Stephania Bell: Jacoby Ellsbury

Stephania Bell and Prim Siripipat discuss the impending returns of Matt Kemp, Jacoby Ellsbury, CC Sabathia and Roy Halladay from the DL as the second half begins.

2012 All-injury All-Star team

July, 10, 2012
7/10/12
6:28
PM ET


In honor of the festivities taking place in Kansas City today around the 2012 MLB All-Star Game, it seemed appropriate to compile a roster of All-Injured All-Stars. The qualifiers for this roster were selected from:

• Players who were chosen for this year's All-Star game but could not participate due to injury
OR

• Past All-Stars who might have had the potential to earn another trip in 2012 were it not for the injuries that beset them this year.

The sad fact is that this was a relatively easy list to compile. Outside of one or two spots that required a stretch to meet the inclusion criteria, it was not difficult to find candidates for each position in both the American and National Leagues. Does that make this year any better or worse than previous years? I'm not sure, but it does remind us how much injuries can impact the game. Not everyone who could possibly qualify is listed. Naturally, as with the actual All-Star roster, there will be debate. But like the managers in the All-Star get to select their lineups, these are my picks, undoubtedly influenced by the number of times their names make an appearance in questions fielded during chats, podcasts, blog entries and Twitter posts.



May I present to you the 2012 All-Injured All-Stars?

National League

Howard


Howard


1B: Ryan Howard, Philadelphia Phillies: Howard finally made his 2012 debut just before the All-Star break after he ruptured his Achilles tendon in his last at-bat of last year's playoffs. Complications following an infection slowed his recovery. The Phillies are hoping for offensive contributions from Howard -- and he has delivered a couple of hits -- but since his return, the team has yet to earn a victory. Howard is still not a daily player as he is easing back into the lineup, and even he acknowledges his leg is not likely to return to 100 percent until next year.

Utley


Utley


2B: Chase Utley, Philadelphia Phillies: Like his fellow infielder on this roster, Utley started the season on the DL and only recently returned to action. Working through chronic patellofemoral pain (pain under the kneecap), Utley underwent an intensive, focused rehabilitation program to be able to get back to baseball. It was slow and deliberate, but how long he will be able to hold up once he is playing on a regular basis is unknown. The Phillies like what they see so far; a couple of home runs, a few RBIs and, most importantly, no setbacks. If only that can last.



Tulowitzki


Tulowitzki


SS: Troy Tulowitzki, Colorado Rockies: Tulowitzki was bothered intermittently by groin pain this season, but a setback during a rehab assignment led to eventual surgery to debride scar tissue from around a nerve. Tulowitzki was projected to be out approximately 6-8 weeks following the procedure, which translates to an August return. Until he resumes baseball activities, it will be difficult to assess how close he is to seeing any game action.

Zimmerman


Zimmerman


3B: Ryan Zimmerman, Washington Nationals: Zimmerman has certainly been playing like an All-Star ever since receiving his latest cortisone injection in his right shoulder. The big question on everyone's mind is whether it will last. Zimmerman initially had trouble with the shoulder in April, which ultimately landed him on the DL. Even after the time off, Zimmerman continued to have discomfort and it showed at the plate. In June, there was discussion about a cortisone shot or even another DL stint. The shot seems to have done the trick, though, and hopefully when post-All-Star play resumes, Zimmerman's shoulder will still be feeling good.

Lucroy


Lucroy


C: Jonathan Lucroy, Milwaukee Brewers: Admittedly, this is a bit of a reach, but Lucroy was batting .345 when he went out with a broken hand in May and there was abundant chatter about his potential selection to the 2012 All-Star roster. Exhibit A from the Milwaukee Journal-Sentinel in May: "He has five homers and 29 RBIs in addition to his gaudy batting average, putting him in the conversation for an All-Star Game appearance." Who knows what might have been? Instead, Lucroy is working his way back toward a return. He has been throwing and running, and was recently cleared to start swinging a bat, putting him on pace to return in late July.



Kemp


Kemp


Lucroy


Stanton


Werth


Werth


OF: Jayson Werth, Washington Nationals; Giancarlo Stanton, Miami Marlins; Matt Kemp, Los Angeles Dodgers: Werth qualifies for the most dramatic injury after he broke his left wrist when his glove caught in the grass as he was attempting to make a sliding catch. To complicate matters, this was the same wrist on which Werth had undergone a prior surgical procedure in 2006. The initial timetable for Werth was projected at three months, but the good news is that he is expected to start swinging a bat sometime after the All-Star break. Let's see how his wrist tolerates those swings before thinking about upping his return date.

Stanton was a late scratch from both the All-Star Game and the Home Run Derby when he was removed from Saturday's game with soreness in his right knee. After undergoing surgery Sunday morning to remove loose bodies, it will be a few weeks before he is ready to return.

Kemp has missed more time this year than he has at any point thus far in his career because of a finicky hamstring strain. Known for his ability to play virtually every day over the past few years, Kemp was reluctantly forced onto the DL in the hope of preventing a more serious injury. He then had to return to the DL when the hamstring acted up in only his second game back. Kemp's timetable has been slower this time around and he was deliberately kept on a lengthier rehab assignment to force more situational running. Everything seems to be pointing to his return to the lineup this Friday when the Dodgers are back in action.

Carpenter


Carpenter


Halladay


Halladay


SP: Roy Halladay, Philadelphia Phillies; Chris Carpenter, Cardinals: The Phillies tie the Nationals with the most members on this NL roster, but the Phillies win in terms of the importance of the players lost to their team (no hard feelings, injured Nationals). To go along with starting infielders Utley and Howard, the Phillies lost one of their most durable and consistent starters in Halladay, who was forced onto the DL with a strained lat. Despite his denials, it seemed as though the injury was affecting him, even if in a subtle manner, since the spring and ultimately the discomfort caught up to him. Halladay has been sidelined since late May but has been steadily progressing in his throwing program. He is expected to make a rehab start Thursday, and the Philadelphia Inquirer reports that if all goes well, he could then rejoin the Phillies for a Tuesday start against the Dodgers.

Carpenter has been either very good or very injured. This year, unfortunately, it was the latter and he was plagued by weakness in his throwing shoulder since the spring. Tests confirmed thoracic outlet syndrome (which he has actually been dealing with for several years but has progressed to the point where he can no longer pitch) and Carpenter is scheduled for surgery later this month. The rehab is long and there are no guarantees, but Carpenter hopes to be able to pitch again next season.

Wilson


Wilson


RP: Brian Wilson, San Francisco Giants: What a difference a year makes. Last year, Wilson was participating in the All-Star Game. This year he is recovering from Tommy John surgery No. 2. Wilson struggled late last season and even had his elbow examined after it was causing him discomfort. The hope was that the offseason rest had helped sufficiently, but it didn't take long to find out that was not the case. Just two weeks into the season, Wilson was done and headed for Dr. James Andrews' office. Whether he will be available to pitch at the start of next season remains uncertain.

