Stephania Bell: Francisco Liriano

This is meant to be a "good news" Friday, so we'll get the ominous news out of the way first. Not surprisingly, Florida Marlins shortstop Hanley Ramirez is out of Friday's lineup, according to Joe Capozzi of The Palm Beach Post. Ramirez has been dealing with severe back pain and intermittent sciatica over the past week, and it appears ever more likely that he will make his way onto the DL, a decision which is expected to come shortly. The biggest hint? The Marlins recalled shortstop Osvaldo Martinez from Triple-A New Orleans on Friday.

Now, onto better things heading into the weekend ...

• It's a good day in Philadelphia when there's a player returning to the lineup, not departing. Phillies outfielder Shane Victorino will rejoin the lineup for Friday's matchup against the Pittsburgh Pirates. He had been out since suffering a hamstring injury mid-May. While the injury was never deemed serious, the team wanted to minimize the likelihood of a setback and placed him on the DL. After a handful of uneventful outings in minor league games, Victorino appears ready to roll. Naturally, everyone will feel better after he's had a couple of uneventful weeks in the majors, but at some point there is nothing left to do but let the athlete test himself in all-out play.

[+] EnlargePablo Sandoval
Diamond/Getty ImagesPablo Sandoval had been hitting .313 when he landed on the disabled list.
Pablo Sandoval and his big bat could be nearing a return. The San Francisco Giants have sent their third baseman to a rehab assignment, starting in San Jose, according to the San Francisco Chronicle. After a short stint there, Sandoval will move to Triple-A Fresno. If all goes well, Sandoval will rejoin the Giants at some point next week.

There is already reason to be encouraged. Sandoval, recovering from surgery to remove the fractured portion of the hamate from his right wrist, has demonstrated he can take swings from both sides of the plate. Batting left-handed during Wednesday batting practice, Sandoval hit two home runs, according to the San Jose Mercury News. The significance lies in the fact that when batting left-handed the knob of the bat puts pressure against Sandoval's surgical area (actually a likely reason for the original fracture, due to repeated contact pressure during his swing), which is often uncomfortable for players when they first resume hitting after a procedure such as this. Other players returning from this injury have reported soreness in the hand or difficulty with grip early on, which limits their power. So far the signs from Sandoval suggest that will not be a big concern for him.

• Although Chicago Cubs pitcher Matt Garza did not come off the DL immediately when eligible, his return does not appear to be far off. Garza threw a 30-pitch bullpen session Wednesday, according to Carrie Muskat of Although he had been throwing fine from flat ground, the bullpen was a bigger test for his bruised elbow. He apparently suffered no ill effects, and it looks as if he could rejoin the team next week.

• Another starter who could rejoin his team next week is Minnesota Twins lefty Francisco Liriano, who has been on the DL with shoulder inflammation, somewhat more concerning given that he also dealt with an episode of shoulder pain during spring training. Despite a couple of bright spots, Liriano has struggled this season, and it certainly appears the shoulder has been a factor. The Twins have to be hoping that a brief period of rest was the answer. The Minneapolis Star-Tribune reports Liriano felt pain-free playing catch Thursday. If all goes well with a planned Saturday bullpen, manager Ron Gardenhire expects Liriano to make his Tuesday start. While the Twins are looking for some positives, until Liriano is able to have consistent outings, it will be hard to have confidence that this is entirely behind him.

It doesn't take much in the way of a medical background to recognize the seriousness of what's ailing Florida Marlins shortstop Hanley Ramirez. Just look at his own description of the extreme pain he's experiencing and how it's affecting him, as told to the Palm Beach Post.

[+] EnlargeHanley Ramirez
Steve Mitchell/US PresswireHanley Ramirez has struggled this year, hitting just .210 with four homers and six steals.
"I feel it doing anything. I can't even put my shoes on. To get up from bed I have to take 10, 15 seconds. I have to do everything slow,' Ramirez said. "That's the worst pain I've ever had in my life, in my career."

