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Monday, May 2, 2011
Zimmerman, Freese, Sandoval face surgery

By Stephania Bell

Suffice it to say it's been a tough few days for third basemen, and for fantasy owners trying to fill that gap in their lineup. Just when one comes back (Evan Longoria is set to return to the Tampa Bay Rays lineup Tuesday), several more are lost to injury. Like Longoria, fellow third basemen Ryan Zimmerman, Pablo Sandoval and David Freese are all expected to miss extensive time. Here's what we're hearing about the recent trifecta of hot corner injuries as we roll into May.

What looked to be a short disabled-list stint is turning into an extended absence for Ryan Zimmerman.
• Of the three, perhaps the bad news on Zimmerman's injury status was the easiest to see coming. After all, Zimmerman was already on the DL with an abdominal strain and was clearly not near ready to come off it when eligible last week. After seeking a second opinion from Dr. Bill Meyers, one of the true pioneers when it comes to this cluster of abdominal/pelvic injuries and surgical repair, Zimmerman learned that his condition would require surgery and an absence of at least another six weeks.

Zimmerman will have surgery Tuesday to repair a torn abdominal muscle. According to the Washington Post, Zimmerman has a rectus abdominis tear. The rectus, as it is often referred to, is the muscle group that forms the dramatic "six-pack" on folks who are in impressive shape. The tendon of the rectus attaches at the pubic bone (located at the center of the pelvis where the abdomen meets the groin). Tearing of this tissue near its attachment point makes any attempt at power movement from the pelvis or the trunk weak and painful. This explains why Zimmerman could not throw or run effectively as he tried to work his way back from the initial injury.

To recap, Zimmerman initially suffered a minor strain during spring training. Little more than a week into the start of the season Zimmerman severely aggravated the injury on a headfirst slide into second base. Days later he was placed on the DL and he has been there since. The severity of these injuries is often difficult to determine at the outset. Failure to recover with conservative treatment often ends up being one of the best indicators for surgery. Imaging tests are useful for ruling out more sinister problems, such as tumors or fractures, but are often not definitive when it comes to determining the need for soft tissue surgical repairs. As Zimmerman acknowledged, despite the disappointment of now finding he will miss even more time, he has not second-guessed the process. According to the Post, Zimmerman said, "Surgery is always the last thing. It's the last resort every time. You want to rehab it, and we gave it that chance."

The success rate following this type of surgery is high. The key initially is to allow scar tissue to form, which stabilizes the area, and the athlete is then brought along gradually as comfort allows to regain strength and power. The average timetable is six weeks but can vary depending on the extent of the procedure and the individual athlete's healing process. Nationals general manager Mike Rizzo told the Post they hope to have Zimmerman back in six weeks, "if all goes well." For what it's worth, St. Louis Cardinals infielder Nick Punto underwent a similar procedure in late February and was recently activated at just less than eight weeks post-surgery. No one should mark the return date for Zimmerman in stone just yet.

• Speaking of the Cardinals, they also saw third baseman David Freese go down this weekend after he was hit on the left hand Sunday by an inside fastball. It now appears that Freese's absence will be lengthy. writer B.J. Rains reported via Twitter that Cardinals general manager John Mozeliak has indicated that Freese will be out 9-12 weeks. While disappointing, the news that Freese will undergo surgery is not a huge surprise. Freese's immediate pain upon being struck conveyed the seriousness of the injury, and X-rays onsite confirmed the presence of a fracture. Surgery with hardware implantation is often required to ensure proper alignment and help facilitate the healing of the bone. The fracture can take up to six weeks to heal and then there is the issue of restoring full mobility and grip strength. Delivering power through the bat swing often takes longer still. Much will depend on how Freese's healing progresses post-surgery, but plan on two months absence at a minimum.

Pablo Sandoval
Pablo Sandoval was hitting .313 with five homers when he landed on the disabled list.
• As we move farther west, we find yet another third baseman out with a hand injury. Pablo Sandoval has a fractured hamate bone and the San Francisco Giants have projected his absence at four to six weeks. We discussed this specific injury when the Philadelphia Phillies lost outfielder Domonic Brown during spring training. Brown underwent surgery in early March and was just removed from the disabled list, and subsequently optioned to Triple-A.

In an interesting twist, Brown's teammate Ben Francisco, who has benefited in terms of playing time during Brown's absence, has experienced this very injury. When I talked with Francisco about the injury during my spring training visit with the Phillies, he noted that the surgical area remained sore for some time afterward. Francisco pointed out that the athletic training staff did a great job of padding his bat, but even after he had technically healed, it took a few additional weeks to regain his power. Certainly, Sandoval was delivering some power for the Giants at the time of his injury and his loss will be apparent. The hope has to be that neither the interruption of play nor the surgery itself will impact him beyond his DL stay.

• Third basemen weren't the only ones who suffered over the weekend. Perhaps the most dramatic injury was the result of an outfield collision between the Houston Astros' Angel Sanchez and Carlos Lee. As Lee went to the ground to try to make a play, his ribs absorbed the blunt force from the knee of a sliding Sanchez. Lee had to be carted from the field and spent the night in the hospital. The good news was that no fracture was observed, but the Astros' website reported that a CT scan revealed a left rib contusion for Lee. Make no mistake: A contusion (or deep bruise) can be just as uncomfortable as a break in the early stages. Lee will have difficulty with deep breaths, reaching, twisting and lying on that side for a while. Although the team is calling him day-to-day, it would not be surprising for Lee to become a DL addition if the pain proves to be lingering.