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Saturday, June 7, 2008
Ortiz, Smoltz updates

By Stephania Bell



I performed a little experiment about 10 days ago. I went on the DL myself, suffering with a miserable spring cold, the one you feel like you shouldn't have when it's 80 degrees and sunny outside. I followed up my DL stint with a week's vacation, my first real vacation in two years. I thought maybe the injuries would decide to vacation simultaneously. Wrong. I came back to learn that Big Papi and The Big Hurt were ailing, that John Smoltz was hovering somewhere between season-ending and career-ending surgery and that hamstring injuries continue to plague the league. So today I officially return to the lineup and try to make sense of some of what has happened in such a seemingly short time.

David Ortiz
Ortiz's outlook is very positive.
David Ortiz, DH, Boston Red Sox: Ortiz tore the extensor carpi ulnaris (ECU) tendon sheath in his left hand on what otherwise appeared to be a normal swing on May 31. The ECU is a forearm muscle that extends (extensor) the wrist (carpi) and ulnarly deviates the hand (bends the hand towards the pinky side) as a result of its attachment on the ulna, the forearm bone on the pinky side, hence the name ulnaris. The tendon is the component that attaches the muscle to the bone and transfers the force of the muscle contraction to the bone resulting in motion. The tendon is encased in a sheath, and this tissue is what Ortiz actually injured, which is a far better scenario than tearing the tendon itself. The current problem for Ortiz is that he is experiencing a painful clicking in the wrist as the tendon slips without the protective sheath intact. I spoke with Dr. Kate Gray, an orthopedic hand surgeon at Kaiser Permanente in San Jose, Calif., who completed her hand fellowship training at the prestigious Hand Center of San Antonio where the textbook on hand surgery is written. Gray, who says that this injury is more commonly seen in tennis players (which makes sense if you look at how they grip the racket), adds that treatment for this condition is most often non-surgical, and usually the tissue is able to heal with a period of immobilization. A recent Boston Herald report supports this concept and the Red Sox are collaborating with Dr. Thomas Graham, who expresses great confidence that Ortiz can have an excellent non-surgical recovery. Graham relates Ortiz's case to that of the Philadelphia Phillies' Pat Burrell, who sustained a similar injury in 2004. Burrell was able to return successfully without surgery (Graham's recommendation) after one month.

According to Gray, the immobilization period is typically four weeks, although a high-level athlete like Ortiz might be able to decrease that time frame. To that end, Ortiz is now sporting a rather large cast that immobilizes his wrist and forearm so that the tendon does not continue to snap and the sheath has the opportunity to heal. He will be re-evaluated in two-to-three weeks, and if the healing is sufficient, he will be able to gradually resume baseball activities. Although the team is not committing to a timetable, Burrell's experience would suggest that approximately one month is reasonable if the healing proceeds normally. Incidentally, if he continues to experience clicking, but the clicking is no longer painful, then Ortiz could continue to play and, if necessary, undergo a surgical procedure to address the problem in the offseason. The functionality of his wrist will ultimately determine the next steps, but it sounds as if Ortiz's early prognosis is very promising.

John Smoltz, P, Atlanta Braves: Tuesday was a bad day for John Smoltz. He woke up with so much pain in his throwing shoulder after his first post-DL closer outing Monday that he knew his only option was surgery. Smoltz announced in a news conference Wednesday that he would undergo season-ending surgery to address the issues with his rotator cuff, biceps tendon and whatever else they might encounter once he is under the knife. Although Smoltz says he will do everything in his power to attempt to come back and pitch next year, the odds are not in his favor. Smoltz has overcome many obstacles in the past when many counted him out, so if anyone can persevere here, he would be the guy. For more details on Smoltz's injury and what he faces, you can read my detailed Smoltz analysis from Wednesday.

Carlos Pena, 1B, Tampa Bay Rays: Pena was hit on the hand by a pitch and suffered a small fracture of his left index finger. Now we know it can't have been too serious since he was able to stay in the game, and even managed to produce a home run! But the fact that a crack was discovered afterward meant that Pena needs to take some time to allow the bone to heal, which is why he was placed on the DL. The good news is that the injury is to the index finger of his dominant hand, so less motion is required at this digit to grip the bat effectively. It might be more of an issue with grip for throwing the baseball, but since Pena is a first baseman, he doesn't have the same throwing demands (distance or frequency) as other position players. At this point it does not appear he will miss more than the minimum time on the DL, according to the Rays' official Web site, assuming the healing continues without a setback. Pena is eligible to come off the DL on June 19.

