Rough week-plus for Blue Jays' rotation

June, 19, 2012
6/19/12
5:46
PM ET
They say things happen in threes. If that's the case, then the Toronto Blue Jays should at least be granted a reprieve in the injury department after losing three members of their pitching staff in succession. The latest unfortunate news: Right-hander Kyle Drabek will undergo what will be his second Tommy John surgery in five years. Drabek, who had his first surgery while still a teenager (an unfortunate trend), recently experienced pain and a popping sensation in his elbow while throwing. Ultimately, the determination was that he was in need of a second surgery, and he will be operated on by Dr. James Andrews.

[+] EnlargeKyle Drabek
Getty ImagesYoung Blue Jays starter Kyle Drabek is headed for Tommy John surgery No. 2.
It's not hard to sympathize with Drabek as he received the bad news for the second time in his young career. "I was down, because they said they saw a little tear, and right when they said that, I flashed back to when I had it previously," Drabek told the National Post. "[I] hated going through it. You miss a year of baseball, you miss a year of hanging out with the guys."

As hard as it is to go through the process of Tommy John surgery and the subsequent lengthy recovery, imagine going through it twice. This year there have been a few notable pitchers who have undergone a second such procedure, including closers Joakim Soria and Brian Wilson. The outcome on second procedures is not nearly as encouraging as the outcome following an initial surgery, and starters seem to not fare as well as closers. On the bright side, Drabek is still just 24 years old, and youth is always a bonus when it comes to a long, intensive rehab. He also has a teammate, Jason Frasor, who has undergone Tommy John surgery twice and successfully returned to pitching. Frasor's second surgery was 10 years ago and he has done well since then, but -- and it's a significant "but," given the recent statistics -- Frasor has the advantage of being a relief pitcher. Maybe Drabek should chat with Dodgers pitcher Chris Capuano, one of the few starting pitchers who has successfully returned to the same workload following a second Tommy John surgery.

Meanwhile, Brandon Morrow, who we discussed last week when he went on the DL for an oblique strain, is still in the early phase of his rehabilitation efforts (typically about a month for pitchers). Drew Hutchison is out with an elbow strain, but it does not appear to be on par with Drabek's. Still, Hutchison is scheduled to consult with Dr. Tim Kremchek in Cincinnati for further evaluation.

The Jays have to be holding out hope that this sudden injury streak has truly come to an end.

Beachy's bad elbow

Atlanta Braves pitcher Brandon Beachy has a partial tear of his ulnar collateral ligament; this much we know. What is not yet known is what the next step is as far as treatment. Beachy, who currently leads the league with a 2.00 ERA, is scheduled to consult with both the Braves' team physician and Dr. James Andrews, after which those steps should be outlined.

The choices would seem to be either an attempted rehab course to see if Beachy can return to throwing, or reconstructive surgery. A partial tear does not automatically dictate surgery; the location and the degree of the tear can influence the ability of the tissue to heal. If a pitcher is anything less than convinced that he absolutely requires surgery, a course of rehab may be in order. If that rehab course is unsuccessful, the timetable for recovery has been pushed back only 6-8 weeks, not necessarily significant in the context of an approximate one-year recovery from surgery. That said, the timing within the season can play a role. A year from June allows for a likely return the following year. A year from August makes a return in the subsequent season a little less certain. These variables will undoubtedly be considered as Beachy proceeds through the evaluation process. Beachy is already on the DL, but an update to his status should be forthcoming this week.

Weaver returns

Last Tuesday, I noted the big step Jered Weaver had taken in his recovery as he began throwing from a mound. Only a week later, Weaver is set to return to competition. After progressing from throwing halfway up the mound to throwing from the rubber, Weaver had no complications, and he went on to throw a simulated game and a follow-up bullpen session.

Considering how serious his injury appeared to be when it happened less than a month ago, Weaver's return has been impressive. There are no guarantees that the issue is completely behind him, though, and Weaver appears wise to that fact. According to the Orange County Register, Weaver said, "I'm 6-foot-7 and lanky, and I have a lot of torque going on. I'm sure it's not the last time there's going to be some back issues going on." Apparently Weaver has now made some of his rehab exercises part of his regular routine. Both his recognition of the potential for symptom recurrence and his efforts to protect his back with a maintenance exercise program work in Weaver's favor from a prevention standpoint going forward.

Quick hits

[+] EnlargeEvan Longoria
AP Photo/Gene J. PuskarEvan Longoria is not quite ready to return from his hamstring injury.
• Just last week, Tampa Bay Rays third baseman Evan Longoria was expressing confidence about being able to rejoin his teammates this week. He is indeed rejoining them, but not in the capacity he had hoped. Longoria has been pulled from his rehab assignment after feeling soreness in his hamstring while running Monday and remains out indefinitely.

Before Longoria began his assignment, Rays manager Joe Maddon had hinted at a lengthier rehab stint to allow him to get his legs in game shape (and undoubtedly to provide multiple opportunities for him to really test the health of his hamstring). It took only two days for Longoria's hamstring to let him know it wasn't ready. According to the Tampa Bay Times, Longoria felt soreness running to first base and did not want to push the issue. He was removed from the game in the third inning, a wise move that might have protected him from truly aggravating the injury. He is set to rejoin the team Tuesday in Washington, D.C., where he will resume a rehabilitation program. As of now, there is no renewed timetable for his return. It has been said many times in this blog space, but it's worth saying again: Until an athlete returns to competition, there is no way to truly test the readiness of a healing hamstring. Consider this episode a gentle warning for Longoria issued by his hamstring, one that told him not to rush back. It might not be so kind to him the next time.

