over the last four years (playing 154 or more for three of those years), sitting and watching is not his style. That may be something Beltre will have to adjust to, however, to preserve his health for the long haul.

Ryan Zimmerman, 3B, Washington Nationals (right thumb): Another dive to a base, another thumb injury. When Zimmerman made the unsuccessful attempt to dive back to second base Saturday, the blood on his hand indicated something was wrong. It turned out to be a fracture in his thumb that will require four to six weeks to heal. Bone is one of the more predictable tissue types when it comes to repair, so the timetable issued by the team appears reasonable, presuming a clean break and no unusual setbacks. General manager Mike Rizzo said Zimmerman will consult with a hand specialist Monday as a precaution.

While his loss is a blow for the Nationals, there may be a silver lining. Zimmerman was already struggling with discomfort in his right shoulder, the source of an errant throw just one week prior to this injury. An MRI revealed only inflammation, but the chronic nature of Zimmerman’s shoulder issues had the team giving him practice time at first base. Now that he is sidelined by the thumb injury, his shoulder will get some well-timed rest.

Alex Cobb, SP, Tampa Bay Rays (left oblique): Cobb sure looked good in his Saturday start, but apparently, by the end of his outing, he didn’t feel so great. According to the Tampa Tribune, Cobb felt something pull in his side early in the game but was able to continue. An MRI taken later revealed a strained left oblique, and Cobb was placed on the DL Sunday.

Cobb’s injury is typical of the type of oblique injury pitchers suffer, that is to the side opposite their throwing arm. The average DL stay for pitchers suffering an oblique injury is just over a month. Timetables can vary obviously depending on the precise location and degree of injury as well as the individual’s rate of healing, but a month’s absence is a reasonable expectation. Cobb’s return date is not likely to be any sooner, but it could roll into five or six weeks before his next major league start.

Adequate down time to ensure the injury heals properly is critical for anyone, but especially a pitcher. Continued attempts to push through an oblique injury lead to compensations by other, often weaker muscle groups, which then can lead to other problems (read: arm). Depending on the time required for the oblique injury to resolve, the amount of throwing a pitcher will need to return his arm strength to normal can vary. It will be important to monitor how Cobb responds once he is allowed to resume throwing, particularly downhill.

Brett Anderson, SP, Colorado Rockies (left index finger): Anderson had some bad luck on Saturday. There are enough ways for a pitcher to get injured; during an at-bat is not the usual one. Unfortunately for Anderson, what was initially thought to be a contusion (or deep bruise) turned out to be a break of his index finger on his throwing hand. He is now expected to miss the next four to six weeks as the bone heals. The challenge for him initially will be overcoming any stiffness in the finger and restoring his normal grip after having the digit immobilized.

Video: Texas Rangers injuries

April, 11, 2014
Apr 11
videoStephania Bell has the latest on Adrian Beltre's injury and when two major arms will return to the Texas Rangers' rotation.
videoStephania Bell discusses Aroldis Chapman's return to the field and the latest on Mat Latos.

Video: Michael Bourn's status

April, 11, 2014
Apr 11
videoStephania Bell discusses when Cleveland Indians outfielder Michael Bourn will return to the lineup.
Forget for a moment the warnings to all other baserunners about the dangers of sliding headfirst into first base. Someone needs to stop Josh Hamilton from sliding headfirst into any base. Period.

Hamilton’s injury to his left thumb, sustained while sliding into first base headfirst Tuesday (or hands first, as it were), is not his first significant injury to be sustained in that manner. In 2011, Hamilton fractured his right humerus (the long bone of the arm that runs shoulder to elbow) in a diving headfirst slide at home plate. Just as many are questioning his decision to lead with the hands in an attempt to beat out a tag at first base, so did many wonder then why he risked injury for a slide that was not very likely to succeed. (For the record, he was tagged out at home in that attempt.) Hamilton’s fractured arm kept him out of major league play for more than five weeks and, it would seem, served as a warning of the risks involved in the headfirst slide. Yet nearly three years later to the day, Hamilton made a wager with a low percentage of success and a high percentage of risk ... and lost.

[+] EnlargeJosh Hamilton
Cal Sport Media/AP ImagesJosh Hamilton may need to slide feet-first like this more often to avoid injuries.

