Bailey, Farnsworth latest closers to go down

Less than two weeks ago, we were lamenting the early loss of two closers to Tommy John surgery: the Cincinnati Reds' Ryan Madson and the Kansas City Royals' Joakim Soria (the second in his career). While Soria and Madson are done for the year, Washington Nationals closer Drew Storen is not, but he will be starting the season on the disabled list due to soreness in his throwing elbow. (Storen underwent an MRI in late March which showed inflammation but no definitive damage to his ulnar collateral ligament, or UCL. He is hoping for a mid-April return.)

Now there are two more closers to add to the list of the walking wounded. Andrew Bailey of the Boston Red Sox will undergo surgery to repair a torn UCL in his thumb (yes, a thumb ligament which goes by the same name as the one in the elbow) and is expected to miss several months. Kyle Farnsworth of the Tampa Bay Rays is hoping to miss significantly less time than Bailey, but he will at least start the season on the DL because of soreness in his throwing elbow.

The news on Bailey seemed to come out of nowhere since there was no prior report of a specific injury to Bailey's thumb. 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 result in pain and swelling, and a complete tear typically results in significant instability of the thumb joint.

For baseball players, most thumb UCL injuries happen as a result of trauma, usually after landing on an outstretched thumb that is forced away from the rest of the hand, overstretching the ligament, as often happens during a headfirst slide when a player hooks his thumb on the bag. Jason Heyward sprained the UCL in his thumb in exactly this manner in 2010. The damage wasn't sufficient enough to warrant surgery, but did end up costing him an appearance in the All-Star Game and a stint on the DL to allow the ligament to heal. Philadelphia Phillies second baseman Chase Utley also injured his UCL on a headfirst slide in 2010, completely tearing the ligament, which required surgery. As for Bailey, it turns out there was a fall on his thumb earlier this spring. "We think it was suffered when he was in a collision in Bradenton," said Red Sox general manager Ben Cherington. "He was covering first and collided with Alex Presley and fell." Although Bailey didn't pay much attention to it at the time, as the soreness persisted, the most likely culprit appeared to be that particular play.

Three months is often given as the standard time to clear an athlete to return to activity following UCL surgery, although the details of the injury and the specifics of the surgery can impact the overall time frame, as does the individual's ability to heal. Utley, for instance, returned at just less than seven weeks post-surgery. Beyond factoring in the impact of the injury and the surgery, one has to consider the requirements of the position. Since Bailey is a pitcher, the demands on his thumb are high for every single pitch he makes. He must have adequate mobility within the joint and enough strength in the muscles around it to effectively control delivery of the ball. Before he can return to pitching, Bailey must also rebuild the arm strength he will have lost following the downtime associated with the injury. Throw into the mix Bailey's injury history (latissimus muscle strain this spring, forearm and elbow issues in the past two years) and the Red Sox will want to make every effort to ensure he is not rushed back into service prematurely. At this point, the team does not anticipate a return prior to the All-Star break.

In the case of Farnsworth, there is nothing as dire as surgery on the horizon -- at least not yet -- but he was scratched from a Tuesday relief appearance because of the elbow. It is expected that Farnsworth will be placed on the DL to start the season after recurrent soreness in his elbow dating back to last year. Farnsworth was scheduled to see team physician Dr. Koko Eaton on Tuesday, according to the Tampa Bay Times, but there has been no word yet about the outcome. The Times hints at a timetable of at least a month, perhaps longer if Farnsworth fails to improve. At 35 years old, with a lengthy pitching career and several episodes of elbow soreness in the background, there is legitimate reason to be concerned as to how significant this setback is, particularly coming on the heels of an offseason of rest.

As for who will be replacing these injured players, the answers are not altogether clear. In Cincinnati, the Reds have indicated Sean Marshall will get the nod. Royals manager Ned Yost has not named an official closer, according to the Kansas City Star, but Jonathan Broxton (formerly of the Los Angeles Dodgers), Greg Holland and Aaron Crow are all in the mix. In Boston, Alfredo Aceves will get the first shot at saves, followed by Mark Melancon. In Washington, the duties could be shared by Brad Lidge and Henry Rodriguez for the Nationals, and in Tampa, Rays manager Joe Maddon has hinted at a plan to go closer by committee.

For more on replacement suggestions, check out Eric Karabell's blog.

In the meantime, can we just get the season under way before any more closers hit the skids?