Ramirez was removed from Sunday's game after experiencing increased back stiffness, but the bigger concern now is the pain radiating into his leg. As Ramirez told the Post, "I'm getting tingles in my leg. That's not a good sign." Right you are, Hanley.

Ramirez is exhibiting classic symptoms of nerve root irritation in his lumbar spine, commonly called a pinched nerve. The progression of his symptoms is also classic. He acknowledges the presence of stiffness in his back for several weeks, which then worsened during Sunday's game. Shortly afterward, the pain began migrating in the form of "tingles" into his upper left leg. Tingling is a hallmark nerve symptom as anyone who has bumped his or her "funny bone" (and thus tweaked his or her ulnar nerve, sending tingling into the hand) can attest. The location of the tingling indicates which nerve is affected. The most common presentation associated with the low back is pain radiating into the back of the thigh and downward which represents the pathway of the sciatic nerve. Pain and tingling, which spread into the leg after starting in just the area of the spine, indicates a relative worsening of the condition.

The condition can be associated with a disc bulge, bony changes (such as spurs) resulting in narrowing of the opening where the nerve root exits the spine, or even simply inflammation in the area. The challenge is that once the symptoms present themselves in this manner, they are typically slow to resolve. Every movement becomes painful, few positions are tolerable (much less comfortable), and the individual has to move very slowly to avoid flaring the symptoms even further. Everyone out there who has experienced sciatica or other radiating nerve pain -- and there are a lot of you as this condition is extremely common -- can relate to Ramirez's agony. If the condition further worsens, the tingling can change to numbness and the muscles in the affected area of the leg can develop weakness. The goal is to try to prevent that next step from happening.

Unfortunately, there's no magic rapid cure. The time it takes for the symptoms to disappear is highly variable. Anti-inflammatories, controlled movement, manual therapy and rest are typically the best defense. Sometimes an epidural injection (a steroid injection into the spine near the nerve root) is indicated and can help calm the inflammation. Philadelphia Phillies pitcher Roy Oswalt has dealt with a disc bulge and associated leg pain off and on for several years, including an episode earlier this year that sent him to the disabled list. Ramirez may not want to go on the DL for the first time in his career, but it would be no surprise if he ends up there given the severity of his current symptoms.

While fantasy owners wait to learn whether Ramirez will end up on the DL, several other key players were already transferred there in recent days.

[+] EnlargeSoriano
Jonathan Daniel/Getty ImagesAlfonso Soriano lands on the DL tied for second in the National League with 12 homers.
Chicago Cubs outfielder Alfonso Soriano pulled up limping in the first inning of Monday's game while trying to run out a ground ball, and immediately his hand went to his left quadriceps (front of his thigh). His sudden, halting steps as soon as he felt the injury made it clear he would be done not only for the day but likely a couple of weeks. Soriano was placed on the DL soon after. Everyone familiar with Soriano knows he has a significant history of muscular strains, including injuries to his hamstring, quadriceps and calf. Perhaps most notable was the time Soriano strained his right quadriceps in August 2007. An MRI at that time revealed an actual defect in the muscle, and it took him the better part of a year to recover. According to the Chicago Tribune, Soriano's MRI this time around did not demonstrate tearing of the muscle, and the Cubs hope this will be a far quicker healing process. Still, when an athlete has a history of soft tissue injuries and has reached the age of 35, there has to be some concern as to how quickly (and effectively) he will return.

• Several pitchers found their way onto the DL this weekend. Minnesota Twins reliever Joe Nathan is experiencing some soreness in his surgically-repaired elbow and the team prudently opted to place him on the DL. The team is calling it a flexor strain (strain of the muscles on the undersurface of the forearm that anchor near the surgical site) and speed bumps like this in the course of recovery are not uncommon. There's a reason that the timetable standardly issued following Tommy John surgery is given as a range from 12 to 16 months (sometimes longer) because it allows for setbacks such as this. Nathan told reporters that he expects to be out anywhere from 10 days to a month and in the interest of his long-term health, there is no reason to rush, nor is there reason for huge concern.