The injury Hamilton sustained Tuesday, a torn ulnar collateral ligament (UCL) of the thumb, is a known risk with the headfirst slide, when a player can catch his outstretched thumb on the bag, forcing it away from the rest of the hand and overstretching the ligament.. The UCL spans the inner aspect of the base of the thumb, running from the first metacarpal (the long bone that sits just above the small wrist bones on the thumb side) to the proximal phalanx (adjacent to the first metacarpal, it is the nearest of the two bones that comprise the thumb itself). When the UCL is injured, it can become swollen and painful. A complete tear typically results in instability of the thumb. The Angels announced Wednesday that Hamilton had suffered the injury, noting he will consult Friday with Dr. Steven Shin -- an orthopedic surgeon at the Kerlan-Jobe clinic in Los Angeles who specializes in the hand -- to determine whether surgery is necessary.

Not all tears require surgery, and the decision as to whether surgery is required includes multiple factors, including the degree of tear, the presence of instability and any factors that would prevent the ligament from healing correctly. A major advantage to surgical repair for a complete tear is a more predictable outcome, according to Dr. Hank Holliger, an orthopedic hand surgeon at Resurgens Orthopaedics in Atlanta.

“The ligament ordinarily regains its intrinsic strength by six weeks,” Holliger said, “which also is the usual time away from hitting activities.” There can be some stiffness that persists beyond that point, and the time to return to competitive play can vary. Two to three months is often the standard time frame issued when an athlete undergoes UCL surgery, although the details of the injury and the specifics of the surgery can affect the overall time frame, as does the individual’s ability to heal. Even after the athlete returns, he is often fit with a splint to wear when baserunning. Boston Red Sox second baseman Dustin Pedroia, who underwent offseason surgery to repair his torn UCL, said he will wear such a splint this season but will put it on after he bats. Holliger says he typically protects a thumb for three months after ligament reconstruction, via splinting or simply disallowing headfirst slides.

Is the cost of the headfirst slide too great when it comes to injury risk?

Here are a few other players who have suffered an injury to the UCL and their paths post-injury:

Yasiel Puig, OF, Los Angeles Dodgers: Injured April 5 on a headfirst slide to first base. Puig’s injury is classified as a sprain of his left thumb and he is considered day-to-day. He has been fitted with a splint and is taking batting practice but has not returned to the lineup. Of note: This is not Puig’s first issue with his thumb. He sprained it last April while still in the minors and missed more than a week.

Hanley Ramirez, SS, Los Angeles Dodgers: A torn ligament due to playing in the WBC? Some would prefer their players avoid the WBC just as much as the headfirst slide, but the injury for Ramirez came on a defensive play, while diving for a ball. He underwent surgery to repair the ligament but opened his season just five and a half weeks later, almost three weeks sooner than the initial projection. The good news? His surgeon was Dr. Shin, who will evaluate Hamilton on Friday.

Dustin Pedroia, 2B, Boston Red Sox: Injured Opening Day of 2013 yet managed to play the entire season, although with a little drop in power. He underwent offseason surgery to repair his left UCL and was ready to roll by the start of spring training.

Chase Utley, 2B, Philadelphia Phillies: Injured on a headfirst slide in 2010 and underwent surgery to repair the ligament. He returned to play at just under seven weeks post-surgery.

Jason Heyward, OF, Atlanta Braves: Heyward damaged his UCL on a headfirst slide in 2010 but did not suffer a complete tear. His injury did not require surgery (but he was forced to sit out the All-Star Game that year). He missed 18 days with the injury.

The significance of Hamilton’s injury certainly hints at the likelihood of surgery, but there will be no definitive word until Friday. At the very least, the initial timetable issued by the Angels of a six-to-eight-week absence appears reasonable. And while the debate about the value of a headfirst slide will no doubt continue, the hope is that Hamilton has learned by now that the risk clearly outweighs the reward.

As the injury news pours in this season, we'll take a quick-hit look at the fantasy-relevant players who are battling health issues. We'll be splitting them up into players who we're keeping a watchful eye on -- players who have sustained injuries recently but have not been placed on the disabled list -- as well as those who have been placed on the DL.

There is no shortage of players in either of those categories, so let's dive right in.

Keep a watchful eye on

Omar Infante, 2B, Kansas City Royals (jaw): It’s not just the pitchers who absorb the hits to the face; hitters are also vulnerable. Infante took a scary fastball to the jaw Monday, leaving him bloodied but fortunately not seriously hurt. Infante required stitches to repair the laceration to his chin. Scans performed later revealed no fractures to the bony structures, but rather a soft tissue injury (sprain) to the opposite side of the jaw from where the baseball landed.