American League

Youkilis


Youkilis


1B: Kevin Youkilis, Chicago White Sox: Whether it was his back injury that landed him on the DL this spring or his general malaise while in the murky Boston Red Sox situation, Youkilis was not performing up to par. The three-time All Star -- who also spent the offseason recovering from surgery to address a core muscle injury -- was not going to be making this year's Midseason Classic. It's worth noting, though, that his performance thus far with his new club has certainly been reminiscent of the Youkilis of old.

Pedroia


Pedroia


2B: Dustin Pedroia, Boston Red Sox: A partial tear of a thumb muscle is likely to blame, at least in part, for Pedroia's struggles at the plate in June. Pedroia was not voted into the 2012 All-Star Game, which may be just as well, because he suffered yet another thumb injury just last week. A diving play resulted in an injury to the volar plate of Pedroia's thumb, the fibrocartilaginous tissue deep in the joint that helps block hyperextension. He is expected to miss several weeks.



SS: None: There were no real candidates for this position based on the inclusion criteria. Something tells me this should make AL shortstops a bit nervous about the second half of the season.

Longoria


Longoria


3B: Evan Longoria, Tampa Bay Rays: Longoria partially tore his left hamstring at the end of April, and his return at this point is anything but certain. In June, he appeared on course, but a rehab outing was cut short when Longoria again felt discomfort in the hamstring. Since that time, there have been wavering suggestions as to when Longoria might resume baseball activities, something which has yet to occur. According to the Tampa Bay Times, manager Joe Maddon said he has no idea when Longoria can return. He then offered perhaps the most precise summation of the challenge of dealing with a partially torn hamstring: "It's a tough injury to overcome and a tough injury to battle back from."

Martinez


Martinez


C: Victor Martinez, Detroit Tigers: The former All-Star underwent surgery in January to repair both the lateral and medial menisci along with a microfracture procedure. His progress has been understandably slow in order to protect the delicate spots on the knee where the microfracture was performed. Based on a recent MRI and clinical evaluation to assess his progress, the Tigers have indicated the soonest (note: soonest) Martinez would return is middle to late September.

Sizemore


Sizemore


Ellsbury


Ellsbury


Crawford


Crawford


OF: Carl Crawford and Jacoby Ellsbury, Boston Red Sox; Grady Sizemore, Cleveland Indians: Just imagine what this outfield could look like when healthy. It's actually difficult to do, as these three players have dealt with extended absences over the past few seasons.

To be fair, Crawford's absence in 2011 was a virtual one; he was healthy but merely a shadow of himself. Then in the offseason, he injured his left wrist and had to undergo surgery to debride a fibrocartilage tear in the joint. A slow recovery was followed by a setback, and just when he seemed on the verge of beginning a rehab assignment, he had elbow pain. It turned out to be a partial tear of his ulnar collateral ligament. No surgery was immediately required (there is some discussion about Crawford having surgery eventually) and he recently embarked on a rehab assignment. That assignment was interrupted by a mild groin strain, and again Crawford's return date has been pushed back. The Red Sox are hoping they will have him in the second half of July.

Ellsbury was hurt early in the season on a collision, which resulted in a shoulder subluxation. He too has started a rehab assignment, and while there is no firm commitment to a date, it sounds as if he could rejoin his team by the weekend.

As for the three time All-Star Sizemore, his healthy days seem to be far fewer than his unhealthy ones in recent years. This year, he is recovering from back surgery, and there is always some question about the true health of his knees. He has actually started a running program and a rehab assignment could be in the not too distant future. No one is counting on a specific date but the Indians would love to see him back on the field at some point in the second half.

Haren


Haren


Sabathia


Sabathia


SP: C.C. Sabathia, New York Yankees; Dan Haren, Los Angeles Angels: Sabathia did not want to go on the DL for his mild left groin strain, but the Yankees did not want him to be hurt in September. And so he went. After all, better to rest a minor groin issue now than have compensations turn into a shoulder or elbow injury later. The good news is that he is doing well and is expected to return shortly after the All-Star break.

Haren has never even been on the DL until now. Considering he's pitched in the majors for 10 years, there should be a special All-Star category for that alone. Haren did admit that the stiff back that sent him to the DL has been bothering him since the spring, and he felt his performance was hindering the team. The Angels are hoping for a brief stay.

Rivera


Rivera


RP: Mariano Rivera, New York Yankees: Rivera, a medical marvel when it comes to pitching and baseball, suffered the unlikeliest of injuries when he tore his ACL while shagging fly balls during pregame batting practice. The 42-year-old closer quickly made it known that this would not be his exit from baseball. While no one has ruled him out from a late-season return, even Yankees general manager Brian Cashman has said he does not expect him back in 2012. No matter what the return date, the fact that he is making such good progress is encouraging.

A handful of top players could be back in action right after the All-Star break. Let's take a look at some players lingering on your DL who could be back in your lineup sooner rather than later.

• Now that Lance Berkman is back with the St. Louis Cardinals, the hope is that he'll be back on the playing field in the not-too-distant future. Berkman is recovering from meniscus surgery (remember when the worry was that he might have retorn his ACL?) and was originally projected to return in 8-10 weeks.



He recently told the St. Louis Post-Dispatch that his knee was "over the surgery," suggesting he merely needed to get in baseball shape. Getting the conditioning back is truly part of getting past the surgery, but to be fair, Berkman has undergone multiple procedures on his knees over the years and has a pretty good idea of what it takes. He sounds optimistic about a return shortly after the All-Star break. It may turn out to be a little slower going for his knee once he gets back into action, but it certainly appears the Cardinals will have him available in mid-July.

[+] EnlargeMatt Kemp
Harry How/Getty ImagesMatt Kemp will compete in the Home Run Derby before returning to big league play.
Matt Kemp has been giving glimpses into just how good his hamstring is feeling -- running on the field to celebrate with his teammates, or just plain running during speed work -- but now the real test begins.



Kemp, who will not participate in the All-Star Game despite being voted in by the fans, has been cleared to begin a rehab assignment Tuesday. According to the Los Angeles Times, Kemp will travel to Kansas City to participate in the Home Run Derby. If all goes well in rehab games, he could return to major league play on July 13, when the Dodgers begin a home series against the San Diego Padres. One thing is certain: the Dodgers will have Kemp participate in more rehab games this time around. When Kemp suffered his initial hamstring injury, he passed every test with flying colors and played in two rehab games without incident. His first major league game after that initial injury also went without incident. In his second game, however, Kemp experienced the dreaded tightening in the back of his left thigh; his frustration was apparent as he broke a bat over his leg before exiting the dugout.

