Updates on Carpenter, Nady and others

It's a busy, busy week in the world of sports. The playoffs have started in the NBA and NHL, the NFL draft is upon us and baseball is in full swing all around the country.

What strikes me is that the injuries just seem to keep on coming. Some teams are already looking at possible personnel moves simply to accommodate the rash of injuries they have already sustained. And it's only April!

On that note, here's who we're focusing on this week in the world of baseball injuries ...

Chris Carpenter, P, Cardinals: It was just a short time ago when we were celebrating Carpenter's return to the mound after virtually two years of absence due to injury. The celebration was short-lived when Carpenter was again forced to the DL, this time as the result of an oblique strain. The St. Louis-Dispatch reports that an MRI confirmed Carpenter injured a left oblique muscle, and as a right-handed thrower, this is the most commonly observed pattern (opposite side of the throwing arm). The less common aspect of his injury is that he sustained it while batting. Certainly power hitters are known to suffer oblique injuries, but no one would accuse Carpenter of being a power hitter. Pitchers, who rely on their oblique muscles to help generate the torque required to deliver the ball, often sustain the injury during throwing.

Nonetheless, whether the injury is sustained during batting or throwing, the rehab remains essentially the same. On average, an oblique injury is a six-week injury for a pitcher. In Carpenter's case, given his extensive injury history to his throwing arm, there will be no rushing his return. Any weakness in his trunk could result in compensations in his throwing arm, putting him at risk for injury. Expect Carpenter to be out for two months, but expect him to come back strong once he's ready.

Daisuke Matsuzaka, P, Red Sox: Arm fatigue? OK, so it's not a fancy medical diagnosis. But it does a pretty good job of accurately conveying the nature of the problem. Officially termed a shoulder strain by the Red Sox, his ailment manifested itself as a lack of control and command. Based on his recent struggles, the Red Sox wisely chose to place him on the DL to allow his arm some rest, perhaps pre-empting a more serious problem down the line.

Fatigue often leads to a change in mechanics as pitchers try to compensate for less power by an alteration in their delivery. Even subtle changes, over time, can lead to significant injury. Rest now, followed by a gradual, progressive return to throwing, should allow Matsuzaka to work his way back to his normal self within a relatively short time frame. Had he tried to press through this, it might have ultimately translated into a more prolonged absence.

The good news is the Boston Globe is reporting that Matsuzaka has been cleared to begin light throwing (think: playing catch), signaling that his arm felt good enough that very little down time was required. He will work through a typical throwing progression, but barring any setbacks, he should not be absent for a protracted period.

Jed Lowrie, SS, Red Sox: Last week we talked about Lowrie's ailing wrist and the unknown path ahead. After multiple consultations, with the final stop taking him to Dr. Donald Sheridan in Arizona, Lowrie's fate has finally been decided. He opted to undergo arthroscopic surgery Tuesday to address his wrist problem. According to the Boston Herald, Lowrie's procedure involved removal of the ulnar styloid, a projection of bone at the tip of the ulna (the forearm bone that runs from the elbow to the pinky side of the hand). Lowrie told the Herald that he is scheduled to return in six to eight weeks.

The concern with any wrist surgery is not just how long it will take a player to get back into the game, but how long it will truly take for him to return to form, particularly at the plate. It is not uncommon to see hitters struggle to regain their power following a wrist injury. Lowrie fans and fantasy owners will want to plan on having insurance for three months. Meanwhile Julio Lugo, recovering from meniscal surgery, is beginning a rehab assignment at Triple-A Pawtucket on Tuesday. According to the Red Sox's official Web site, he could return within another week or so. Keep in mind that the Red Sox will not rush him simply because Lowrie is out and Lugo is still having some soreness in the knee. Best to plan on at least two weeks for Lugo's return to the lineup.

Alex Gordon, 3B, Royals: It seems like the injury du jour for third basemen is hip labral tears. Mike Lowell started the trend with his injury last season. Alex Rodriguez, who underwent hip labral surgery in early March, is perhaps the biggest celebrity of the group. Gordon is the latest addition to the list.