• Nathan's teammate, Francisco Liriano, was also placed on the DL this weekend because of soreness in his left (throwing) shoulder. Liriano first experienced soreness during spring training and it became an issue again last week. According to the Minneapolis Star-Tribune, an MRI revealed inflammation, but Liriano did not respond well to a session of catch on Monday, hence the move to the DL. The move is retroactive to May 23, suggesting Liriano could return after missing just one more start, but given that this is his second episode in three months (leading to a second MRI), there's reason to be concerned as to whether he will be truly healthy once he returns.

• The Houston Astros placed Wandy Rodriguez on the DL over the weekend due to fluid in his left (throwing) elbow. According to, Rodriguez underwent an MRI, which revealed the fluid, after being scratched for Saturday's start due to discomfort. Fluid within a joint is a result of irritation within that joint, not an injury in and of itself. There has been no indication as to what the team suspects might be causing the problem, although officials do not appear overly concerned. In fact, general manager Ed Wade told that the only pitch bothering Rodriguez during his last side session was the breaking ball. However, pitchers over the age of 30 with swelling in their throwing elbow should still raise a caution flag. Time will tell how Rodriguez responds to the rest.

• Finally, collisions at the plate are likely to remain a hot topic for the remainder of this season. After San Francisco Giants catcher Buster Posey suffered a season-ending injury while blocking the plate Wednesday, Pittsburgh Pirates catcher Ryan Doumit found himself on the DL performing the same task. Fortunately, Doumit's injury is less severe. The Pittsburgh Tribune-Review reported the injury as an ankle sprain (no fracture), but Doumit is in a protective boot and on crutches for the time being. Ankle injuries are clearly problematic for catchers given their routine squat position, so it will not be surprising if it takes more than 15 days for Doumit to return.

Posada, K-Rod and Jeter headline injuries

April, 12, 2008

Wow! The hits just keep on coming. And I'm not talking about offensive power, at least not on any of my fantasy teams. I'm talking about the hits teams are taking, real and fantasy, as a result of injury early in the season. Is there any team that has not succumbed to the injury bug yet this year? Not as far as I can tell. Some seem to be particularly unlucky, but maybe teams like the Angels and the Rays are just getting all of their injuries out of the way early. No doubt that's what they are hoping is the case. I'm just the messenger. Let's take a closer look.

[+] EnlargeJorge Posado
Elsa/Getty ImagesPosada at least can hit right now.
Jorge Posada, C, New York Yankees: "Dead arm" sounds like a scary condition. But don't let it scare you. I actually wrote about this in our fantasy draft kit and described it as a condition that most often affects pitchers, which is still true. Certainly a catcher is throwing the ball fairly frequently during the course of a game and is subject to suffering from this ailment as well. Posada, who himself said on the Yankees' official Web site that he felt as if his arm was "dead," indicated that he has suffered from this condition in the past, including earlier this year in spring training. The issue is one of fatigue, and the complaint most often, as was the case with Posada, is an inability to throw because the arm feels weak, not painful. Recovery is fairly quick, and usually simply requires a few days of rest. An MRI was reassuring in that it reportedly showed no structural damage, and Posada already has returned to the lineup as a designated hitter. The Yankees likely will give Posada some more time before he resumes throwing, primarily to ensure that this does not turn into something more serious.

Mike Lowell, 3B, Boston Red Sox: Lowell is now a member of the disabled list thanks to a sprained left thumb sustained Wednesday while fielding a ball. The injury is to his non-throwing hand, but nonetheless, he needs to be able to get his hand into his glove, and needs to grip a bat effectively, both of which would be limited by pain and swelling. Lowell admitted that the thumb felt worse the day after the injury than he initially thought it would, and the team placed him in a thumb splint to help rest the joint and the soft tissue around it. The time frame for Lowell ranges from two to four weeks, and the variability in an athlete's response to swelling and functionality after a hand injury makes it difficult to be more precise. Keep in mind that it is not just the ability to return to play, but the ability to be productive that usually takes a bit longer with these cases.