Even Kemp acknowledged at the time of reinjury that he would likely be headed back to the DL (he was) and that it would perhaps take longer to get healthy (it has). An MRI showed another strain higher up in the hamstring and swelling in the previously injured area, according to Dodgers head athletic trainer and physical therapist Sue Falsone. Despite passing all field tests, nothing reproduces the unanticipated demands on the hamstring quite like playing in a game. Situational running, whether trying to leg out a ground ball or making a defensive play, is impossible to reproduce in drills or practice. The hope is that with a few extra days of game play, Kemp will have an opportunity to increasingly challenge his hamstring, preferably without a setback. This would then help increase Kemp's confidence in his leg, something that can become problematic once there is a second injury. Athletes can become reluctant to press or challenge their leg for fear of suffering yet another setback.

• Meanwhile one of Kemp's teammates, second baseman Mark Ellis, could also be on the verge of return. Ellis underwent an emergency fasciotomy in the middle of May to release pressure and swelling inside the left leg after taking a blow just below the knee. After a fasciotomy, the initial priority is allowing the wound to heal, then increasing range of motion, particularly through the ankle. A gradual return to activity is permitted as the healing allows. Ellis has been on a rehab assignment and is expected to play seven innings in his final rehab game Tuesday, alongside Kemp, according to the Dodgers' website. Ellis could then be activated and join the Dodgers on Thursday.

• Baby steps are still steps. Boston Red Sox outfielders Carl Crawford and Jacoby Ellsbury seemed to be in a state of suspended animation for the last two months when it came to the question of when they might return. The only real news was that they were progressing through rehab. Now however, they are making significant strides toward returning.

Crawford, who started the season on the DL following wrist surgery, then sustained a partial tear of the ulnar collateral ligament in his throwing elbow, has been on a rehab assignment in Florida. He appeared in five games, initially as DH, then progressing to the field, a key test for his elbow. So far, so good. Apparently the medical staff feels the same way Crawford does, moving his rehab assignment to Double-A Portland, according to ESPNBoston.



Ellsbury may not be too far behind. Out since April after suffering a shoulder subluxation, he began his rehab assignment in Florida on Saturday. Ellsbury also began his stint serving as the DH, but has now progressed to seeing some outfield play. Given that his injury is to his glove side, playing defense is an important measure of his recovery. There's no guarantee that all situations can be accounted for during a rehab assignment, but the idea is to account for as many of those possibilities and see how the shoulder responds. One good sign is that his bat seems to be responding; Ellsbury hit a home run Monday. He remains in Florida for now.

Given the time clock of 20 days for position players on a rehab assignment, both Ellsbury and Crawford should be able to join their team shortly after the All-Star break, barring any late setbacks.



[+] EnlargeRyan Howard
AP Photo/Alex BrandonRyan Howard hasn't played since injuring his Achilles on the final play of the Phillies' season last fall.
• The Philadelphia Phillies' Ryan Howard initiated a rehab assignment in Florida on Thursday, meaning the rehab "clock" has begun ticking. So far, he has been alternating between a DH role and first base. According to The Philadelphia Inquirer, Howard is expected to see an increase in innings in the field Tuesday. The healing of Howard's surgically repaired Achilles is not so much the issue at this point. Instead, it is getting back the feel of playing baseball while not focusing on his leg. Even Howard acknowledges that his leg will not likely be at full strength this year. Most who have undergone this procedure say it takes a full year before the leg really feels back to normal. Still, if he can contribute, even at less than full power, the Phillies will welcome his presence. But how much he'll be able to deliver out of the gate is uncertain.

Drew Storen's timetable has remained fairly consistent since he came out of surgery to remove bone chips from his right elbow. His progress has been steady and he has not experienced any pain in the elbow. Storen's challenge has been taking it one day at a time and not overdoing it during his recovery. His bullpen sessions have gone well; next up is a short rehab assignment. According to The Washington Post, Storen expects to return to the Washington Nationals for the first game following the All-Star break. Given his smooth progression thus far, and the increased extension Storen has in his elbow post-surgery, there is reason to be optimistic about how the second half of the season will shape up for him.

Players whose timetables are unknown

Evan Longoria: The Tampa Bay Rays third baseman has been out since April with a partial tear in his hamstring. After making it to a rehab assignment in June, Longoria experienced discomfort in the thigh in only his second outing, causing him to exit the game before the injury worsened. Understandably, it has been a cautious road back. Longoria has only just been cleared to resume baseball activities. Depending how he tolerates resuming hitting, ensuing running and field drills will determine when he will make his next attempt at a rehab assignment. Longoria still looks to be several weeks from a return.

Chris Carpenter: Despite taking some positive steps in his return to throwing, the St. Louis Cardinals' ace continued to experience episodes of weakness in his throwing shoulder. That led to consultation with a vascular surgeon in Dallas, and a diagnosis of thoracic outlet syndrome, a condition not uncommon in pitchers, in which nerves and/or arteries between the neck and shoulder can be compromised, resulting in symptoms into the arm.



In Carpenter's case, there is no immediate surgery planned, suggesting the source of the symptoms is more neurogenic (nerve-related) than vascular (circulatory). "If I can pitch, that's what I'm going to do," Carpenter told the St. Louis Post-Dispatch. "If I can't, then we come up with another plan." The outcome is still tenuous at best and will continue to be a day-to-day assessment based on how Carpenter feels. Surgery may still be an option, just not one Carpenter is intending to pursue right now.

Update (5:38 p.m.): Carpenter is now scheduled to undergo surgery later this month, and will miss the rest of the season. According to Cardinals general manager John Mozeliak, recovery time is three to six months, so the team hopes to have him ready for spring training next year.



Stephania Bell joins the Fantasy Focus Baseball podcast to discuss a number of injury issues around the majors including:

• The return of Brian Roberts

• Recent injuries to Yoenis Cespedes, Adam Dunn

• A setback for Troy Tulowitzki

• Updates on the potential returns of Jacoby Ellsbury, Emilio Bonifacio, Jered Weaver, Chris Carpenter, Drew Storen, Evan Longoria and Chase Utley.

Click here to listen to the podcast.