The Kansas City Star reported that Gordon first felt "tightness" in the hip on Opening Day. Earlier reports suggested that he first injured his hip sliding into second base a week ago, then further aggravated it during an at-bat. Either way, the limitations in his hip appeared to be impacting him at the plate. Gordon had his hip operated on Friday by Dr. Marc Philippon, the same surgeon who operated on Rodriguez. According to the Royals, Gordon is expected to miss anywhere from 10 to 12 weeks. This timetable suggests that the labral repair was the primary issue and that he did not require extensive bone work (like Lowell for instance, who had a rehab timetable that extended for several months).

The good news for the Royals here is that Gordon is young and healthy, which should aid in his recovery. Given his timetable, expect to see him back in the lineup just after the All-Star break.

Vladimir Guerrero, OF, Angels: What was initially described as a pectoral muscle strain (suggesting minor tissue damage) turned into a more serious torn pectoral muscle (suggesting more extensive bleeding and soft tissue injury), landing Guerrero on the DL for at least a month. According to the Los Angeles Times, he may not even return to the outfield once he's eligible to rejoin the lineup. Instead, the Angels may opt to keep him in a designated hitter role.

The risk with any muscle tear is that a return too soon will result in reinjury, perhaps even more serious than the first time around. Depending on the location and extent of Guerrero's tear, the Angels could be concerned that further damage could lead to a surgical situation. He has said that the injury does not affect his swing, but the concern for further injury is likely the reason Guerrero is being forced to completely rest at this time.

Muscle tears can vary widely in terms of healing time, so it is very difficult to project a true timetable from afar. The level of the Angels' concern, though, reflects the seriousness of Guerrero's injury. Fantasy owners should make alternate plans knowing that his return is up in the air.

Xavier Nady, OF, Yankees: It's not as bad as it could have been. That's what the Yankees are saying now that it appears Nady will not undergo what would have been his second Tommy John surgery on his right elbow. The outfielder first underwent an ulnar collateral ligament (UCL) reconstruction in 2001 and was clearly able to enjoy a successful return to baseball. The joy of embarking on a new season in a new stadium was brought to a crashing halt last week, however, when Nady experienced sharp pain in his right elbow while making a throw.

It had all the makings of an UCL tear, and a second surgery seemed imminent. There was definitely cause for concern, since a return to baseball following a second UCL reconstruction has a much lower success rate than the return following a first-time procedure. Team physician Chris Ahmad performed various studies to image the soft tissue and the bone, and consulted with Dr. Lewis Yocum, who performed Nady's original surgery. The decision about how to proceed provided some good news for Nady and the Yankees.

According to the New York Post, Nady does have a partial tear of the ligament, but the decision has been made to have Nady undergo a course of conservative rehab instead of heading under the knife again. Given the lengthy rehab following surgery and the low success rate, this is a very reasonable course of action. After all, consider that the Angels' Ervin Santana is working on returning to pitching despite the presence of a partial tear in his UCL.

Nady is not a pitcher, so the demands on his arm are significantly less, and the Yankees do have the option of bringing him back as a DH initially while he works his way back to the outfield. Also, the presence of scar tissue in his elbow that has built up since his first UCL surgery might help provide some additional stability to the joint despite a tear in the ligament itself. Whether Nady can successfully return remains to be seen, and it will be at least a month before that happens, but at least he and his teammates can hold out some hope that he will be able to test out the new stadium after all.

On the mend

Despite the increasing body count on the DL of late, there is reason for a number of teams to be smiling this week. A number of players who started their season on the DL are seeing the light at the end of the rehab tunnel, with return dates to their major league lineups fast approaching.

In Milwaukee, the Brewers hope to have closer Trevor Hoffman back by the end of the week. Hoffman, who began the season on the DL because of an oblique strain, pitched for Triple-A Nashville on Tuesday, with no ill effects. He will throw one more rehab outing before rejoining the Brewers. There is always a risk for recurrence with oblique injuries, but Hoffman has been brought back slowly, and the fact he is a closer and throws fewer pitches per outing works in his favor. Despite his age and injury, I'm optimistic about Hoffman once he returns.

