Stephania Bell: Brandon Phillips
The All-Star break gives us a chance to see how teams have fared thus far and project what will happen the rest of the season. One of the big influences, if not the biggest, year in and year out, is injuries, and 2014 is no different. Much of the first three months of the season was spent talking about the number of Tommy John surgeries (including revision or second surgeries to the ulnar collateral ligament of the elbow) befalling major league pitchers this year. When pitchers’ elbows weren’t the hot injury topic, baserunners’ thumbs were. Perhaps the second most common surgery of the first half of the season also involved an ulnar collateral ligament, specifically the one found in the thumb, often injured by baserunners getting it caught on the bag while sliding. Looking ahead to after the All-Star break, teams who have been without some of their key players are hopeful of getting them back, at least for a portion of the season. But are those hopes realistic? To try to answer that question, we take a closer look at 10 of the more interesting injury scenarios for the second half.
Reds manager Bryan Price didn’t sound entirely optimistic when he offered his assessment of Votto's status going forward. “Our plan of attack will be to do everything we can to get him back to play over the course of the year," Price said. "We don't have a timetable on how long that will be, but the goal is to get him back and able to help us before the year is out.” In other words, the Reds are still looking to get a functional Votto back, not necessarily a completely healthy one. Votto went through a difficult recovery following meniscus surgery on the same knee two years ago. While it is unclear whether there are joint changes that are specifically contributing to his challenges with this year’s quad strain, the cumulative injuries in the area don’t help the overall picture. The takeaway at this stage is that even if the Reds are able to work Votto back to the playing field this season, their own assessment of the situation hints at him not returning to full strength before the year is out.
According to the Atlanta Journal-Constitution, Gattis has begun some baseball activities, including taking light batting practice. Given the torque through the trunk during a swing, the fact he was able to do so successfully is a good sign that the acute pain has settled down. The next test will be to ramp toward rehab games, presuming no setbacks from the batting practice. While there remains no formal timetable, it’s clear Gattis won’t be ready to come off the DL when first eligible immediately after the All-Star break. It remains to be seen whether he continues on this trajectory when he puts in consecutive days of swinging the bat hard and making defensive throws from behind the plate, another skill which forces rotation through the spine. Knowing how slow these problems can be to improve, his progress thus far is encouraging but the concern of a subsequent flare-up will linger.
Just a week after being placed on the DL, Cole was throwing a side session, indicating the relatively low severity of this latest soft tissue injury. Still, everything the team is doing seems to indicate caution on their part. After all, the larger lat muscle contributes to the stability of the entire upper kinetic chain (think: shoulder blade, shoulder, elbow, wrist and hand) via the extremity’s anchor to the body and can force increased reliance on the small, coordinating muscles of the shoulder (think: rotator cuff) when it fatigues. An injury to the lat can therefore influence the shoulder during throwing, both directly and indirectly. This DL stint may be as much about the Pirates working with their young pitcher to increase his arm endurance in a protected way so as to ward off a truly major problem as anything else. It still translates to more lost time for him but hopefully that remains shorter than the alternative.
The Phillies may be more interested in showcasing Lee’s return to health to other potential suitors than anything else, given their current status in the standings. From a global health perspective, it would be nice to see Lee post a strong second half of the 2014 season with no arm setbacks, something he has a decent chance of doing based on how his last month of work has gone. Flexor tendon injuries (injuries to the attachment of the muscle group on the inner aspect of the forearm which controls grip and rotation) can precede ligament injuries but an uneventful July to September -- maybe even October -- would offer some peace of mind that Lee’s decline is not imminent, despite the mileage he has accrued in his career.
Tanaka had been a bright spot in the Yankees’ rotation, leading the team in wins and inspiring confidence when he took the mound. He quickly proved the value of his offseason acquisition by the team, especially given their injuries to other starters: CC Sabathia, whose degenerative knee is likely to keep him out the remainder of the year; Ivan Nova, who is in the thick of rehabbing his own (April) Tommy John surgery; and Michael Pineda, who continues in his recovery from a teres major strain and will not return before August, at best. With the news of Tanaka’s injury, however, the question becomes how much his perceived value takes a hit. The jury remains out for now as everyone waits to see whether his prescribed trial of rest and rehab following a platelet-rich-plasma injection will succeed.
