Pujols on DL with fractured left forearm

Is no one immune? The one they call "The Machine," the man who has appeared in more than 1,600 games since 2001, yes, he too is susceptible to "breaking" down. Literally. Albert Pujols, diagnosed Monday with a small fracture in his left forearm, will now join seven other teammates currently on the DL (including Adam Wainwright, who was lost before the season started to Tommy John surgery).

Here's what we've learned about his injury. The St. Louis Cardinals announced that Pujols is expected to be out four to six weeks with a small, non-displaced fracture in his left radius, the forearm bone which runs from the elbow to the wrist along the lateral or thumb side. The radius, along with the ulna (the other forearm bone, located on the medial or pinkie side), forms articulations with the small bones of the wrist (carpals). Pujols reportedly fractured the radius near the wrist (as opposed to higher up the forearm) and he is now in a splint to protect the bone as it heals. The Cardinals also indicated that tests of Pujols' sore left shoulder revealed no structural damage "at this time." The fact Pujols did not suffer a displaced fracture or a carpal dislocation requiring surgical intervention is a big relief.

Anyone who saw the video replay of the injury could tell it was significant when Pujols fell to the ground in pain. Not only is it exceptionally rare to see Pujols in that state, but the way his vulnerable outstretched left arm awkwardly absorbed the body blow from runner Wilson Betemit seemed to threaten his entire upper extremity. In fact, while Pujols' main concern was his wrist, which he was holding supportively with his right hand as he walked off the field (often a natural reaction in the case of a more severe injury), we later learned he also had pain in his left shoulder. Although it appears he escaped serious injury to his shoulder, as Pujols nears his return, this will be something to watch.

Naturally the question on everyone's mind however is: Will Pujols really be back in four to six weeks? As in back to smacking the ball out of the park, back to presenting a deep threat every time he steps up to the plate? No one can really answer that question, at least not without special powers to read into the future. But in terms of the actual injury, it's certainly reasonable to expect a small, non-displaced (bony ends remain in good alignment) crack to heal within a few weeks. It typically takes six weeks for a fracture to fully heal and the bone continues to remodel or reshape itself for even longer, but if there is evidence of good healing within a few weeks, an athlete will be allowed to progress his activities (think Josh Hamilton, who earlier this year was allowed to take swings sooner than expected as his non-displaced arm fracture healed nicely). That said, there is significant torsion through the wrists when swinging the bat, especially the mighty Albert Pujols swing, meaning the bone needs to be healing convincingly to return to that motion.

The biggest secondary consequences from an injury such as this result from immobilization. Immobilizing the wrist and forearm (why Pujols is in a splint) is necessary to allow the bone to heal. Motion introduced before adequate healing has taken place threatens to create a bigger crack or, in some cases, displace what starts out as a non-displaced injury. The downside of immobilization is that the soft tissue in the area (ligaments, muscles, tendon and connective tissue) gets stiff and atrophies. Anyone who has been in a cast for any period of time knows how unrecognizable the body part is once the cast is removed, after the muscle has withered away to a shadow of its former self. Regaining the range of motion in the joint and the strength in all the muscles that support the joint is often the more difficult part of the recovery. This aspect is more difficult, yet most critical in terms of an athlete regaining his form. Nowadays the goal is to introduce movement as quickly as possible while still respecting the healing time for the bone, in an effort to minimize those soft tissue changes. If Pujols' forearm shows good early healing, he will be moved along accordingly. This has to be what the Cardinals are hoping for more than anything: no delayed healing.

It would not be a huge surprise if the timetable for Pujols should become slightly extended or if he should show some rust when he first returns. But at the end of the day -- and it's been a long one in St. Louis -- the Cardinals have to be somewhat thankful because this injury and its consequences could have been far worse.