The Minnesota Twins have been quietly keeping their fingers crossed as catcher Joe Mauer passes incremental tests in his rehabilitation from an inflamed sacroiliac joint. The one thing Mauer couldn't do in spring training was run because it was simply too painful. After several months of non-impact training on an elliptical machine and a stationary bike, along with new medication, Mauer was finally given clearance to test his back with light running. He was able to run for consecutive days and was then cleared to begin running the bases. After successfully passing those tests and, perhaps more importantly, feeling well the day after running, Mauer was cleared to play in a simulated game, which he did Monday. That was the first game situation he had been in since the end of last season. The Minnesota Star-Tribune reports that Mauer will head to Class A Fort Myers on Friday for approximately six games. The goal now is to build up Mauer's endurance to ready him for a return to major league action.

So far this is good news for Mauer; the primary things that were limiting him (most notably running) appear to not be hindering him at all right now. But keep in mind that his activity has still been very controlled. And it is still somewhat of a mystery why he developed inflammation in the sacroiliac area, a highly unusual injury for a baseball player. The true proof that he is beyond this episode will be when he can last the season without any recurrence of symptoms. Until then, there will always be some concern as to whether the issue has truly been resolved or has just subsided for a period of time as a result of less activity.

Brandon Webb has started throwing again, making the Arizona Diamondbacks and his fantasy owners very happy. Webb was placed on the DL on April 13 because of shoulder bursitis. Webb had reported some stiffness in his shoulder, and the team opted to proactively rest him to prevent it from turning into a more serious situation. The news on Webb has been good so far, and despite the workload he has turned in over the past few years, I am not any more concerned about Webb's shoulder than that of any other pitcher. His next test likely will come Friday, when, according to the Diamondbacks' Web site, Webb will throw another bullpen session, perhaps incorporating inning breaks to see how his shoulder responds to periods of rest between throwing.

Tampa Bay's Jason Isringhausen threw two innings in an extended spring training game Saturday, followed by an outing for Double-A Montgomery on Monday. Izzy has dealt with injuries to his hip in the past and is now returning from surgery to repair a torn flexor tendon in his forearm. Look for him to potentially contribute to the Rays' bullpen by June. Despite his injury history, Isringhausen still has something to contribute, and the flexor tendon surgery he had is not nearly as serious as ulnar collateral ligament reconstruction. He will no doubt come in under the radar but could be a valuable addition.

The Angels have been hit hard by injuries, most dramatically in their pitching staff. The loss of Nick Adenhart stands alone. Three other aces were ailing to start the season, however, and all three are working toward a return. Kelvim Escobar, who was far ahead of schedule in his return from labral surgery, had a minor setback. But he is playing catch again and should be back on a more-significant throwing progression soon.

Meanwhile Ervin Santana, who has a partially torn UCL, has been able to throw his full complement of pitches in bullpen sessions. Santana's program is very structured and gradual, because the fact remains that he has tissue damage, and the team wants to bring him along slowly. So far, he has passed every test. Although the signs are encouraging, especially the fact Santana is reporting no pain, he still has some big hurdles to pass to return to major league action.

John Lackey, who started the season with inflammation in his throwing elbow, has been able to throw all of his pitches in bullpen sessions. Lackey told the Los Angeles Times that he still is "feeling something" in his elbow but feels he needs to push through it. He is expected to throw a simulated game Wednesday, and the Times notes he could begin a minor league assignment later this week. Lackey and Santana could rejoin the team at some point in May if their progressions continue well. I would not be surprised to see Lackey first, while Santana might be held out a little longer.

Last but not least, Royals outfielder Jose Guillen, who reluctantly went on the DL because of a hip flexor injury earlier this month, plans to rejoin the lineup when eligible Saturday. He told the Kansas City Star, "I'll be ready." This injury did not appear serious when it happened so I'm inclined to agree with Guillen's assessment.