There are indeed cases where partial tears of the UCL, the ligament that stabilizes the medial elbow, do not require surgery, at least not immediately, but they are not well-documented and appear to be relatively rare at the major league level. A study published in 2013 in the American Journal of Sports Medicine examined the return-to-play status of 34 athletes with partial tears of the UCL who had undergone PRP injections and found an 88 percent success rate. It should be noted, however, that only two of the athletes in that study were professional baseball pitchers. Still, given the fact that return to prior level of performance following Tommy John surgery is not guaranteed and, at the very least, requires an extensive recovery process that typically exceeds one year, the decision to attempt conservative treatment first makes sense for Tanaka and the Yankees. The bottom line is this: By late August we should have a good idea as to whether Tanaka will be poised for a 2014 return or whether we’ll have to wait until 2016 to see him back in major league competition.
Yadier Molina, C, St. Louis Cardinals (right thumb): This year we have seen numerous thumb injuries during slides, the bulk of them coming when leading with the head and the hands. In Molina’s case, the slide was feet first and he appeared to be using his hand to help control his approach to third base. His pain was apparent right away and the tough-as-they-come Molina was forced to leave Wednesday’s game in the third inning.
On Thursday, the Cardinals delivered the bad news that this would be more than just a two-week rest-and-recovery absence. Molina is scheduled for surgery Friday to repair the ligament, and the team has issued a timetable of eight to 12 weeks for his return. There is variability in the recovery time for these injuries, but as catcher, Molina has to throw repeatedly with this hand, including hard defensive throws, potentially lengthening the time for him to return to play. He is also potentially at risk for more contact than most. From a hitting perspective, the good news is the injury is to Molina’s top hand, making restoration of his natural grip of the bat somewhat easier. While it’s certainly possible he could emerge on the short end of the timetable, the Cardinals have to prepare for the possibility that Molina may not be available before their regular season fate is sealed.
Brandon Phillips, 2B, Cincinnati Reds (left thumb): If it’s not sliding into a base, it’s the diving defensive play that puts the vulnerable thumb at risk. It happened to Los Angeles Dodgers shortstop Hanley Ramirez last year when he suffered a torn ulnar collateral ligament in his right thumb while diving for a ground ball in the World Baseball Classic.
On Wednesday, it happened to the Reds second baseman while making a diving catch in the eighth inning. Phillips was seen wearing a splint on his left thumb after the game, and on Thursday the team announced he would be undergoing surgery. It’s fair to broadly estimate an absence similar to those who have undergone similar procedures. The Reds have indicated a projection of six weeks, which in reality could range from just short of six weeks (like Ramirez) to eight weeks (like Washington Nationals outfielder Bryce Harper). In short, the Reds should expect to be without Phillips’ services until late August or early September. Phillips has not been on the DL in the past five seasons, so his absence for any length of time is a jolt to the Reds' lineup.
In the same game, Reds outfielder Billy Hamilton left early with hamstring tightness. Hamilton, who acknowledged the muscle had been bothering him for a few days before it tightened up Wednesday, anticipates missing a few games, but the All-Star break could work in his favor. With the four “free” days allotted by the break, Hamilton could avoid a DL stint.
Homer Bailey, SP, Cincinnati Reds (right knee): The Reds do seem to be taking their injury lumps all in the span of a few days, adding a pitcher to the mix in Bailey. While the team can take some comfort in the fact that he is not dealing with an injury to his throwing arm, the point remains that he could not complete his Thursday outing. Bailey had discomfort in his left knee while trying to pitch to Starlin Castro in the sixth inning, with the team calling it a strain of his patellar tendon, the broad, flat tendon that anchors the quadriceps muscle below the knee. For now, the Reds say Bailey will make his next start, but even so there will be some concern until he successfully completes that outing.