Ryan Zimmerman
Zimmerman is hoping for a quick return.
Ryan Zimmerman, 3B, Washington Nationals: Zimmerman originally injured his left shoulder on a head first slide against the Orioles back in May. He continued to try to fight through the discomfort but it persisted, primarily when swinging the bat. A subsequent MRI revealed a slight labral tear, according to the Washington Times, which fits with the symptoms Zimmerman was having. The Nationals decided to place him on the DL in the hopes that the pain and inflammation will settle enough with rest to allow Zimmerman to finish out the season. The primary limiting factor is discomfort, not a structural integrity issue, but when the pain is present it is enough to impede the power of Zimmerman's swing, rendering him far less effective at the plate. Fielding wouldn't be as significant of an issue for him, and obviously he could still make his throws since the injury is to his non-throwing arm, but any diving catches towards the left would threaten to aggravate the condition. Zimmerman will be on anti-inflammatories while he rests the arm, and only once he starts to resume activity will it become clearer whether he can persevere or whether surgery is imminent. In the meantime, the Nationals are consulting with several surgeons regarding Zimmerman's situation, but judging from how these types of problems are typically managed, expect Zimmerman to play through the season after a period of rest, but expect that his productivity may be up and down depending how the shoulder is responding.

Daisuke Matsuzaka, P, Boston Red Sox: This is not what Red Sox fans wanted to see. Rotator cuff problems in one of your pitching aces can never be construed as a good thing, even if it is not uncommon. Luckily, it sounds as if Matsuzaka is dealing with a mild cuff strain and is expected to begin a throwing program Saturday, starting with throwing on flat ground according to the Providence Journal. The timetables on these throwing programs are always variable and moving on to each subsequent step depends upon how the prior step was tolerated. Suffice it to say that the Red Sox will play it cautiously so as to avoid any setbacks, and anticipate weeks, not days, before he returns.

Jake Westbrook, P, Cleveland Indians: No sooner did Westbrook return from a DL stint for a strained intercostal (rib) muscle then he turned right around and got back on the DL train with a different ailment. This latest one is of far more concern because it is his throwing elbow. Out with what is being called elbow inflammation, Westbrook had an MRI Tuesday but the results are not yet known. According to the Indians' official Web site, Westbrook was slated to see Dr. Lewis Yocum for a second opinion Friday, another not-so-good sign. Westbrook has been through surgery on this elbow before for bone spur removal and ulnar nerve transposition (where the position of the nerve is altered slightly so that it does not rub against or over the elbow). He also dealt with inflammation in the elbow last year. Elbow problems are often the Achilles' heel for pitchers and this latest setback does not sound so good for Westbrook and the Indians. Stay tuned to see what develops over the next week.

Jacoby Ellsbury, OF, Boston Red Sox: It was a beautiful catch! But anyone watching Thursday knew right away that it was also a painful one as Ellsbury stood up after the dive, shaking his right wrist, clearly in discomfort. Initial X-rays were negative and a subsequent MRI came back "really clean" according to manager Terry Francona in a Boston Herald report. Currently the team is calling Ellsbury's injury, in which his right hand got folded up underneath him, a wrist strain, and although he did not play Friday in order to rest his sore wrist, this does not appear to be a long-term issue. Since this is his non-throwing hand, Ellsbury could be back in the lineup in a matter of days, as soon as he feels he can adequately perform at his position.

Frank Thomas, DH, Oakland Athletics: You turn 40 and everything falls apart! Or at least that must be how Thomas feels after celebrating the big 4-0 on May 27 and subsequently exiting the game early with an injury on the same day. Thomas has a quadriceps muscle strain and according to the A's official Web site, the MRI showed significant inflammation. Have you noticed the size of those quadriceps? Of course you have. Even Thomas knows that with his age, his power and his muscle girth, he does not want to risk rupturing the quad, so a move to the DL was the smart thing to do. Knowing the extent of the inflammation and how these muscle strains can be slow to respond, expect his stint to go beyond the 15-day minimum.

And in the good news department...

Vernon Wells, OF, Toronto Blue Jays: Wells, who went on the DL for a fractured left wrist he sustained while diving to make a catch on May 9, is apparently healing quite nicely. Wells was originally projected to be out 4-to-6 weeks, a normal timeframe for a fracture of this type. But he is already back in rehab games and the team expects he could join them by next week according to an AP report. Keep in mind that wrist injuries sometimes affect plate productivity as the athlete adjusts to regain full strength, but Wells is making contact during his rehab assignment, so this is good news for the Jays.