The jaw is a bilateral hinge joint where movement on each side is connected through a single bone, the jawbone or mandible. Displacement from a force landing on one side can therefore stress the joint tissues on the opposite side. In Infante’s case, the blow from the baseball on the left side of his face led to a sprain of the temporomandibular joint (abbreviated TMJ, where the temporal bone of the skull and the mandible meet, just below the ear) on the right. Infante also passed all concussion tests and was equally fortunate to escape this episode without a major head injury.

According to the Kansas City Star, a team spokesman for the Royals offered the following statement: “Based on the Kansas City medical team’s initial diagnosis, it does not appear he’ll miss a significant amount of time.”

Infante will continue to be monitored closely, and it could be a few more days before a decision is made with regards to the disabled list. As unpleasant as this injury is, Infante and the Royals know this could have been much worse.

Ryan Zimmerman, 3B, Washington Nationals (right shoulder): Zimmerman is again experiencing soreness in his right shoulder, leading to errant throws. That scenario led to his early exit from Saturday’s game and a follow-up MRI. Nationals manager Matt Williams described Zimmerman’s shoulder as “arthritic,” per the Washington Post, not necessarily surprising given his history with the joint.

Zimmerman struggled with the shoulder in 2012 and underwent surgery after that season to clean up the acromioclavicular (AC) joint, the joint at the point of the shoulder. He described the difficulty in making his normal arc of throwing motion when the shoulder was problematic, which explains his intermittent lack of accuracy. The hope was that this challenge would be behind him following surgery, but that has not proven to be the case. For now, the team is approaching his status as day-to-day.

For more on Zimmerman’s injury and what to expect, check out my video with Eric Karabell and his Insider blog post on Zimmerman.

Yasiel Puig, OF, Los Angeles Dodgers (left thumb): Puig seems destined to make regular appearances here given his style of play. The question will be how serious the injury is -- or could be -- at any given time. Puig injured his thumb on a headfirst slide into first base Saturday and was out of the lineup Sunday. Initial X-rays were negative and a follow-up MRI confirmed only a minor ligament injury (Note: Manager Don Mattingly described the injury as a strain, according to the Los Angeles Times; ligament injuries are generally classified as sprains).

The key piece of information is the apparent lack of severity. Mattingly said of Puig’s situation, “It seemed more like a day-to-day thing than a DL thing.” The headfirst slide is often responsible for tears of the ulnar collateral ligament of the thumb, and in severe cases surgery is required. That does not appear to be the case for Puig at this time, but he may miss a day -- or several -- depending upon how the thumb responds.

To the DL

A.J. Ellis, C, Los Angeles Dodgers, (knees): Ellis underwent arthroscopic surgery Tuesday with team physician Dr. Neal Elattrache to address a torn meniscus in his left knee. He sustained the injury Saturday when trying to score from second base.

Given that this procedure involved removing the piece of damaged meniscus as opposed to repairing the tissue, the timetable for Ellis’ return is shorter. He is projected to miss four to six weeks, a slightly more conservative timetable than for a non-catcher. With the demands of the position (sustained crouching, repetitive motion into and out of a deep squat), there is a little slower return to action than for another position player, but his overall short-term prognosis is quite good.

Ellis did have a meniscal procedure on the same knee in 2012, and in his role as a catcher may be more susceptible to long-term knee issues, particularly cartilage wear. For now, however, the Dodgers can look forward to his return sometime in May.

Mark Teixeira, 1B, New York Yankees, (right hamstring): Teixeira left Friday’s game in the second inning with the hallmark “I hurt my hamstring” sign, pulling up his stride and reaching back instinctively to the back of his thigh as he tried to get to first base.

While the injury was described as a Grade 1 strain by the team, indicating it is minor, the Yankees are taking no chances on allowing it to get worse. Teixeira may only miss the minimum -- or slightly longer -- but the bigger concern may be his own apprehension with regards to his previous wrist injury. Teixeira appears to still be finding his swing coming off last year’s surgery to repair a torn tendon sheath in his right wrist. Maybe removing him from play for a couple of weeks will allow him to regroup on both counts.

