Stephania Bell: Brandon McCarthy

All eyes on Lidge's, Sizemore's rehab

June, 10, 2009
6/10/09
12:22
PM ET
We lead Tuesday with a few players who went under the knife this week yet hope to return at some point this season.

Rangers outfielder Josh Hamilton underwent surgery to address a partially torn abdominal muscle and hopes to return in four to six weeks. Recovery from this type of surgery (a sports hernia-type repair) can vary, though. Even when an athlete is cleared for full activity, it often takes him longer to return to full speed. Fantasy owners should keep that in mind as they plan around Hamilton's absence. His rate of activity progression during the next few weeks of his rehabilitation will provide important clues as to whether he can meet the projected timeline.

Mets relief pitcher J.J. Putz also underwent surgery this week, but his recovery time will be closer to about three months. Putz had bone spurs removed from his elbow. The good news is that the spurs, which were causing him pain and decreasing his velocity, are now out of the way. The not-so-good news is that the presence of spurs suggests increased shear forces in the joint, often associated with instability (as in looseness in the ligament). We have seen pitchers undergo bone spur removal, only to end up requiring Tommy John surgery down the line (Chris Carpenter in 2007, for instance). This is not to say such surgery is definitely in Putz's future, but it's an observation worth noting.

And here are other players I'm tracking closely this week:

Brad Lidge
Howard Smith/US PresswireBrad Lidge owners have to hope his most recent knee injury won't bother him all season.
Brad Lidge, RP, Phillies: Lidge was placed on the DL on Tuesday because of a sprained right knee. Typically, a sprain reflects an acute injury to a ligament, but in Lidge's case, this is something that has been coming down the pike for a while as a result of chronic irritation within the joint. It certainly is no secret that Lidge has struggled and that his right knee, which already has undergone a couple of surgeries (including one at the beginning of the 2008 season after he tore the meniscus), has been part of the equation. An MRI earlier this year revealed nothing new. Nonetheless, The Philadelphia Inquirer reports that Lidge will undergo additional tests during this downtime in an effort to get to the root of the problem.

I discussed Lidge's knee in early May, and given his history, this course of events is not unexpected. The big concern now is that if Lidge continues to try to pitch through discomfort, he might end up compensating in ways that impact his mechanics and threaten greater injury, not only to his knee but also to his throwing arm. Given the uncertainty around his situation, it might be more than two weeks before we see Lidge back in the closer role.

Grady Sizemore, OF, Indians: Sizemore is on the DL, but how long will he be there? Will he return when eligible, or will he end up facing an arthroscopic procedure on his elbow? Those are the big questions.

We already know the answer to the first part of that second question. This recovery process will take longer than two weeks, even if he doesn't have surgery. The Cleveland Plain Dealer is reporting that the plan for Sizemore is to limit him to rest and treatment for two weeks, and after that cooling-off period, Sizemore will test the elbow by throwing a ball and swinging a bat. If the symptoms linger, surgery will be the next option.

Pay close attention this week. The answer will make itself apparent in the next few days as Sizemore hits the two-week mark, and there are reasons to be concerned that this might end up a surgical situation. First, Sizemore's elbow has bothered him all season. Chronic inflammation, which usually implies changes in the soft tissue, rarely resolves within two weeks. Sure, Sizemore will feel better while resting, but the true test will come when he tries to restart baseball activity. Second, his symptoms are reportedly most aggravated with elbow extension. If he wants to play, that's something he absolutely cannot avoid, and in fact needs to perform forcefully.

Despite the "no structural damage" MRI report, Sizemore's symptoms, as noted above, are suggestive of changes in the soft tissue as a result of repetitive activity. Surgery would mean an additional six weeks of absence. Sizemore's fantasy owners should take preparations and seek insurance.

Brandon McCarthy
Tim Heitman/US PresswireBrandon McCarthy has quite an extensive injury history for a 25-year-old.
Brandon McCarthy, SP, Rangers: The Dallas Morning News is reporting that McCarthy is out indefinitely after an MRI revealed a stress fracture in his right shoulder blade. He will not even pick up a ball for several weeks while the bone heals. The odd feature here is that McCarthy suffered a similar injury in 2007. He missed about one month initially, came back for a handful of outings, then was shut down the season's final week because of subsequent forearm problems.

After an elbow injury and a sprained finger in 2008 limited him to just five starts, McCarthy had to hope that his injury woes were finally behind him. He even began this season with extra bulk on his tall frame in an effort to remain healthy. Not the case. Even during spring training, McCarthy's shoulder was causing him some discomfort, although he seemed to be past the problems as the season got under way.

At just 25 years old, his injury pattern must be a concern for both McCarthy and his team. In the meantime, fantasy owners should seek other options.