Stephania Bell and Michele Steele review the latest injury news, including:

Joe Mauer's hand injury

• The recovery time for injured Philadelphia Phillies' stars Chase Utley and Ryan Howard

• The timetable for the return of Boston Red Sox outfielders Carl Crawford and Jacoby Ellsbury

• Good news for the San Francisco Giants' Pablo Sandoval



Arizona Diamondbacks center fielder Chris Young took a flying leap while making a big play Tuesday, and his right shoulder crashed into the outfield wall. He made the catch but the wall made a mark, at least a 15-day mark, as Young was placed on the DL Wednesday. Clearly in discomfort as he lay on the ground for several moments following the impact, Young was able to eventually get up on his own. As he walked off the field, he raised his left hand up toward his right collarbone and shoulder, as if he were cautiously checking to make sure all was still intact. According to the Arizona Republic, Young later indicated that he was specifically concerned about his collarbone after the crash, but X-rays showed no fractures. Even in the absence of a break, the possibility of a variety of soft tissue injuries exist after such a collision and, as is sometimes the case, more detailed imaging can reveal more subtle bone injury. Young, who did not return to the game following the injury, is scheduled for an MRI on Wednesday to further evaluate the area. "I can't lift it right now," Young said, adding, "We'll see. ... All we can do tonight is ice it, do a little [electric-stimulation] machine on it and hope it feels better in the morning." Inability to lift the arm overhead is not uncommon acutely in the presence of pain and swelling, even when the injury itself is relatively minor. For now the team is calling Young's injury a shoulder contusion, or deep bruise, which the Diamondbacks hope is the extent of it. Stay tuned for details.

[+] EnlargeChris Young
AP Photo/Ross D. Franklin Chris Young is on the DL after getting hurt making this catch on Tuesday.
Young isn't the only outfielder ailing right now. Teammate Justin Upton has a left thumb injury suffered in the first week of the season (those darned headfirst slides!) that has continued to nag at him ever since. Upton consulted Tuesday with Dr. Don Sheridan, a hand specialist (incidentally, Sheridan is the surgeon who operated on Boston Red Sox outfielder Carl Crawford's wrist), who confirmed the initial diagnosis of a bone bruise and drained the thumb of fluid, according to the Republic. While the team is still hoping Upton can avoid a trip to the DL, it does remain a possibility. Upton has essentially played through the injury but will likely rest a couple of days after having it drained (he did not play Tuesday and is not in the starting lineup Wednesday). The thumb is critical for bat grip and control and although Upton has managed to stay in the lineup thus far, we have seen how lingering thumb injuries can sap a hitter's power (the Atlanta Braves' Jason Heyward in 2010 comes to mind, also injured his thumb on a headfirst slide, played through for a while, then went on DL). The Diamondbacks will likely see how Upton responds over the next several days before making a decision.

No "immediate" surgery for Ellsbury


According to ESPNBoston.com, Boston Red Sox manager Bobby Valentine indicated that Jacoby Ellsbury will not require immediate surgery on his injured right shoulder, a decision arrived at following consultation with Dr. Lewis Yocum. Yocum reviewed Ellsbury's MRI results after which "there was a consensus of opinion on both the damage and how to proceed," Valentine said. Now the focus is on rehabilitation for Ellsbury, working towards gradually restoring range of motion and strength before ultimately returning to baseball activities. As noted here on Monday, there will be challenges for Ellsbury to overcome both offensively and defensively in his recovery from this injury.



The key word here may be "immediate." While avoiding surgery, especially in the shoulder, is always preferable if not absolutely necessary, there are sometimes situations where surgery becomes an option down the road. Since we do not have any details as to what soft tissue damage was specifically present, it is impossible to know what exactly Ellsbury is dealing with other than pain, swelling and weakness which would accompany any subluxation. What can be assumed is that no one saw anything on imaging so severe that it would require immediate surgical attention. We have seen players successfully play through various soft tissue injuries, then undergo surgery once the season ends. (Successful in this context means showing up to play on a regular basis. It may or may not mean performing at the level typical of that athlete.) We have also seen players rehabilitate fully from similar injuries and return to play at a high level with no follow-up procedure required. The translation then is that there is hope for a positive outcome in Ellsbury's case but until we see him back and performing as he was pre-injury, nothing is certain. The Red Sox have not issued a timetable but given the injury, expect Ellsbury to be out for at least a month.

Baker ends up with Tommy John surgery


Many were surprised to learn that Minnesota Twins pitcher Scott Baker, who went into surgery anticipating a repair of his flexor tendon, emerged with a new ulnar collateral ligament (UCL). In other words, Baker underwent Tommy John surgery. The hardest part undoubtedly for Baker was learning when he woke up how long his rehab just became. On the other hand, he has to feel somewhat validated for the struggles he has been having with his elbow for some time. It's also worth noting that this scenario is not unheard of in the world of sports medicine. The UCL is a complex structure with multiple bands, and even a partial defect can render an athlete incapable of throwing. The athlete's elbow can still appear stable on clinical exam and imaging may be imperfect. To further complicate the issue, pitchers often have tissue changes visible on MRI which are the normal consequence of repeated throwing, hence the need to put the patient's history, clinical exam and imaging together to come up with the most likely diagnosis. And even then, as is evidenced by Baker's situation, there is no better way than actually visualizing the anatomy during surgery to be certain. Unfortunately, surgery is an extreme way to diagnose and comes with its own set of risks and potential complications, which is why it is generally viewed as a last resort. While the rehab Baker now faces is going to be lengthier than what he envisioned before he went under the knife, at least he can rest assured that structurally, there are no more questions.


Friday the 13th indeed


And people wonder why baseball players are superstitious.

On Friday, April 13, nearly two years to the day since he suffered what would become essentially a season-ending rib injury, Boston Red Sox outfielder Jacoby Ellsbury made an ill-fated slide into second base, trying to take out Tampa Bay Rays shortstop Reid Brignac. Turns out Brignac's backside, which landed on Ellsbury's outstretched arm, did the taking out. Ellsbury, who seemed in considerable pain immediately after the collision, left the game with his arm held against his side, a common instinctive protective position when the shoulder is injured. The Red Sox issued a statement which read, in part, "An MRI was performed and showed findings consistent with a subluxed shoulder. We are in the process of gathering further information and determining the treatment plan."



[+] EnlargeJacoby Ellsbury
AP Photo/Charles KrupaAfter a breakout 2011 season, Jacoby Ellsbury is likely out for two months.
Although it is widely expected that Ellsbury will be out at least six to eight weeks, the team's official website noted Sunday that more tests will be forthcoming as the swelling in Ellsbury's shoulder subsides. Swelling often makes initial visualization of the soft tissue structures difficult, so subsequent testing is often indicated. At this point, it is fair to say that the full extent of Ellsbury's injury is not yet known.

What is known is that Ellsbury suffered a subluxation of his right shoulder (where the arm bone [humerus] slips beyond its normal range within the joint but does not completely dislocate). While subluxations are often thought of as less traumatic since they do not require medical assistance to "reduce" the dislocation (put the arm back in place as it were), that may not necessarily be the case. When any joint moves out of its normal alignment, there is a risk of damage to the surrounding soft tissues. In the case of the shoulder, the most vulnerable structures are the labrum (the cartilage ring around the joint which enhances its stability), the capsule (fibrous tissue around the joint) and the ligaments which also help stabilize the joint. Additionally, depending on the mechanism and direction of dislocation, the cartilage surface on the humerus can be damaged. In a 2007 study published in the American Journal of Sports Medicine looking at shoulder instability events in military cadets, the authors found many injuries associated with subluxation to be just as serious as those with dislocation. In fact, labral injury and cartilage damage, typically associated with dislocation, were often present in subluxation events.