Joe Saunders, SP, Texas Rangers (left ankle): Is it possible the Rangers have sustained yet another injury? For Saunders, the good news is that this is not an injury to his throwing arm, nor does it look to be a long-term concern. Saunders was hit by a comebacker, leaving him with a bruised and swollen ankle.

A balky ankle would throw off his pitching motion and make fielding difficult, so the DL stint (retroactive to April 5) makes sense.

David Robertson, RP, New York Yankees (groin): Robertson suffered a minor groin strain Sunday, and the Yankees have proactively placed him on the DL. While the injury does not appear serious, the groin -- part of the core musculature -- is critical for stability to pitchers who spend most of their time in a one-legged stance. An injury here, even a minor one, can lead to compensations, which can in turn lead to arm problems. It's better to rein him in now and allow this to improve, rather than take any chances at risking something bigger.
Ryan Braun is reportedly having issues with his right thumb again. According to’s Adam McCalvy, this is the same problem (numbness in the thumb that affects his grip and in turn leads to blisters) that led to the first DL stint of his career in 2013. Braun missed a month but returned to play in just a handful of games prior to being suspended for the remainder of the season. Consequently, the thumb was never truly tested after the time spent on the DL.

According to the Milwaukee Journal-Sentinel, Braun and the medical staff were trying different tactics this spring to prevent a recurrence, such as padding on the bat or in his batting glove. It can be extremely difficult to find something which protects a thumb or finger but still allows the hitter to feel like he has a “normal” grip. Too much padding and he becomes less effective at the plate, too little and the problem persists. Now Braun is apparently dealing with challenges when throwing the ball, in addition to his discomfort when swinging the bat. Given that there are no guaranteed outcomes with surgery, it appears that Braun and the Brewers are going to attempt to manage the problem conservatively at this point, which begins with Braun at DH as the Brewers open a weekend series against the Boston Red Sox at Fenway Park. The question will be how long the management approach can be effective, because clearly the problem is not resolving.

Stephania Bell discusses what to expect from Los Angeles Dodgers outfielder Matt Kemp and gives the latest update on pitchers Clayton Kershaw and Brian Wilson.

Rankings are meant to be a jumping-off point for debate and discussion. This list should be no different. Everyone has his or her own interpretation for how injuries will affect a team. Other than the prorated dollar amount of salary to lost time plus the cost of replacement players, impact is very difficult to quantify. When I was asked for the top five teams whose seasons would be impacted by injury, I had a very instinctive initial reaction. No science, no rationale, just a gut feeling. Then I decided I should perhaps invest some more thought into my selection.

Here are a few musings.

Opening Day status: Some rosters do not look anything like a manager expected on Opening Day. Starters on the disabled are a big reason. Not only is there the obvious loss of the starters, there is the psychological blow to a team that doesn’t feel as though they’re fielding their top players. The more the injuries pile on, the more the team psyche is bruised. It’s hard to perform optimally under these conditions, and a string of early losses can make it difficult to recover, even once those injured players return to the lineup.

Uncertainty factor: Most injuries have a fluid recovery timetable but some are more predictable than others. For instance, while losing a player to Tommy John surgery is devastating, there is at least some comfort in knowing how to adjust for the remainder of the season. But when players are on vague timetables, particularly with a less common type of injury or one with a wide range of healing times, the uncertainty can weigh on the team.

Injury details (or lack thereof): While all teams will provide some information with regards to their injured players, it is still limited. It would help this ranking concept if there were more details about the imaging tests, clinical exams and rehab programs. Of course, even then the timelines wouldn’t be assured (which is why teams issue projections such as 4-6 weeks, 2-3 months, or "no specific timetable"). So we work with what we have.

Funny thing is, at the end the list looked virtually identical to the one generated from instinct. While I can’t be sure what that implies, I hereby humbly submit to you my top five teams who, as of the first week of the season, are potentially the most impacted by injury concerns.

Who knows? Maybe we’ll revisit this topic late in the season and see if we’re talking about five entirely different teams. Those who appear below would certainly enjoy proving this list wrong.

1. Texas Rangers

There weren’t major injury alarm bells sounding prior to spring training. Sure, there were a few issues. One member of their starting rotation was lost for at least half the season. Their everyday third baseman might not be able to play everyday anymore. But they didn’t feel like a team in trouble until they moved deeper into spring training. Every few days seemed to bring more bad news. Both pitchers and position players were affected. And the biggest concern? The uncertainty quotient, including not knowing how three of their starting five pitchers will perform in the majors.