Wrong Turn for Wright
It seems like New York Mets third baseman David Wright just can't catch a break. Or maybe that's the problem: He does seem to be on the receiving end of breaks lately. Last year it was his back, as a stress fracture in his lumbar spine (low back) resulted in two months away from the game. He then suffered an abdominal strain this spring (to be fair, nothing was broken) that threatened the start of his season. The Mets wisely controlled his activity and he was able to rehab his way into the lineup by Opening Day. Then, just when everyone was celebrating how well the healthy Wright was swinging the bat to start the season, it all went wrong in one quick dive. Monday night Wright dove back into first base on a pickoff throw and, as he described it, "I went in there a little bit too hard and jammed my pinkie into the bag."
Wright was fitted with a customized splint Wednesday at the Hospital for Special Surgery. The trick in crafting a functional splint is providing enough stability to protect the break and allow the bone to heal, while still permitting enough motion around the injured part to perform. The amount of swelling in the area will effectively limit motion in the finger, and pain, even if one is stoic enough to press through it, will inhibit strength to some degree.
Although Wright is eligible to return as his symptoms allow, it is hard to know at this early stage if it will be several days or if he will require a trip to the disabled list. As manager Terry Collins pointed out, with a day off Thursday, the team will not likely make any decision on roster moves until Friday. That allows time, Wright's best friend in terms of recovery, to work its magic.
But will it be enough time? Hitting will undoubtedly be the biggest challenge Wright faces in attempting to return. "For me, the main thing ... after I did it, hitting really hurt," said Wright. "Throwing wasn't nearly as bad as gripping the bat." If Wright can't grip effectively because his finger can't curl around the bat handle or is uncomfortable in contacting his other hand, he will lose power at the plate, especially given that the injury is to his top hand. Whether the pain and swelling can subside enough to allow him to perform reliably within just a few days is a big unknown.
While the comparison isn't identical, Los Angeles Dodgers outfielder Andre Ethier suffered a broken pinkie finger in 2010 and missed 17 days. There were a couple of significant differences. Ethier fractured the tip of his pinkie finger, not the middle like Wright, making it easier to splint without compromising the bulk of the function of that finger. But Ethier's injury was to his non-throwing hand, also his bottom hand when holding the bat. Accommodating the bottom pinkie finger where it rests against the rounded knob of the bat was a challenge and a big part of the reason Ethier ended up on the DL. Even when he returned, Ethier struggled at the plate despite wearing a splint, simply as a function of his decreased grip ability with that finger.
It is important to stress that the differences in location of the Wright and Ethier injuries along with the routine mantra that no two individuals or injuries heal in exactly the same manner make it impossible to predict just what to expect in terms of time missed in this case. For now Wright is literally day to day, but no one should be surprised if a couple of days turn into a couple of weeks.
Re-MorseWashington Nationals outfielder Michael Morse started the season on the DL due to a strained lat, which was specifically giving him pain below his right shoulder blade. This week, he took a step backward. Initially, manager Davey Johnson had expressed hope that Morse would be off the DL and available for the team's home opener on Thursday. In fact, Morse has been hitting the ball well in minor league games and had moved from Harrisburg to Hagerstown on Monday in anticipation of rejoining his team later in the week. But Morse did not finish Monday night's game, exiting in the seventh inning after experiencing pain when throwing. The bigger issue for Morse all along has been throwing, not surprisingly since the lat (short for latissimus dorsi) is so involved throughout the throwing motion. According to the Nationals' official website, Morse underwent further tests, the results of which have not been shared publicly. Those results were shared however with Dr. James Andrews, who is also evaluating Nationals closer Drew Storen. Even without knowing the details, suffice it to say that the presence of a setback now, more than a month after the original injury, hints at a prolonged rest from any throwing. Presuming primarily soft tissue injury to the muscle itself, this would not appear to be a surgical situation, but a time frame is impossible to project at this stage. The Nationals have indicated that Morse is out indefinitely.
