And just when no one thought it could get any worse for the Mets ... Johan Santana is now done for the season. Let's get right down to business:
Johan Santana, SP, Mets: Despite the trauma of losing yet another player to the DL -- and in this case, it's a definitive season-ender -- it appears to be overall relatively good news for Santana and the Mets. Santana, whose left (throwing) elbow has been bothering him for quite some time, will not be undergoing Tommy John ligament reconstruction, which would keep him out for most of next season. Instead he will undergo a far less extensive procedure to remove bone chips and should be ready for spring training in 2010. But this is not a cut-and-dried situation.
The presence of bone spurs can be suggestive of subtle instability in the elbow. The spurs themselves form in response to stress within the joint. They can become painful and limit motion. They can also fragment and form chips or loose bodies. Removing the spurs or chips can help reduce pain and restore motion. There is some speculation, though, that the spurs provide additional stability, and that once removed, the increased motion in the elbow could place additional strain on the all-important ulnar collateral (Tommy John) ligament. Cardinals ace Chris Carpenter had bone spurs removed in 2007, only to end up having Tommy John surgery a few months later. Of course, there are other pitchers who have gone on to pitch successfully after bone spur/chip removal.
One of the advantages of doing the scope is that the surgeon will be able to visually inspect the ligament to see just how healthy it is at this point. Occasionally, during surgery the ligament is shown to be torn, despite not being visible on MRI, and then a reconstruction would be in order. Surely the Mets are not even considering that as a possible outcome because it might just be too much to take. The more likely scenario is that some stretching or fraying of the ligament might be evident, which would be expected in a veteran pitcher, and although it provides some information, it doesn't really change the next steps. In this case, the bone chips are removed, the athlete will undergo rehabilitation and everyone remains hopeful that there will be no further issues.
The Mets have to be hoping this arthroscopic procedure will be the only one Santana will need.
Jake Peavy, SP, White Sox: Peavy had a very scary moment in what the team was hoping would be his final rehab start. Peavy, who has been working his way back from a partially torn posterior tibial tendon in his right lower leg, was hit in his throwing elbow by a line drive Monday night. He managed to stay in the game to throw out the next batter he faced and close out the fifth inning (which was the scheduled length of his appearance), but the elbow swelled as the night went on.
Peavy has since joined the White Sox, but whether he makes a start for them this week or not will depend on how the elbow responds. Until the blow to the elbow, Peavy appeared to be in line to start for the White Sox Saturday at Yankee Stadium. "Every part of me wants to be out there Saturday in a great venue against a great team, giving my team a chance to win," Peavy told the Chicago Sun-Times on Tuesday. In the whole scheme of things, this appears to be a minor road bump that shouldn't interfere much, if at all, with his ultimate return. Most importantly, he does not appear to have any residual issues with the ankle and has looked strong in his rehab outings.
Freddy Sanchez, 2B, Giants: Although the decision to place Sanchez on the DL because of his sore left shoulder might concern fantasy owners, it's worth noting that this move is retroactive to Aug. 18. If Sanchez can come off the DL when eligible, he could rejoin his team during the series in Philadelphia.
Sanchez originally strained the shoulder two weeks ago while swinging. He returned for a couple games, but the soreness persisted, forcing him out of the lineup for six games before he was ultimately placed on the DL. The good news is that this is not the same shoulder that gave Sanchez trouble last year. It is also not his throwing shoulder. The main issue with his inflamed left shoulder is that it hinders his ability to swing the bat. As long as it is just inflammation -- there is no reason to think otherwise at this point -- Sanchez should be able to work his way back following the 15-day DL period.
Alfonso Soriano, OF, Cubs: The Cubs' injury concerns have been overshadowed by the Mets', but the Cubs have had their share of troubles. This time it's Soriano, who faces a possible trip to the DL for an ailing knee. Soriano's left knee has apparently been bothering him since he collided with the outfield wall in late April. According to the Chicago Sun-Times, Soriano says he has been told that he has tendinitis, although it's worth noting that trauma is not the most common mechanism of the onset of tendinitis. It's possible, though, that trying to play through pain could create a chronic inflammation of soft tissue in the area, which might be one reason Soriano could head to the DL for some forced rest.
The Sun-Times reports that Soriano was planning to see the doctor and anticipated a possible MRI. He says he's experiencing pain when he has to run or unexpectedly put weight on the leg, neither of which is avoidable while playing his position. While it's unclear just how much time he might miss, if any, knowing that Soriano has a history of leg muscle strains that have kept him out for extended periods is definitely a concern. Fantasy owners should get insurance now, just in case.
On the Mend
• Diamondbacks outfielder Justin Upton appears to be swinging the bat quite nicely, thank you. Recovering from a right oblique strain, Upton played in his second rehab game Tuesday and delivered a grand slam. It sounds like the oblique is no longer an issue and he should rejoin the team within days.
• Mariners outfielder Ichiro Suzuki, known for his durability, is sitting out for a few days with a calf strain. Although the Mariners initially thought he would return Wednesday, it appears that they will hold off a little longer. This should not be interpreted as anything other than the team's taking a cautious approach with one of its stars. We have seen other players try to test their calf (Lance Berkman comes to mind) only to find out that trying to push off while running sets them back. The Mariners would hate to see Ichiro's tightness turn into a more serious muscle tear. That said, it appears he will avoid a DL stint and will return late this week. Fantasy owners may want to see how he looks in his first outing back to ensure he's up to speed before returning him to the lineup.
• Here's something new! I'm going to use the words "good news" and "Mets" in the same sentence. The good news for the Mets is that third baseman David Wright, who took a scary pitch to the head and suffered a concussion, has been able to increase his activity. This is a good sign because there are certain targets a player has to meet in order to begin physical exertion following a brain injury. According to the Daily News, Wright has been able to do some light running and is hopeful to come off the DL when eligible next week. There is still more that he needs to do, but the fact that he has been able to progress to running is extremely positive. Meanwhile, the Daily News reports that Wright's teammate Carlos Beltran, still recovering from a bone bruise in his knee, has had no pain with outfield running but has not yet been cleared to run the bases. Call me skeptical, but I'm still not convinced that we will see him back this season, despite his desire to return.
• According to the Rockies' official Web site, there is reason to be relieved about Aaron Cook's shoulder: An MRI showed no major structural damage. With the team flying high and Cook being critical to their rotation, the news that he could return to help his team down the stretch is encouraging. The plan is to allow him to rest his throwing arm while undergoing treatment, and then gradually resume a throwing program next week as his symptoms permit. As we all know, throwing shoulders can be unpredictable, but so far this looks good for the Rockies.
• And finally, it looks as if Red Sox pitcher Daisuke Matsuzaka is making the case for a return early next month. His most recent rehab start had him throwing three innings, and the Red Sox staff is happy with what they're seeing. Manager Terry Francona seemed to be absolutely glowing when he told the Boston Globe, "The last two months have gone, in my opinion, as good as possibly expected. He's not only met, but exceeded, every milestone that's been put in front of him." Matsuzaka has been out with a shoulder strain after having arm fatigue near the very start of the season. Bringing him back slowly may well pay off in the late season for the Red Sox, as Matsuzaka may have avoided a more significant injury. Fantasy owners in a playoff run may be able to take advantage here.