Yu Darvish: His 2013 season ended with low back pain and nerve irritation. Injections were involved. By November, the team felt comfortable the issue was behind him. Unfortunately, it is hard to know whether the issue is truly in the rearview mirror until the athlete returns to his prior level of function. Darvish developed neck stiffness fairly early this spring and when it didn’t disappear as quickly as everyone had hoped, he was sent to a spine specialist. The good news? No structural damage. That, however, does not necessarily equate to pain-free resolution. Darvish opened the season on the DL but has resumed a throwing program and the team hopes he can return within a week. So why worry?

[+] EnlargeYu Darvish
Kim Klement/USA TODAY SportsYu Darvish opened the season on the DL, leaving the Rangers' Opening Day rotation very thin.

1. Spine problems tend to be recurrent. Until he demonstrates over multiple weeks that this is behind him, it will be hard to feel confident. Even then, there is still no guarantee it doesn’t crop up again at some point.

2. The neck and the shoulder are closely related. Something as simple as neck stiffness can translate to problems in the shoulder, even fatigue, which could present an issue for a typically high volume thrower such as Darvish.

3. The proximity time-wise of neck and back issues for Darvish -- even if they are unrelated episodes -- is disconcerting.

Matt Harrison: Two starts last year were followed by a back problem which required not one, but two surgeries. Months later he required thoracic outlet surgery on his right (non-throwing) side; he had previously undergone a similar surgery on his throwing side a few years prior. He finally appeared ready for spring until stiffness in his neck got everyone nervous. While it seems to have settled and he is now progressing through minor league outings, the soonest he will likely join the team is late April.

Derek Holland, SP: Holland underwent microfracture surgery on his left knee after he tumbled down some stairs at home (apparently tripped by his dog). Healing parameters following this procedure dictate a graduated recovery. His placement on the 60-day DL indicates the team does not expect him until at least June. After all the downtime, it’s hard to know what to expect.

Position players

Jurickson Profar, 2B: Profar came into spring training with some shoulder soreness that was dubbed tendinitis. But one hard throw while attempting to turn a double play in late March resulted in a tear of his teres major. The team projected him to miss 10 to 12 weeks out of the gate, an indication of the severity. Soft tissue injuries are hard to gauge until the player tests the aggravating activity, which in Profar’s case means hard throwing. He likely won’t be a regular contributor until the second half of the season and that presumes no setbacks.

Geovany Soto, C: Soto tore his lateral meniscus in his right knee (followed by arthroscopic surgery March 26). His projected absence is three months, but the demands the position places on the knee make the recovery more challenging for a catcher.

Not on the DL, but worthy of a mention

Adrian Beltre, 3B: Recurrent calf and hamstring injuries are a concern for Beltre, especially at age 34. While he hasn’t missed much time in the past two seasons, there are already plans to use him in a DH role more often to preserve his health. Oh, and he already had an episode of quad tightness this spring.

Colby Lewis, SP: He’s coming off a hip resurfacing procedure and there are no other active pitchers who have undergone a similar surgery, making him a test case. Early results are encouraging but it remains to be seen how he will produce and, more important, how he will hold up across a season.

2. Atlanta Braves

It’s possible to sum up the Braves’ injury problems in one word: pitching. It was almost too much to believe when they lost not one, but two pitchers to their second torn ulnar collateral ligament. What might be crazier is that the Braves are counting on getting production from two pitchers who are still working their way back from Tommy John surgery. The magnitude of their losses across their pitching staff puts them second on this list.

Brandon Beachy: Beachy had a bumpy road back from his first Tommy John surgery, then managed only five starts before getting shut down with elbow inflammation. An offseason scope didn’t do the trick and when he felt pain in his elbow this spring, the fears of a re-tear were confirmed. He underwent his second surgery in March and will miss the entire 2014 season.

Kris Medlen: Medlen at least had a few years between surgeries but he too has undergone his second Tommy John surgery and will miss all of 2014.

Mike Minor: Minor opens the season on the DL, largely as a result of being behind in his throwing program following a urinary tract procedure in December. The good news with Minor is that his situation relates more to him catching up with his arm strength as opposed to an undiagnosed injury. The Braves hope to have him in late April.

Gavin Floyd: Floyd had a flexor tendon repair concurrently with his Tommy John surgery last May. He is expected to make his first minor league start this week and could return to the majors within the month.