Matt Garza, SP, Tampa Bay Rays: The Rays are hoping ace Scott Kazmir is on the mend in short order because they just placed another teammate on the disabled list. Garza left Tuesday night's game with what the team is referring to as "radial nerve irritation." Garza reportedly told the team that he was experiencing numbness in his right hand and had trouble gripping the ball. The radial nerve travels through the back of the upper arm and across the top of the forearm toward the hand. Overstretching of the nerve, or tightness of the muscles through which it passes, can cause irritation, and in Garza's case, there may have been some of both. Garza has had discomfort of this type before but, as he told the St. Petersburg Times, he always has been able to pitch through it. Many pitchers are tight in their forearm musculature, especially because it is well-developed. Interestingly, during Tuesday night's outing, Garza fielded a ground ball hit back his way, and in the process fell forward such that his right wrist got folded up underneath him. It just so happens that this is exactly the position that could place an excessive stretch on the radial nerve. Although we can't say for certain, Garza did exit the game shortly thereafter, complaining of discomfort and demonstrating a lack of ball control. A combination of tight musculature, and a quick abnormal stretch, could very easily provoke symptoms similar to what Garza described. The team has indicated that Garza will not be allowed to throw for several days in order to let the inflammation settle, and then he will be re-evaluated in two weeks. Since Garza has had similar symptoms in the past, the Rays no doubt want to be sure that this does not become severe and chronic. Translation: Extra rest if he requires it. Assuming no setbacks in his rehabilitation, Garza likely will return in late April or early May.

Justin Duchscherer, SP, Oakland Athletics: First Harden (out on the disabled list with what is now being called a subscapularis strain), then Duchscherer. The Athletics must be wondering what they need to do to catch a health break for their starting rotation. Duchscherer felt a pull in his right biceps during Friday night's game, a particularly unfortunate circumstance because he had been pitching well. An MRI confirmed the presence of inflammation at the biceps, which surprised Duchscherer because he had described the pain as "mild," according to the Athletics' official Web site. The A's, however have learned to take no chances where their starters are concerned, and decided to rest Duchscherer a bit longer by placing him on the disabled list. The biceps is especially important in the pitcher's anatomy because it attaches to the labrum. A pitcher's torn labrum most often requires surgery, and that would spell an end to a season. Resting him and quieting the biceps now may go a long way toward preserving his throwing arm, so the move is completely reasonable. The good news? Duchscherer has already thrown from 80 feet without experiencing pain and will be eligible to return April 20, assuming he continues to progress well.

[+] EnlargeFrancisco Rodriguez
Jeff Gross/Getty ImagesK-Rod has been KO'd by some weak ankles.
Francisco Rodriguez, RP, Los Angeles Angels: As if the Angels needed another injury in the pitching department. The latest Halo to suffer a setback is K-Rod, he of the not one, but two, bad ankles. Rodriguez had trouble with his left ankle last year after contending with a crumbly pitcher's mound. Apparently, according to a report in the Los Angeles Times, the ankle continued to bother him during the winter, although the Angels insist he had no trouble with it during spring training. Saturday, however, Rodriguez twisted the right ankle coming down the dugout steps, and it continued to bother him Monday. An MRI revealed no major soft tissue injury (ligament or tendon) which provided a bit of a silver lining, but nonetheless, with his ankles as sore as they were, the Angels wanted Rodriguez to rest for a few days.

The concern here is that the ankles, which each provide a full weight bearing base of support for Rodriguez at different points in his pitching motion, must be strong for him to pitch effectively. As manager Mike Scioscia told the Los Angeles Times, "We don't want to put him at any undue risk." The concern becomes that Rodriguez could injure himself further, and in a worst case scenario could injure his throwing arm if either ankle gives out on him while pitching. The hope at this point is that after a few days rest, Rodriguez will be able to throw a bullpen, or perhaps even make a game appearance this weekend. It is of concern, however, that the left ankle has some lingering symptoms from last season, and fantasy owners should consider that this may be the type of thing to crop up again during the season.