The news thus far can be viewed as either glass half-full or half-empty, depending on one's outlook. Since the injury was to Ellsbury's right shoulder, his non-throwing side, returning to make throws from the outfield will not be a huge obstacle for him to overcome. But, the injury is to his glove side, which makes fielding potentially problematic. Outfielders have to be able to make diving catches with the glove arm outstretched, a particularly vulnerable position for a shoulder with any hint of instability (this is, after all, the position Ellsbury's shoulder was in when he was injured). At the plate, Ellsbury's injured shoulder is his lead shoulder. If there is any residual instability, particularly in the form of labral injury, it could very easily affect his swing. The painful catching sensation that accompanies lead shoulder instability on the follow-through of a hitter often forces him to shorten his swing or alter his angle, whether consciously or unconsciously, to avoid veering full speed into the discomfort at the end of that motion.



Rays outfielder B.J. Upton and Marlins third baseman Hanley Ramirez both underwent surgery to repair labral tears on their lead shoulder, as did Ellsbury's teammate and fellow lefty, first baseman Adrian Gonzalez. They all came back to a high level of performance but there is no doubt that it takes time. Again, there is no word as of yet as to whether Ellsbury sustained any significant soft tissue damage, but it is worth noting that labral tears do not heal on their own. And so, we wait.

As fantasy owners await further updates on Ellsbury, for replacement options be sure to check out Eric Karabell's blog entry dedicated to just that topic.

Another closer's season ends very early

[+] EnlargeBrian Wilson
Chris Humphreys/US PresswireBrian Wilson likely finishes the season with just one save.
Disappointed as everyone may be, few are completely shocked by the news that Brian Wilson has an elbow injury which is expected to sideline him for the remainder of the season. After all, Wilson struggled with the elbow late last year, even paying Dr. James Andrews (who performed Wilson's first Tommy John surgery while he was at LSU) a visit. At the time, Wilson was given clearance to proceed with a conservative approach. After a DL stint in August, Wilson made a brief reappearance before being shut down for good in late September.

This spring, the San Francisco Giants proceeded cautiously with Wilson, ramping his activity up slowly and limiting his Cactus League appearances. But it didn't take much once the season began to effectively put an end to Wilson's season. Wilson indicated that he sustained the latest setback with his elbow during Thursday's outing against the Colorado Rockies and an MRI confirmed structural damage. The specifics of the MRI were not detailed, but Wilson told reporters that he expects to undergo reconstructive surgery, although he is seeking additional opinions, including one from Dr. Andrews, this week.

Although the list of two-timers for Tommy John surgery is not long, if Wilson does indeed head under the knife for a second procedure, he will not be the first closer to do so this season. Joakim Soria of the Kansas City Royals holds that distinction. Soria, who had his ulnar collateral ligament first reconstructed in 2003, underwent his second surgery on April 3 with Dr. Lewis Yocum in Los Angeles. While the data is not nearly as positive for pitchers undergoing a second such procedure -- and the total sample size is notably smaller -- the odds do seem to favor relief pitchers.



It would be easy to complain or to lament one's circumstances given the grim news, but Wilson has gone a step further. Wilson seems to have put his latest injury in perspective, telling reporters he sees it as an "opportunity for me to get a better arm. How's that disappointing?" Talk about finding a silver lining.

The physical therapist in me liked what I saw Thursday when I checked in on the Boston Red Sox as they faced the Tampa Bay Rays in Port Charlotte, Fla. Three key players whose 2010 seasons were cut short by injuries were on the field making plays as if they hadn't missed a beat.

Fantasy baseball owners and Red Sox fans will be happy to know that the team as a whole is on the mend following an injury-plagued 2010 season. Only two key players I wanted to check on did not play Thursday. But second baseman Dustin Pedroia (foot surgery) was out of the lineup only because he will be making the lengthy bus trip to Kissimmee on Friday when the Red Sox face the Houston Astros. And newly acquired first baseman Adrian Gonzalez (shoulder surgery) has taken batting practice and could see game action next week.

Corner infielder Kevin Youkilis was at third base Thursday and played like the seasoned veteran he is, hitting his first double of the spring. Forget that he had thumb surgery in August to repair a torn adductor muscle (at the base of the thumb). Youkilis was hitting and throwing as far back as October, making his injury seem like a distant memory.

Meanwhile, outfielder Jacoby Ellsbury turned in four innings in center field. He didn't manage a hit, but he looked to be in great shape. Most importantly, he didn't make any physical contact with the ground or another player; considering his 2010 woes, that's a good thing. By all accounts, those who have been watching him this spring, including ESPNBoston.com writer Gordon Edes, have been saying he looks solid and appears to be past the rib injuries that plagued him in 2010.

[+] EnlargeMike Cameron
Derick E. Hingle/US PresswireOutfielder Mike Cameron, 38, says he is eager to get back into a baseball groove after offseason surgery to address a sports hernia.
The player who garnered the bulk of my attention, however, was Mike Cameron. The 38-year-old outfielder (who, incidentally, is in better shape than many twenty-somethings) served as a DH on Thursday and put his body through some physical tests. Cameron, who underwent surgery in the offseason to address a bilateral sports hernia, showed no hesitation diving headfirst for third base when he had to return quickly following a lineout. He got up carefully, dusted himself off, then scored on the next play. Two innings later, Cameron took a more traditional foot-first slide into second base but was out as the result of a double play. Perhaps most importantly, from my perspective, Cameron's play was instinctive and aggressive, not guarded or tentative.

After the game, Cameron confirmed that he feels great physically. Although he was the DH Thursday, he has spent time in the field and feels that he has put himself through all the necessary paces to know he's fully healthy.

Pointing out that he has been rehabbing "since Aug. 27, four days after surgery," Cameron says he's physically ready; it's just a matter of getting reps in after being out for so long.

"I've been out of baseball since July," Cameron said. "Now it's just a matter of getting back in the groove. I'm feeling good, and my swing feels more powerful now."

And while he has been out of baseball since July, he was playing hurt long before that. Cameron said he was injured first on the right side, then about 10 days later on the left. Sports hernia injuries most notably sap an athlete's power, making it virtually impossible for him to run. I asked him how he had been able to last as long as he did. Cameron acknowledged that he lost his power -- both in the field and at the plate -- but he wanted to try to keep going as long as he could. He would play one day, then take two off, but eventually it was time to shut it down for the season.