Asdrubal Cabrera, 2B, Indians: Early reports last week suggested that Cabrera had dislocated his shoulder. As it turns out, Cabrera separated his shoulder, also known as an acromioclavicular sprain, which likely means he'll miss less time. Cabrera injured himself while breaking up a double play, and the force of the impact of his shoulder's hitting Minnesota infielder Brendan Harris' leg resulted in an injury to the ligaments that link the collarbone to the shoulder blade. Cabrera has been projected to miss anywhere from two to four weeks.

The good news here is that the sprain could not have been too severe because X-rays were initially reported as negative. Even though X-rays show only bony injuries, if there were a significant degree of separation as a result of severe ligament damage, the bony ends would appear out of alignment on film. The sprain itself was revealed in a subsequent MRI, and the timetable also reflects a relatively minor injury. Judging from how painful the injury appeared at the time, Cabrera and the Indians are fortunate that it was not worse. The focus now that the pain has subsided will be on restoring Cabrera's range of motion and strength, with a gradual progression toward baseball activities.

On the mend

• A's pitcher Justin Duchscherer is preparing to throw again. Perhaps he has been off your radar screen following March elbow surgery, but it's time to start thinking about him again. Duchscherer had his rehab throwing program interrupted for more than a week because of a sore back, according to the San Francisco Chronicle, but that minor setback seems to have abated, and he will now pick up where he left off. The Chronicle also reports that the A's might bring him back in a relief role. That's significant for fantasy owners not only because of how he can be used but also because it might allow him to rejoin the team sooner. He's still weeks away, but he should at least be on your radar now.

• Teammate Travis Buck, who has been on the DL because of an oblique strain, should return when eligible Sunday. According to the A's Web site, he has made it through batting practice just fine and is scheduled to make some minor league appearances this week. Perhaps you've noticed that oblique injuries in hitters are much more variable in terms of severity, with many players able to return when eligible following a 15-day DL stint. In the case of pitchers, the injury seems to be much more specific (in terms of location) and often more severe, usually requiring a four-to-six-week absence. It's something worth noting the next time one of your hitters suffers a strained side muscle. Don't be too quick to drop him, because it might be only a minor inconvenience.

• The St. Petersburg Times reports that Rays manager Joe Maddon already has confirmed that shortstop Jason Bartlett will not return this week when eligible. That is not to imply Bartlett is not progressing; he is, in fact, doing some infield work. But the Rays are wise not to bring Bartlett back too quickly from even a minor ankle sprain because the demands of his position, particularly the quick lateral movements, will stress the still-healing ligaments. No sense in turning a minor injury into a major one. Keep a close eye on Bartlett, though, as his activity suggests his absence will not be extended much longer. Bartlett suggested to The Tampa Tribune that his return could come Tuesday at Colorado.

• Another Rays player nearing a return is pitcher Scott Kazmir, who has been out because of a strained quadriceps. Look for Kazmir to make a couple of rehab starts to ensure that his strength and mechanics remain on track. But so far, his rehab performance has been encouraging, as in, far better than what we were seeing before he went on the DL.

• Diamondbacks outfielder Conor Jackson's recovery from valley fever is ever so slow. The illness, which sapped Jackson's energy and caused him extreme fatigue and weight loss, has taken its toll on his physical conditioning, and it will take him quite some time for him to work his way back. The Diamondbacks' official Web site reports that Jackson was very fatigued following a batting practice session Saturday, proving that he still has a long road to hoe before returning. No timetable has been set for him to rejoin the team. If you've been holding out hope and keeping him on your fantasy bench, you might want to seek other resources. This could prove to linger for the remainder of the season.

• Cubs starter Rich Harden, no stranger to the DL, should rejoin the rotation very shortly. Harden has been out because of a middle-back strain and was originally scheduled to return Friday, but a case of the flu set back his timetable. It looks as if the setback was minor, however, as MLB.com reports that Harden is expected to take the mound Saturday against the Twins. Harden looked strong in his last rehab outing on Monday, and fantasy owners should expect more of the same when he returns to the majors. Yes, there's always some level of concern with Harden's health, but this latest setback does not suggest anything serious. Definitely worth the gamble.

• And finally ... not such good news for Reds third baseman Edwin Encarnacion. It sounded as if he was headed for a minor league rehab assignment, but a recent MRI on his wrist was less than positive. Reds manager Dusty Baker told the Dayton Daily News that although Encarnacion would be on the road with the team, he would only be receiving treatment. "No baseball work right now," Baker said. Encarnacion originally sustained a chip fracture in his left wrist in late April and reportedly had been progressing well until this week. No word on what the MRI showed exactly, but wrist injuries always have the potential to drag on a little longer than expected. The fact that the setback is occurring before Encarnacion returns to a game situation is definitely cause for concern.

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