Phillips cramps upBrandon Phillips may have left Monday's game early because of cramping in his left hamstring, but that hasn't stopped him from smiling. The Cincinnati Reds certainly can't be too worried about his health either since they signed him to a six-year, $72.5 million extension the following day. Phillips is expected to miss a few days as a precautionary move -- a wise one considering that the weather is still chilly and there is the perspective of the 162-game season to consider -- but the team could have him back in the lineup this weekend. According to the Reds' official website, Phillips blames the issue on not drinking enough water, but he was already running on a treadmill Tuesday, suggesting the problem is not severe. While this early "hint" of a hamstring issue is never something anyone likes to see, it's also too soon to panic. And it's never too soon to hydrate.
How about some good news for a change? There are a handful of players who are expected to rejoin their teams' lineups this week, giving fantasy owners some options to consider.
• Cincinnati Reds second baseman Brandon Phillips is returning to play Tuesday after resting a few days because of a mild right groin strain. Phillips sustained the injury last Wednesday and, although he has hinted that he could have played by now, the team has not wanted to take any chances. Groin injuries can be particularly problematic for second basemen, who have to make explosive lateral defensive maneuvers on a regular basis. The last thing the Reds need is to see Phillips' injury turn into a more severe strain and an extended absence. According to the Cincinnati Enquirer, manager Dusty Baker also factored the elements into the equation as far as holding off Phillips' return, saying, "This [cold] weather isn't helping." It appears those concerns are no longer an issue, as Phillips is in the lineup for Tuesday night's game against the Arizona Diamondbacks.
• New York Mets outfielder Jason Bay's return to the starting lineup has been a long time coming. Bay suffered a scary concussion last July when he crashed into the outfield wall at Dodger Stadium, ending his 2010 season prematurely. Bay's concussion-related symptoms finally subsided in September and he appeared to be headed for a fresh start in spring training. That optimism didn't last long, as Bay strained a left intercostal muscle in late March. Originally, Bay denied the injury was serious but he was forced to start the season on the DL to let it heal. Bay began hitting off a tee less than two weeks ago and has steadily increased the vigor of his swing to playing in rehab games. ESPNNewYork.com reports that, in the absence of any setback, Bay is expected to be activated Thursday.
• In Toronto, there could be a switch at the closer position soon with Frank Francisco's return from the DL. Francisco, out since the start of the season with a strained pectoral muscle, was activated by the Blue Jays on Tuesday but is not expected to close right away. His 2010 season (with the Texas Rangers) ended with an injury to his right latissimus muscle, and he was unable to participate in the playoffs. The 31-year-old reliever's health was not enough of a concern to keep the Blue Jays from acquiring him, but they may be relieved to have Jon Rauch as insurance. Rauch has performed admirably at the closer position to start the season with Francisco out.
Francisco's latest injury involved not only his pectoral muscle but also inflammation of his biceps, a key structure in a thrower's shoulder in part because of its physical attachment to the labrum. Given his age (translation: wear and tear on the shoulder over time), there is reason to maintain at least some level of concern, even if minor. MRIs taken of Francisco's shoulder this spring revealed no structural damage, according to the Blue Jays' official website, which is encouraging, but only time will tell how well he holds up. The Blue Jays are expected to work Francisco back into relief duties but aren't likely to pass the closing baton to him automatically.
• The Blue Jays will also be getting Brandon Morrow back in the mix. Morrow started the season on the DL with right elbow inflammation after experiencing forearm tightness following a spring outing. Morrow initially expected to miss only one start, but the team kept him on a slower pace of building his pitch count, a wise move considering the length of the season. According to the Blue Jays' website, Morrow is expected to start Friday or Saturday.
• There may be some shuffling in San Francisco as the Giants prepare for the return of Cody Ross. Ross started the season on the DL with a calf strain and has progressed pretty much on pace with the Giants' initial projection of a three-week absence. Calf strains can be slow to heal and easily aggravated, but Ross showed no limitations in his spring outings as his innings gradually were extended. If Ross returns to the team Tuesday, which was the plan if there were no setbacks after his Monday outing, then Aubrey Huff would (no doubt thankfully) return to first base, according to the Giants' official website. Manager Bruce Bochy may then opt to send rookie Brandon Belt back to the minors for the time being. Fantasy owners should double-check pregame lineups because Bochy hinted that the weather in Colorado could be a factor in determining when Ross is activated.