"It was tougher mentally than anything," said Cameron when speaking about the lack of energy he felt from his body when trying to perform. "But I had to adjust to what was given to me. I think it's good for me now to understand what the body goes through."

Cameron says he is focused on staying healthy, and he stays loose in the dugout -- he has extra energy to burn when serving as the DH -- by doing simple exercises and stretches.

Now that's something a physical therapist likes to see.


Some say it's the year of the pitcher. I say it's the year of the thumb.

We seem to have a trending injury every year. While a review of recent injury patterns does not support the notion that there are any statistically significant differences from one year to the next, it always feels like there is some "hot" injury in any given season. This season is no different and the hot spot is the thumb.

DeJesus
AP Photo/Kathy WillensDavid DeJesus injured his left thumb crashing into the Yankee Stadium wall trying to track down an eventual Derek Jeter inside-the-park homer.
Sure, there have been the usual array of injuries involving the ulnar collateral ligament (Minnesota Twins closer Joe Nathan), the abdominal oblique (Milwaukee Brewers ace Yovani Gallardo) and the hit-by-a-pitch broken hand (Colorado Rockies power hitter Tory Tulowitzki). There have also been a couple of injuries that are so unusual, you might not see them again in five, 10 or 15 years (Joel Zumaya's fractured olecranon and Jake Peavy's detached lat tendon).

But there has also been an odd cluster of thumb injuries. Not only are there a number of high-profile players who have dealt with some sort of thumb injury (Jason Heyward, Aramis Ramirez, Chase Utley, Victor Martinez, Shin-Soo Choo, to name a handful) but the frequency seems to be on the rise. Whether it's the result of a headfirst slide (Utley, Heyward), an awkward bend to the glove hand (Choo) or a foul tip (Martinez), the injury is typically serious and results in missed time. The amount of time varies depending on the severity of the injury and whether surgery is required, but in many cases it translates to a DL stint.



So while we celebrate the fifth no-hitter of the year (congratulations, Matt Garza), I still say the thumb outranks the pitcher in 2010, especially when it comes to this blog. Just ask the Kansas City Royals' David DeJesus, who will watch the rest of the season from the sideline thanks to the outfield wall that sabotaged his thumb.

Let's not let the thumbs steal all the injury thunder though. There are plenty of alternate ailing body parts to go around this week and we start with those in the lower half.

Magglio Ordonez
Tony Ding/Icon SMIMagglio Ordonez's fantasy usefulness screeched to a halt as he limped off the field Saturday.
Magglio Ordonez, OF, Detroit Tigers: The headfirst slide has been a topic of much discussion because of the injured thumbs that have resulted this year. But there's no guarantee that the foot-first slide is injury-proof. Ordonez found that out Saturday when a traditional slide led to a broken right ankle. He is expected to miss up to eight weeks (and potentially the remainder of the season) while the injury heals. But was the slide itself to blame?



Ordonez, who was already dealing with a sore ankle and was limited to DH duties, was thrown out at the plate while attempting the slide. According to Mark Snyder of the Detroit Free Press, Ordonez's ankle appeared to give way as he was sliding. It's possible that the pre-existing weakness made Ordonez less able to control his ankle on what would normally be an automatic maneuver. Now, it seems, he will be spending the next month and then some working on his ankle strength and stability once the bone heals. Ultimately, he should recover fully from this, but fantasy owners should plan on doing without Ordonez for the remainder of their season.



Carlos Guillen, 2B, Detroit Tigers: When it rains, it pours. Just ask Jim Leyland. After losing Ordonez to the aforementioned ankle fracture last Saturday, the Tigers saw Guillen exit later that day with a right calf strain.

The good news is that Guillen's injury does not appear to be serious and he is expected to return at the end of his 15-day DL stint. In fact, Guillen is likely to resume baseball activities within a week, according to the Detroit Free Press, and assuming no setback, should be ready to return when eligible. Guillen has experienced some issues with his calf since mid-June resulting in intermittent days off to rest it. Given that this was not his first episode and knowing how disabling a significant calf strain can be (Philadelphia Phillies shortstop Jimmy Rollins has endured two DL stints this year because of it), the Tigers are fortunate -- for once -- in that this should not cost Guillen excessive time.

Ben Sheets, SP, Oakland Athletics: Remember when everyone was buzzing about Sheets' January throwing sessions for scouts when he was looking for a team after his flexor tendon repair? And remember when the A's picked him up at the exorbitant price tag of $10 million for one year?

Ben Sheets
Jason O. Watson/US PresswireBen Sheets had stayed relatively healthy until recently, although he's just 4-9 with a 4.53 ERA this season.
Here's an excerpt from our fantasy draft kit where we talked about thoughts on Sheets from an injury perspective heading into 2010:

The concern is not so much in the recovery of this particular injury. Overuse of the flexor-pronator (the muscle group on the front side of the forearm that controls downward wrist motion and some forearm rotation) is not uncommon in pitchers and failure (or partial failure) of the tendon (which anchors that muscle group to the bone at the inner aspect of the elbow) is not unusual. ... The issue is whether the flexor tendon tear is an isolated injury or whether there is other structural damage present which, even if insignificant now, could manifest itself in the future. Where is a crystal ball when you need one?

Sheets had plenty of time to recover from this particular surgery in advance of the 2010 season. Unfortunately, there is no true way of knowing how long his health will hold up.

It seems as if some of those preseason concerns are indeed manifesting themselves. Sheets, on the DL and out indefinitely, has had recurrent problems with swelling in his throwing elbow, which suggests that there are bigger issues lurking beneath the surface. The San Francisco Chronicle reports that Sheets is scheduled to visit his orthopedic surgeon, Dr. Keith Meister, on Tuesday and the team will wait until that visit is complete to discuss his condition. Given that Sheets already indicated that the problem could be season-ending, there is not a lot of reason to be optimistic.

More definitive details regarding Sheets' diagnosis should be forthcoming shortly but it's safe to say that recurrent swelling and discomfort in a pitcher's throwing elbow is never good. Fantasy owners should begin making alternate plans if they haven't already.

And dare we say it ...

Colorado Rockies shortstop Troy Tulowitzki is expected back in the lineup Tuesday. Last week we said all signs were positive as Tulowitzki headed to a rehab assignment. Indeed they were. Tulowitzki has shown manager Jim Tracy enough to warrant rejoining the team. Fantasy owners should bear in mind that he is just shy of six weeks since the injury, pretty much close to his original timetable. There may be a delay between Tulowtizki returning to the lineup and Tulowitzki returning to hitting over .300.