Colorado Rockies shortstop Troy Tulowitzki paid a visit to Dr. William Meyers in Philadelphia for further evaluation of his left-sided groin injury. Like Longoria, Tulowitzki had initiated a rehab assignment when he felt pain in the injured area, which prevented him from continuing. Meyers is considered a leading expert in the area of athletic pubalgia, or athletic injuries in the groin and abdominal region which result in pain and loss of function. These injuries are often grouped in the category of sports hernias, which are not true hernias, but rather defects in the abdominal wall that typically require surgery to repair. There are multiple potential causes of chronic groin pain (Tulowitzki's injury dates back to the start of the season), and a full evaluation by Meyers is aimed at getting to the root of the problem. Unfortunately, it sounds as though there are no definitive answers just yet. According to the Denver Post, Tulowitzki summed it up this way: "We're not sure what's wrong." For now, Tulowitzki remains sidelined, and there is no timeline to discuss until more information emerges.

• Minnesota Twins catcher Joe Mauer is day-to-day with a bruised quadriceps, the result of a Rickie Weeks knee to Mauer's thigh in a collision at home plate. Mauer was already dealing with soreness in the hamstring of the same leg, which he was playing through despite not being able to run at full speed. After injuries limited Mauer to just 82 games last year, his 2012 campaign was off to an impressive start. Before injuring his thumb in an at-bat, Mauer had played in 52 of 53 games. The thumb did not require a DL stint, but it did force him to sit four games. Then the sore hamstring came along. He didn't miss a game but served only as a pinch hitter this past Saturday. On Sunday, Mauer returned to his normal spot behind the plate, where he sustained the bruised quad. Mauer looks as though he will again avoid the DL, despite some lingering stiffness and soreness in the thigh. So far, so good.

• The Chicago Cubs have placed pitcher Ryan Dempster on the DL with tightness in the latissimus dorsi muscle on his right (throwing) side. He had been throwing well despite the presence of soreness in his past couple starts. "It's just gotten harder and harder to get loose and maintain," Dempster told reporters. This doesn't sound like a serious strain, such as the one sidelining Phillies ace Roy Halladay, but anything affecting a pitcher's throwing arm raises eyebrows. In Dempster's case, given the potential trade interest surrounding him, the topic becomes even more relevant. The best way to avoid a significant injury is to proactively address a minor ailment, and that seems to be what the Cubs are doing with Dempster. If a brief break from throwing allows the issue to resolve itself, there should not be any significant concern going forward.

[+] EnlargeChris Carpenter
Ronald C. Modra/Sports Imagery/Getty ImagesChris Carpenter is still a ways from returning, but at least he's making progress.
• The St. Louis Cardinals continue to have mixed news when it comes to injuries. Pitching ace Chris Carpenter is quietly making progress and could face live hitters as soon as this weekend, according to the St. Louis Post-Dispatch. Carpenter, who has been working his way back from a pinched nerve that was affecting his throwing arm, was able to throw some breaking pitches in his most recent side session. If he has another successful outing Wednesday, he could be cleared to throw batting practice a few days later. He still has a ways to go before he returns to competition -- multiple weeks, it would seem -- but even Carpenter acknowledged that progress is indeed being made. Nerve tissue has its own slow timetable for recovery, which makes it difficult for players and management to issue any sort of recovery projections. Functional progress is the best indicator that the tide is turning, and Carpenter's return to the mound certainly provides encouragement.

Meanwhile, teammate Matt Holliday has a sore hip flexor, per Joe Strauss of the St. Louis Post-Dispatch. Holliday left Sunday's game because of the injury, but this reportedly has been bothering him intermittently for several months, with this being the latest flare-up. While it doesn't appear as though he's headed to the DL just yet, this could affect his availability at least this week. Hip flexor strains can be difficult to completely resolve in-season so this is something that could continue to impact him on an intermittent basis. On a positive note, second baseman/centerfielder Skip Schumaker has been activated from the DL after missing time since late May because of a hamstring injury. The Cardinals' official Twitter site has announced that Schumaker is "uniformed" for Tuesday night's game in Detroit.

• One player who won't be active Tuesday night is Milwaukee Brewers ace Shaun Marcum. He has been scratched from his scheduled Tuesday start due to tightness in his throwing elbow. The Milwaukee Journal-Sentinel reports Marcum is going to be evaluated by Brewers team physician William Raasch, after which next steps will be determined. It is worth noting that Marcum underwent Tommy John surgery on this elbow in 2008.

• And finally, keep an eye on Arizona Diamondbacks shortstop Stephen Drew, who crossed a huge hurdle this past weekend in playing three consecutive rehab games. Drew, who suffered a severe ankle fracture last season, has been battling lingering soreness and stiffness in his surgically repaired ankle, which has prevented him, until now, from playing in back-to-back games. Diamondbacks manager Kirk Gibson has indicated Drew is gradually nearing a return, but as the Diamondbacks' official website reports, it might be in a part-time role. Although he is showing improvement functionally, he has not completely overcome some of the challenges associated with this type of injury, specifically the joint-related soreness that follows activity. "I don't think [when Drew returns] it will be as an everyday guy," Gibson said. "He'll have to be worked in and out of the lineup. We'll watch the whole thing with his recovery. There are going to be limitations if he comes back in the near future." Those limitations may well be the ingredient to getting -- and keeping -- Drew back with the team.

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