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Monday, May 7, 2012
Werth likely out 12 weeks with broken wrist

By Stephania Bell



Just as the Washington Nationals prepare to welcome third baseman Ryan Zimmerman off the DL (he is expected to return Tuesday after an episode of inflammation in his AC joint), they lose yet another starter to injury ... for months. Outfielder Jayson Werth was attempting to make a sliding catch Sunday night when his glove caught in the grass, forcing his left wrist backward into hyperextension. The added load as his body weight came down through his forearm contributed to the immediate fracture of Werth's left radius, the forearm bone on the thumb side that forms part of the wrist joint.

Jayson Werth
Jayson Werth may not be back until well into August.
Not only is a fall on an outstretched hand the most common mechanism for a radius fracture, the instinctive response of Werth to cradle his left arm against his body as his right hand supported his forearm bones at the wrist is a classic reaction to a break. Still, given Werth's left wrist injury history and the many possible outcomes after such an impact, the specifics of his injury could not be presumed by watching the video. The only takeaway was that this was unquestionably a serious injury that dealt Werth a painful blow.

MLB.com reported Monday that Werth underwent surgery to stabilize the fractured radius and the timetable has initially been presented as at least 12 weeks. Standard repair of distal (meaning near the wrist, as opposed to proximal or near the elbow) radial fractures involves implantation of hardware such as a plate and screws to help position the bone for optimal healing. Consider six weeks for the bone to heal, if all goes well, followed by a gradual return to activity as range of motion and strength permit. Ultimately a rehab assignment will be in order prior to Werth rejoining his team. One of the biggest challenges following this type of injury is regaining normal range of motion following the requisite period of immobilization. The initial timetable of three months is reasonable but certainly could be modified along the way depending upon how Werth is progressing. A sooner return is highly unlikely. A lengthier absence is entirely possible.

Werth's prior wrist history, which began when he was hit by a pitch while with the Los Angeles Dodgers in 2005 and eventually resulted in a 2006 surgical procedure by Dr. Richard Berger at the Mayo Clinic (the same surgeon who performed Monday's surgery, according to the Nationals) to repair a split tear of Werth's ulnotriquetral ligament, is not without importance here. While this latest injury is on the opposite (thumb) side of Werth's wrist, the wrist complex (which includes the two forearm bones-- the radius and the ulna -- their articulations with the eight small carpal bones that form the wrist and the articulations of the carpals with the metacarpals -- long bones of the hand) is precisely that, complex. Superimposing a major injury on an area that has already suffered an injury can be problematic. Although Werth clearly returned to an elite functional level from that initial injury, any alterations in his wrist motion or mechanics, however minor, can present additional challenges with a second injury in the region. Certainly Werth has to feel more comfortable with Berger performing this latest surgery, given his specific familiarity with Werth's wrist. And this is not to say Werth can't make a complete recovery; the expectation, based on the limited available information, is that he can and will. But it won't be fun.

Gonzalez tears ACL


Shortstop Alex Gonzalez has now become part of an unusual club among Milwaukee Brewers, a club whose members are relatively few but one to which no one seeks membership. That would be the torn-ACL club, and Gonzalez will join recently inducted first baseman Mat Gamel as this year's dubious honorees. Pitcher Yovani Gallardo tore his ACL back in 2008, an injury made even rarer by the fact he is a pitcher. Torn ACLs aren't as common in baseball as they appear to be in some other sports, although the potential for occurrence in any athletic endeavor always exists. Apparently this is something the Brewers know all too well.

The two infielders tore their right knee ligaments within the same week but under completely different circumstances. Gamel tore his ACL when he crashed into a wall Tuesday in Petco Park while attempting to make a play on a foul ball. Gonzalez was stealing second in Saturday's game against the San Francisco Giants when an awkward slide did the damage. Gonzalez is in the standard pre-surgery waiting period, but as the Milwaukee Journal-Sentinel reports, general manager Gordon Ash confirmed the end of his season, saying, "Alex is going to have surgery. It's just a matter of who is going to perform it." The rehabilitation program following ACL reconstruction is well established and both players should be physically capable of returning to their sport. The disadvantage for the 35-year-old Gonzalez, however, is that he was playing on a one-year deal with the Brewers. His options may be determined, in part, by how he progresses through this rehab.



Quick Hits


• And stop me if you've heard this one before. Pitcher Huston Street, no stranger to the DL, has made his first visit of 2012, this time for a strained latissimus dorsi (commonly referred to as "lat") muscle, injured during a Friday night appearance. While manager Bud Black told reporters he didn't think it was anything that would require surgery, that's not necessarily revealing since most lat injuries don't. The lat is critical to shoulder function, however, and time out can range from weeks to months, depending on severity. As of now, there is no timetable for Street.

Cory Luebke
Cory Luebke, a popular sleeper pick entering the season, has a 3-1 record with a 2.61 ERA.
• Street's teammate Cory Luebke is out indefinitely with an elbow issue. An MRI reportedly showed damage to his ulnar collateral ligament (UCL) and his flexor tendon along with fluid in the area. Luebke says he is waiting for the inflammation to settle before making a decision. When it comes to deciding about what would be Tommy John surgery for Luebke, it's critical that the player come to that decision fully invested and without question. The rehab is incredibly long and demanding, and surgeons will often say they want the athlete to essentially come to his own decision that surgery is the only option. This is one reason athletes will sometimes take a few weeks of rest, then try to throw again to see how the elbow responds. If it fails to perform, the choice becomes clearer. And so we wait.

• There is some good news, though. Detroit Tigers pitcher Doug Fister will start Monday night in his return from a costochondral strain. After an impressive rehab outing last week, he should be good to go. As noted above, Nationals third baseman Ryan Zimmerman is expected to be back in the starting lineup Tuesday. Zimmerman has been hitting the past few days without pain -- something he could not do initially -- and barring a setback should be ready after a team day off Monday. And Philadelphia Phillies ace Cliff Lee is expected to rejoin the rotation Wednesday, as he returns from an oblique strain. While Lee was not able to come back at 15 days as he originally hoped, he certainly beat the average number of days absent for pitchers with oblique injuries. Perhaps the fact it was a low-grade injury coupled with Lee's experience in dealing with some variant of abdominal issue over the past few seasons has helped him move through the process more quickly. Two pain-free bullpens have Lee convinced he's ready. Believe him.