Jacoby Ellsbury
Elsa/Getty ImagesJacoby Ellsbury has not played since May 24.
Boston Red Sox outfielder Jacoby Ellsbury started a rehab assignment, a significant step in his comeback efforts from multiple rib fractures. Ellsbury played DH on Monday with the Red Sox's rookie league team, going 1-for-3. Clearly he still has a way to go before returning to the majors, but getting back to facing opposing pitchers was an important target. The Boston Globe reports that Ellsbury could be moved to Triple-A Pawtucket this week if all continues to go well, perhaps as early as Wednesday. While the Red Sox, for obvious reasons, are reluctant to offer a specific timetable for Ellsbury, his rehab calendar suggests that he will rejoin the team within the next 2-3 weeks. Given his much more gradual progression back this time, fantasy owners can have more confidence in his return.

New York Yankees lefty Andy Pettitte is feeling good in his recovery from a left groin strain. Pettitte told the New York Daily News that he is "not having any problems at all." Of course he is quick to add that he hasn't done much other than play catch in the outfield. There are still a number of hurdles to cross before Pettitte can consider rejoining the rotation and the team will be cautious for reasons outlined in a previous blog, meaning the original timetable of 4-5 weeks may yet hold. Nonetheless, the fact that Pettitte is not having any pain is a positive sign.

Dan Haren, the new addition to the Los Angeles Angels' pitching staff, suffered a bruised right forearm when he absorbed the brunt of a comeback line drive Monday. Haren will be evaluated Tuesday to ensure that this is indeed just a soft tissue injury to his throwing arm. Obviously any sort of bone injury would translate to significantly more missed time. Not what the Angels want to see happen the day after they make a trade.

From my mailbag:

Adam (Los Angeles): Maybe a paragraph on Andruw McCutchen would be nice.

Stephania Bell: Thanks, Adam, for writing. Hopefully you were able to sneak McCutchen into your fantasy lineup for this week! But for those who may still be wondering about the nature of his injury ...

McCutchen suffered an injury to his AC (acromioclavicular) joint when he made a diving catch in the outfield. The AC joint is where the acromion (tip of the shoulder) meets the clavicle (collarbone) and is easily sprained (meaning the ligaments that support the joint are injured) by a fall onto the point of the shoulder. An injury here makes overhead movement difficult, but general soreness around the shoulder could potentially limit most baseball activities, including batting. Because McCutchen made his return to the Pittsburgh Pirates' lineup Sunday, it confirms the original projection of a mild injury and unless he happens to dive and land on it exactly the same way, he should be fine going forward.

This week brought more thumb-wringing for fantasy owners, and not just because of the headfirst slides that sent two potential NL All-Stars -- Jason Heyward and Chase Utley -- to the DL recently. The head-first dive (in an attempt to catch a fly ball) made by Cleveland Indians outfielder Shin-Soo Choo stung quite a few teams as well.

Shin Soo Choo
Steven King/Icon SMIShin-Soo Choo is going to be watching baseball, not playing it, over the next few weeks.
The good news: It appears Choo will not need surgery on his injured thumb. The bad news: He has a sprain, and the Indians could be without him for several weeks. Any sprain of the thumb requires a period of immobilization to allow the involved ligament(s) to heal. The no-surgery decision suggests that the bone was intact and that there was little to no instability, but in order to prevent the injury from worsening, it must be rested adequately. Choo owners can breathe a sigh of relief but still should prepare to be without him for a while.

It seems as if the run-up to the All-Star Gamehas been filled with as much injury news as at any other point this season, and the timing of the three-day break in the midst of DL assignments makes interpreting these injuries a bit more difficult. Teams benefit from the three-day break since the days do count toward the 15-day minimum of a disabled list stint. In other words, a player is able to sit out three days but not miss any games during that time. Without that break, the DL might be less attractive, especially if a team could return a player after 10-12 days for an important series.

Put a different way, if there is any question right now as to the severity of an injury and whether there would be a risk in returning the player too soon, the team is likely to move that player to the DL and benefit from a roster replacement. Additionally, if that player is an All-Star candidate, the move to the DL immediately removes him as an option (which also removes the temptation for him to participate in the event and risk a setback) and allows another player the opportunity to take part.

Take these two examples:

Manny Ramirez suffered what the team referred to as a minor hamstring strain last week. By the time he had an MRI two days later, he was showing signs of improvement. While the MRI confirmed the injury, the real question became whether to place Ramirez on the DL or not. If he improved enough within the week, he could be useful in the important pre-All-Star series between Manny's Dodgers and the Cubs. But if he aggravated the hamstring by returning too soon, the Dodgers could be dealing with a longer-term problem. The Dodgers ultimately decided to place him on the DL, and while Ramirez will miss the Cubs series, if he indeed returns when eligible, he won't miss any games beyond that.

Meanwhile, Brewers ace Yovani Gallardo hit the DL this week because of an oblique strain, giving the All-Star Gameyet another injured player. While it already appeared Gallardo would not be able to pitch next week, the official transfer to the DL confirmed it. The Brewers have indicated that Gallardo's strain is minor, but if that is the case, they surely do not want to risk exacerbation by having him throw in the All-Star Game, even if he's feeling better. Opposite-side oblique strains in pitchers (which is the case with Gallardo, a righty with a left oblique injury) average four to six weeks, depending on the degree of injury. If the Brewers believe he can return in a somewhat shorter time frame, then caution is definitely warranted, which explains the DL move.

In addition to the injury scenarios involving these key players, there have been a string of setbacks for a few players who were seemingly on the road to recovery. In turn, there has also been some encouraging news. Let's get to the injury updates:

Erik Bedard, SP, Seattle Mariners (60-day DL, 3/26): It was just too good to be true. All signs pointed to Bedard returning on July 6 from his long absence following shoulder surgery, and right up until the witching hour it appeared he would. But Bedard was scratched from that start because of inflammation in his throwing (left) shoulder. Manager Don Wakamatsu told the Seattle Post-Intelligencer that Bedard is scheduled to throw a bullpen this weekend, and even went on to suggest that if the bullpen goes well, Bedard could potentially be penciled in for a start right after the All-Star break.

Hmm. Color me skeptical. I still maintain my concern about Bedard, and it'll take more than a few bullpen sessions and probably even more than one or two healthy starts for me to believe in him again.

Brad Penny, SP, St. Louis Cardinals (15-day DL, 5/22): Penny has been on the DL so long that fantasy owners might not remember that he ended up there because of a batting episode. Penny hit a grand slam back in May and felt the consequences in the form of a strained latissimus muscle in his upper back. At the time, the diagnosis was positive -- many thought it was an injury to his rotator cuff -- and the early projection was him missing just a few weeks. Obviously that was optimistic. In fact, when it became clear in mid-June that Penny's absence would be protracted, Cardinals general manager John Mozeliak told the St. Louis Post-Dispatch, "The injury was probably underestimated."

