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Lee, Hudson, Santos, Dempster land on DL

4/23/2012

This weekend provided plenty of injury news worth discussing:

Santos has sore shoulder

On Friday, I noted that with five closers out due to injury, they could form an entire division. That division just expanded in size. As of Saturday, a sixth closer had been added to the DL but the hope is that it will be a short-term visit. Sergio Santos of the Toronto Blue Jays becomes the first of the group to go on the DL because of a shoulder issue.

According to the Blue Jays' website, Santos felt some tightness in his shoulder while pitching in Friday night's game. Although he was able to pitch through it and pick up the save, Santos felt worse when he woke up Saturday. Santos said he could feel "something wasn't quite right" during his outing Friday but when he woke up Saturday with the shoulder bothering him he decided to tell the team. "I came in and let the staff know," Santos said. "Their thought was let's get this over with and not have it drag on, so let's shut it down now and hope that we can catch it early."

Santos is an interesting case because he has only been pitching for a few years, as he converted from shortstop to pitcher while with the White Sox organization in 2009. While his shoulder should have less wear and tear than the shoulder of a lifetime pitcher, Santos has not had the benefit of developmental adaptations to throwing.

The Blue Jays are referring to his condition as shoulder inflammation, which sounds non-specific and not particularly serious. For the time being there is no specific timetable for Santos, but he will be evaluated further by Dr. Lewis Yocum on Monday. Francisco Cordero will serve as the closer while Santos is out.

Another abdominal injury for Lee

There were consequences after Cliff Lee's impressive, scoreless, 10-inning outing against the San Francisco Giants on Wednesday that he even tried to lobby to extend into the 11th. The Philadelphia Phillies' loss that night may have been the insult; however, Lee's subsequent oblique strain made it even worse. Lee was placed on the DL on Saturday with a left oblique strain, an injury with which he has become somewhat familiar. Lee has dealt with various abdominal injuries over the years, even starting his 2010 season on the DL for that reason. That injury was termed a lower abdominal strain and Lee, then with the Seattle Mariners, received a platelet-rich-plasma (PRP) injection to support the recovery process. Lee was able to rejoin the team in late April (about five weeks after the injury occurred) and held up the remainder of the year.

This February, Lee skipped a bullpen session after experiencing some abdominal soreness. Although he made it out to be no big deal at the time, Lee acknowledged to the Philadelphia Inquirer that his history was a factor in taking a day off. "In the past I've had ab strains and it was a little sore," Lee said, "so I decided to skip my bullpen, which is a minor deal and just basically play it safe at this point." That rest seemed to pay off as Lee was able to resume his normal throwing schedule later that week and, until Wednesday night, had been fine. The Inquirer reported Lee hurt himself in the 10th inning but he and Phillies general manager Ruben Amaro Jr. denied the lengthy outing played a role, citing higher pitch count outings in the past with no complications. (It's debatable whether throwing the same number of pitches in fewer innings results in the same physical demand as the 10 innings Lee delivered Wednesday night.)

Amaro also said this injury in the rib cage area is higher in the abdomen than Lee's prior injuries. Regardless of exactly where the injury is in the abdomen, the average oblique strain costs a pitcher 34.5 DL days as noted in a 20-year retrospective study of professional baseball players published this year in the American Journal of Sports Medicine. Given Lee's history of prior abdominal injuries, his age and the ease with which these injuries are aggravated, caution is certainly warranted. Although the team has indicated it does not expect Lee to miss more than a few starts, his return ultimately will be dictated by how quickly he heals and how soon he can return to throwing without any discomfort. The data on multiple pitchers over time -- which includes Lee's prior appearances on the DL with abdominal injuries -- speaks for itself, though. While an early return would be welcome, with the way Lee has been pitching, the Phillies undoubtedly would rather have him available for the bulk of the season than risk a chronic injury. He should not be counted on until late May.

D-backs' Hudson lands on DL

Daniel Hudson is joining Arizona Diamondbacks teammate Chris Young on the DL, also with a shoulder problem, albeit not the result of a crash into a wall. Hudson has been diagnosed with a shoulder impingement, really a fancy term for "pinching." A number of structures can become impinged in the shoulder of an overhead athlete, and the pain typically results from inflammation developing in and around the area. The narrow space at the top of the shoulder where several soft tissue structures pass underneath the bony projection of the shoulder blade (acromion) becomes even smaller during overhead motion. Thickening of the soft tissues and the presence of inflammation can further decrease the available space, creating even less room. Any friction or pinching (impingement) can create pain. The initial goals are aimed at decreasing the pain and inflammation by eliminating the painful motion (shutting down the thrower). Treatment can include anti-inflammatory medication along with physical therapy directed at pain relief along with exercises targeted at reinforcing proper muscular balance around the shoulder. Sometimes cortisone injections are indicated.

Hudson underwent an MRI which did not reveal any specific structural damage, according to manager Kirk Gibson. The goal is to prevent this from becoming a bigger issue for Hudson by not having him press through a painful shoulder. At this point it is too soon to know if he will require more time than the minimum 15 days.

Odd injury for Dempster

Here's one you don't see every day. A pitcher has been placed on the DL because of a quadriceps injury. Ryan Dempster strained his right quad (the large muscle on the front of the thigh) while throwing a bullpen and is still experiencing soreness. Dempster is not a complete stranger to unusual injuries. Remember back in 2009 when he inadvertently broke his right big toe while climbing over the dugout railing? This latest injury doesn't fall quite in that category, but it is atypical for a pitcher, where we're more accustomed to seeing injuries of the shoulder, elbow or oblique variety.

According to the Chicago Cubs' website, Dempster's DL stint was backdated to April 18, and he is expected to miss only two starts. In other words, the good news is this strain is considered mild, and Dempster is expected to return when eligible in early May.

Beltre's hamstring again

Last July, Adrian Beltre had a left hamstring injury that cost him 37 games, but according to ESPNDallas.com, he says this one isn't as severe. "I don't think it's quite as bad as last year," Beltre said. "It didn't grab me that much. I don't think it's that bad. Hopefully, that's the case."

Beltre, who left Saturday's game early with the injury, is scheduled for an MRI on Monday. Regardless of how significant the actual injury is, the concern it raises going forward is legitimate, given the 33-year-old Beltre's history.