Jonny Venters: Working his way back from Tommy John surgery, Venters is hopeful of rejoining the team in late May or early June. The plus? Relief pitchers tend to fare better the second time around.

3. Los Angeles Dodgers

They look so good on paper. But in order to be that good, they need to play. At the start of spring training, other than Matt Kemp's status, there were no obvious flags. But Australia seemed to be associated with injuries -- either the kind that kept some from traveling (such as Zack Greinke's calf) or the ones that cropped up afterward (Clayton Kershaw's upper back) -- and no explanation. The latest addition is relief pitcher Brian Wilson. If the Dodgers keep adding more names to the list or more time off to those who are already there, then they move up in this ranking.


Clayton Kershaw: Kershaw’s upper back injury does not appear serious, but the Dodgers are taking no chances. Inflammation in the teres major muscle (located in the upper back region but a contributor to shoulder motion) could be a precursor to a bigger injury if not allowed to fully heal. Consequently, Kershaw is on the DL after earning a win in the opener in Australia and will be on a submaximal throwing program for 2-3 weeks before being re-evaluated. There is no official timetable for his return, but May is looking more likely. Consider this a proactive measure by a team looking at the length of the season and expecting to be competitive down the stretch.

Josh Beckett: The question entering spring training was how Beckett would bounce back from thoracic outlet surgery (removal of a rib to alleviate pressure on nerves and blood vessels which supply the arm). His recovery was good (no more finger numbness) but then he hurt his thumb in March, banging it against a door. He’s improving and should be back in early April.

Chad Billingsley: His progress recovering from Tommy John surgery has been solid, but even if he returns in May or June, his innings may be controlled. Not to mention, most pitchers have some ups and downs in performance in their first few months back.

Brian Wilson: Wilson did not have a good outing Sunday and he was placed on the DL Tuesday with nerve irritation in his elbow. Wilson has had two Tommy John surgeries, the most recent in 2012, making this a little more worrisome.

Position players

Matt Kemp, OF: It seemed to be gloom and doom for Kemp when he was not able to run on land as spring training opened. Once he got clearance however, his progress has been steady and he appears on the verge of being activated. Considering he enters this season stronger as a result of being able to work his upper body more in the offseason, as long as the hamstrings hold up, he could have a bounce-back year.

4. Cincinnati Reds

The Reds could have been much worse. Aroldis Chapman was lucky. Mat Latos is improving. Johnny Cueto seems to be OK. But if one or two players take a turn for the worse, the Reds move up in the rankings.


Mat Latos: The concern when Latos came into spring training was about about easing his arm back into action after offseason surgery to remove bone chips. Concern shifted to his knee when he slipped on the mound, sustaining a medial meniscus tear that required surgery. Latos has been pitching in minor league games and is expected to join the team in the first couple weeks of the season.

Aroldis Chapman: His might be one of the scariest injuries on record: Chapman taking a liner to his face, just above his left eye in a spring game. Remarkably, the damage was relatively limited (facial fractures, concussion). Following insertion of a plate to stabilize his facial fractures, Chapman has done some very light activity but he could be cleared to throw any day, possibly pitching in game conditions by late April. Physically the road appears straightforward; the challenge could come when he has to face live batters again.

Position players

Devin Mesoraco, C: Mesoraco strained his left oblique in late March the way position players often do, swinging a bat. The typical recovery is several weeks and taking the proper time to heal is key to avoiding a setback. Mesoraco starts the season on the DL (retroactive to March 21) but is currently taking batting practice and could be ready to rejoin the team fairly early in April.

Skip Schumaker, 2B: Schumaker dislocated his left shoulder while diving for a ball in a late spring game. He hopes to return in a month.

Jack Hannahan, 3B: Hannahan had right shoulder surgery in the offseason and is still recovering. The team placed him on the 60-day DL so he will not even be an option until June.

Not on the DL but worthy of a mention

Homer Bailey, SP: Bailey is on track to make his start this week but he suffered the injury to his groin just two weeks ago. The hope is that he is not compensating in some way that could affect his mechanics and, ultimately, his throwing arm.

Johnny Cueto, SP: Last year Cueto went on the DL three times with a lat injury and it ultimately ended his season. He started on Opening Day and says he’s healthy. But he did have a little scare with scapular (shoulderblade) irritation this spring, so is this problem truly behind him?