Rafael Soriano, RP, Atlanta Braves: Soriano experienced some elbow soreness after pitching last weekend, and the Braves wasted no time moving him to the disabled list. One of the reasons the decision was made to impose a period of forced rest on Soriano is that he had similar symptoms during spring training. Soriano's symptoms are actually above the elbow, near where the triceps muscle (large muscle on the back of the arm) attaches. The team is calling Soriano's condition elbow tendinitis according to the Atlanta Journal-Constitution, and it sounds as if this muscle group could be the culprit. Soriano has had his share of elbow woes, having undergone Tommy John (ulnar collateral ligament reconstruction) surgery and missing most of 2004 and all of 2005 as a result. The good news here is that Soriano's discomfort does not appear to be located near the area of reconstruction, and tendinitis issues are much likelier to resolve than ligament sprains or joint problems at the elbow. It sounds as though the Braves are taking a cautious approach with their closer, which will no doubt benefit him and the team in the long run. Soriano will be out until at least April 22, but the hope is that this will not be a season-long problem.

In brief

Dontrelle Willis, SP, Detroit Tigers: Willis, who had a walk-filled first outing to start the season, was hoping to right the ship Friday. That was not to be. Despite the best efforts of the Chicago grounds crew, rain in the area may have contributed to a slippery mound. Willis started by walking leadoff batter Carlos Quentin, then slipped on the mound while facing the second batter, Orlando Cabrera. Willis' front leg stretched out in front of him as he transferred his weight during ball release, forcing his right knee into hyperextension. Willis reached for the back of his leg in obvious discomfort. Although Willis remained in the game through Cabrera's at-bat (another walk), he clearly appeared to be struggling as he faced the next batter, Jim Thome. Willis was removed from the game, and we will now wait to see what the future holds for him.

Derek Jeter, SS, New York Yankees: Jeter has not played this week since straining his quadriceps muscle. There is still a chance that he could make an appearance this weekend, but according to the Hartford Courant, manager Joe Girardi says that is "doubtful," meaning Jeter could sit out until next week. Despite the enticement of the Yankees-Red Sox rivalry, it is important that Jeter's minor strain does not become major, and the team will exercise patience.

Jimmy Rollins, SS, Philadelphia Phillies: All good things must come to an end. And so it goes with Rollins' streak of 230 consecutive games played. Rollins sprained his ankle on Tuesday night when making a directional change to get back to second base. Rollins has been out of the starting lineup for three straight games, but it does not appear that this injury will send him to the disabled list. According to Rollins in a quote on the Phillies' official Web site, the ankle bothers him when going "left to right," and that is a big part of his defensive game. Don't be surprised if he makes an appearance this weekend, but check the lineups daily, as the team could decide to hold him out until Tuesday if cutting remains a problem.

Francisco Liriano and Kevin Slowey, SP, Minnesota Twins: Finally, there is some good news to report: The return of Liriano has arrived! The Minnesota Star Tribune is reporting that Liriano will start Sunday for the Twins in place of the injured Kevin Slowey, who is being placed on the disabled list with soreness in his biceps. Liriano, who will make his major league return after undergoing Tommy John surgery in 2006, has struggled somewhat in the minors. It is normal for pitchers to take some time to regain their velocity and command after this procedure, so his struggles are not a concern from a health perspective. And just wait until he gets more time under his belt. By July, Liriano's numbers should be on the upswing. Meanwhile, Slowey, who left his first start with pain in his biceps, is improving, although he is still experiencing some lingering soreness. This downtime will give Slowey an opportunity to recover fully, and it helps make room for Liriano.

I know. I know. It appears never-ending. Where there are sports, there are bound to be injuries. And so it will go throughout the season. Keep checking back, and we'll keep updating you. Right here at On Fantasy Insider (ESPNews, 11 a.m. EST). On Fantasy Focus (ESPN Radio, 9 p.m. EST). And wherever else those injury nuggets crop up. Have a good weekend, and may your fantasy teams go injury-free!