5. Arizona Diamondbacks

How did they get here? It seems as though this team has often been the recipient of bad news late in spring training, including the loss of their ace. The Oakland Athletics are on their heels, but the Diamondbacks edge them out.


Patrick Corbin: Corbin tore his ulnar collateral ligament and underwent Tommy John reconstruction shortly afterward. He will miss the 2014 season.

David Hernandez: Like his teammate Corbin, Hernandez underwent Tommy John surgery and will miss the 2014 season.

Daniel Hudson: Hudson is recovering from his second Tommy John surgery and is not likely to return before the All-Star break.

Position players

Cody Ross, OF: Ross dislocated his hip last year and it has been a slow recovery process, complicated recently by back stiffness. He could rejoin the team by mid-April, but can he stay healthy?

More Manny Machado notes

March, 20, 2014
Mar 20
Following up on the earlier news that the Orioles Manny Machado has had his physical restrictions lifted, here are a few more important notes:

1) As for the soreness in his calf and hamstring Machado experienced a week ago, which forced him to rest for a few days, ElAttrache suggested it was a minor and not entirely unexpected response to intense running. The graft to create Machado's "new" MPFL was harvested from his hamstring tendon and can become irritated initially when returning to run. "The scar tissue from the original injury coupled with the graft site make this an area that's easily strained when resuming running," ElAttrache said. Machado ran in a pool last week and worked on an elliptical machine to give the muscle some rest and says his discomfort has subsided substantially.

2) Machado will return to the Orioles' spring training facility in Sarasota to continue to rehab. As the local muscle strain resolves, he can be progressed to full speed running, turning corners and sliding. The next step would then be an appearance in a spring training game, although when that will happen is unclear.

It also remains uncertain whether Machado will be in the team's lineup on Opening Day when they host the Boston Red Sox. The priority is getting Machado back to full speed running, while getting at bats and adding reactive defensive work to help ensure confidence not only in his knee but in his overall readiness to play.

Still, Machado is clearly knocking on the door of a return to action, ahead of where even he thought he might be just a few months ago.
The news that Carolina Panthers quarterback Cam Newton is having ankle surgery Wednesday that is expected to sideline him for approximately four months generated a wave of anxiety about the potential consequences. There has been concern expressed about how Newton's absence from spring activities will affect his ability to develop rapport with his new receivers. The question has also been raised, perhaps more importantly, about how this procedure will impact his signature style of play, and whether his mobility will be compromised.

In truth, one could make the case that not only will neither of these things suffer from Newton undergoing surgery at this juncture, but both may actually benefit.

Just to be clear, no one in medicine would suggest that surgery is preferred if rest and rehabilitation resolve the problem. However, when the problem persists and surgery offers a means of improvement, it becomes the best option.

[+] EnlargeCam Newton
Jeremy Brevard/USA TODAY SportsCam Newton's recovery from ankle surgery will prevent high-stress activities in the spring, but he should be ready to roll by training camp.
Consider Newton's history with his left ankle. In 2012, he suffered a high ankle sprain late in the season. The rest of the ensuing offseason helped, but it didn't completely eliminate some of the effects that can linger after such an injury, even a mild one, especially when that ankle is stressed by the zigs and zags of a mobile quarterback. In 2013, Newton aggravated the ankle late in the season, sustaining lateral (low) ankle damage at some point -- or even multiple points -- along the way (as reflected by the Charlotte Observer report that ligaments were "stretched out" and will be tightened during surgery).

Everyone knows that NFL players often play through discomfort -- if not some degree of injury -- especially late in the season, and Newton was no different. The accumulated physical stress on his ankle of another season and additional injury undoubtedly left the joint stiff and swollen on a routine basis. The only way to find out if it would resolve with just rest and rehabilitation was to give it an opportunity to do just that.

However, multiple sprains -- especially combination high and low ankle injuries -- can lead to problems with the joint beyond the obvious pain and swelling. The injured ligaments surrounding the joint may heal with scar tissue, yet lose elasticity, leading to instability. The joint can develop spurring of the bones from resultant abnormal stresses, all of which leads to chronic irritation in the ankle. That irritation manifests locally as pain and swelling, but functionally translates into decreased mobility, agility and stability; in other words, it could affect all the qualities necessary to make a quarterback like Newton remain Newton-like. Rest and rehabilitation may provide some form of relief, but it may not be sufficient to overcome the injury.

Thus, surgery becomes an option. Barring the discovery of any major cartilage damage within the joint, the process is fairly straightforward. Clean the joint of any debris that may have accumulated as a result of the wear and tear, including removing any spurs that interfere with normal motion, restore stability to the ankle by, in essence, tightening up the lateral soft tissue support and reinforcing the ligaments, then initiate a rehab plan. The more the range of motion approximates normal, and the more proper the mechanics are within the joint, the better likelihood the ankle responds as it should. Presuming Newton commits to the rehab plan and returns full strength to the ankle, his stability and agility should both improve and his pain should be resolved, meaning he may have an easier time moving nimbly about the field. Look out, NFC foes.

Recovery from surgery such as this -- assuming no surprises are discovered in the process -- can vary, but typically takes 12 to 16 weeks. There is no reason to rush a return to high-impact activity, since the goal is to ensure the joint heals properly. In fact, regaining full motion and strength are far more important in the early phase than full-speed running. While this timeline suggests Newton will miss OTAs and minicamp, it's not as if he won't be present, and he may be able to do a fair amount of work on the side. He may even be cleared for some level of throwing. By the time training camp rolls around, Newton should be able to be a full participant, even if his workload is increased in a gradual manner.

As far as developing rapport with his receivers, there have certainly been other quarterbacks (ahem, Peyton Manning) who have found time outside of structured team activities to gather with receivers and work out independently. Some would argue an enhanced relationship could be constructed under those conditions. If Newton is moving well in four months, he would have plenty of opportunity to do something similar; whether that happens or not is a different matter.

Given that Newton's ankle remained problematic weeks after the season came to a close, the decision to move forward with surgery makes sense. And who knows? By the time the season rolls around, the Panthers may not be the ones who are concerned about Newton's health.

It may be everyone else who has to face him.

On March 1, the Minnesota Twins announced that star infield prospect Miguel Sano would undergo Tommy John surgery to reconstruct a torn ulnar collateral ligament (UCL) in his right (throwing) elbow.

[+] EnlargeMiguel Sano
Kim Klement/USA TODAY SportsMiguel Sano hit 35 homers in the minors last season and was Keith Law's No. 8 prospect overall entering spring training.

Sano initially experienced pain in the elbow last October while playing in the Dominican Winter League and an evaluation revealed a partial tear. After consultation with the team’s medical staff coupled with a second opinion from Dr. James Andrews, Sano underwent a period of rest and rehabilitation. However, when the symptoms resurfaced during spring training, the decision was made to proceed with surgery. According to the Minneapolis Star Tribune, Sano is expected to undergo surgery within the next two weeks. Dr. David Altchek, team physician for the New York Mets, will perform the procedure at the Hospital for Special Surgery in New York.

Tommy John surgery is nothing new in baseball, but it is far more common in pitchers than position players. In fact, according to a recent survey of major league players who had undergone the procedure, only 17 percent were non-pitchers. Of all the infielders responding to the survey, less than 5 percent had a reconstructed UCL. In other words, the injury is not common in this demographic. Considering Sano is so young in his professional career, it begs the question as to why his ligament failed. While there is no way of knowing what all the contributing variables might be (including Sano’s specific medical history), most young position players who sustain such an injury have spent a fair amount of time pitching somewhere along the way.

The good news is that the success rate for the procedure remains high and, for position players, the recovery time is considerably shorter. Pitchers spend months re-introducing their body to the throwing motion and helping the arm adapt to various pitches, particularly breaking balls; position players do not have the same demands on their arm. As for the effects on a hitter, there is no data to suggest that reconstruction of the UCL has any impact on power, which is good news for Sano, the player’s Keith Law labeled “the best pure offensive prospect in the minors.” The biggest challenge in returning to full game play for a non-pitcher usually comes with making hard defensive throws, such as across the body from third to first.

As for Sano’s timetable, the typical recovery period for a position player ranges from eight to 12 months, compared to the 12 to 16 months usually required for a pitcher. If all goes well, Sano could begin hitting approximately 16 weeks post-surgery and he should have no trouble being ready for next spring. In fact, he could be ready sooner if there are no setbacks. With that in mind, the Twins are leaving open the possibility that Sano could serve as a DH in the latter part of the minor league season, allowing him to continue to develop his hitting.

The bottom line is while this injury represents a temporary setback for Sano and for those who were looking forward to seeing him play, it should be viewed as just that, temporary. As they say, good things come to those who wait.