But Penny appeared to be making progress recently, and he threw off a mound Monday. As I've often said, though, throwing from a mound is a distinct progression that results in a ramped-up delivery. It is a key testing phase, as setbacks are likely to happen around this transition. And this seems to be what happened with Penny, who could not complete the outing because of soreness in his throwing shoulder. The St. Louis Post-Dispatch reports that partway through the session, Penny complained of stiffness in his triceps, near the location of his original injury. Penny is scheduled for additional evaluation Wednesday, including an MRI, but the team remains hopeful that this is not a significant setback. Given that Penny had just begun throwing from a mound, fantasy owners should presume at least a few weeks (rest, return to throw, throw from mound, rehab starts) before he returns.

Etc.


Meanwhile, yet another member of the Red Sox left a game (Tuesday) because of an extremity injury. Kevin Youkilis left Tuesday's game in the fourth inning because of a right ankle injury, but before anyone gets too upset, please note that Youkilis has already hinted that he could play Wednesday. According to Associated Press reports, Youkilis' ankle acted up in a bizarre fashion. Youkilis described it as feeling "like I had a cramp in my ankle." Assuming this turns out to be nothing significant, Youkilis might still make the All-Star roster. If so, he'd be one of the few Red Sox candidates healthy enough to play. For instance, teammate and starting pitcher Clay Buchholz was not so fortunate; even though his left hamstring strain is considered minor, he could not avoid the DL, and his placement on the list forfeited his spot on the All-Star roster.

Jacoby Ellsbury
Elsa/Getty ImagesJacoby Ellsbury (ribs) is finally making progress.
On the good-news front, Red Sox outfielder Jacoby Ellsbury might be back with his team this weekend. Last we heard, Ellsbury was still recuperating in Arizona while working out at Athletes' Performance. The Boston Globe is reporting Wednesday that Ellsbury could rejoin the team in Toronto if he is ready to resume baseball activities. Fantasy owners need to bear in mind that this would not mean he is ready to return to play, just that he is making progress. A return to actual major league play is still likely weeks away.

Braves outfielder Jason Heyward just might pop up in Anaheim after all. According to the Braves' official website, Heyward's thumb has responded well to the forced rest it received while splinted, and if he continues to progress well, he might take batting practice Friday. Naturally, the primary goal is for Heyward to be ready for competition after the All-Star break, but if he is able to swing freely without pain, it's possible that in addition to making the trip to Anaheim, he might actually participate in Tuesday's game.

The Cincinnati Reds will have pitcher Edinson Volquez back in the rotation soon; it just won't be on July 7, as was originally projected. Volquez, who is coming off Tommy John surgery, had been throwing well in rehab outings, but in his latest appearance he exhibited one of the classic hallmarks of a pitcher returning from this procedure: lack of command. It's no secret that pitchers coming back from Tommy John surgeries often have ups and downs in their first few months back, most markedly in the area of control. According to the Cincinnati Enquirer, that almost assuredly means another rehab outing, which translates to a delayed return. Volquez is not far off and this is certainly not alarming news, but it does serve as a reminder to fantasy owners that this is what you can expect in the near future.



By now, everyone knows that Boston Red Sox outfielder Jacoby Ellsbury suffered four hairline fractures in the ribs on his left side following an April collision with teammate Adrian Beltre. And everyone also knows that after more than a month-long absence, Ellsbury suffered another setback that again sent him to the disabled list. It turns out that Ellsbury sustained yet another rib injury in a different location.

Jacoby Ellsbury
William A. Guerro/Icon SMIJacoby Ellsbury played just three games in late May before returning to the disabled list for a second time.
The following joint statement from team physician Dr. Tom Gill and Los Angeles Angels team physician Dr. Lewis Yocum (who also examined Ellsbury following the second injury) was issued: "An MRI of Jacoby's thoracic spine and posterior rib area, recommended by us jointly, revealed a non-displaced rib fracture and edema in the left posterior-axillary line. This fracture, which is in a different area than the initial fractures and which was not present on previous scans, is likely the result of a new injury which occurred when Jacoby dove and impacted the ground during his brief return to play. Jacoby will require several weeks of rest and physical therapy."

In short, this tells us that the injury was indeed new, it was located towards the back side of the rib cage (along a vertical line through the ribcage which travels downward from the back side [posterior] of the armpit [axilla]), it was non-displaced (meaning the bony ends were in alignment, a good thing indicating that the fracture should heal well on its own) and that Ellsbury's absence would be extended by a few weeks.

The two things that every fantasy owner wants to know are when Ellsbury will return and whether this injury will really be behind him when he does? The answer to the second question is dependent, in part, upon the first. While there is no specific date for his return, it is clear after this setback that he will not even approach returning until the symptoms have completely resolved. The team does not want him to be tentative in his return or be concerned about the risk of yet another injury. Ensuring that he is completely pain-free before he returns helps in that regard, but that takes time.

To help him focus on conditioning and recovery outside of baseball specific activities, Ellsbury is traveling to Arizona to work at Athletes' Performance Institute, according to the Boston Globe. As Gill said, "Sometimes getting a change of scenery can help, both mentally and physically." Ellsbury is expected to refrain from all baseball-related activities for at least two weeks.

Given all of these considerations, it seems highly unlikely that Ellsbury would resurface before the All-Star break, but his return could come soon afterward. The clues will come when he starts to swing the bat and field the ball again and we see how well he tolerates it. He will get past this injury and should be able to deliver a strong second half of baseball, but he needs to remain candid about any persistent symptoms along the way.

The bad news: There are more injured players this week than there were a week ago. The good news: Not every one of them has required a trip to the disabled list.

Take Joe Mauer, for instance. What sounded potentially very serious at first turned out to be not so bad after all. That said, there are several more injured players who still might end up on the DL. It's important to take it all in context, though. It's May. Teams have learned over time that it's better to play it safe in May and have an athlete put the injury behind him. No one wants to lose a star in the middle of a late-season pennant race, especially if it's because of a recurring injury.

On that note, here are the players I'm looking at this week:

Troy Tulowitzki, SS, Colorado Rockies (status unknown): Tulowitzki made an early exit from Sunday's game after making an awkward movement in the fifth inning while attempting to turn a double play. It was later reported that he had suffered a quadriceps (the large muscle on the front of the thigh) strain and that the injury was not considered serious.

Troy Tulowitzki
Jeff Gross/Getty ImagesTroy Tulowitzki left Sunday's gane because of a quad injury.
In 2008, Tulowitzki did suffer a serious quadriceps (or quad) injury that kept him out for months. But it was his left thigh that was hurt two years ago when he actually tore the tendon attachment away from the bone. According to the Rockies' official website, this injury is to his right quad. Tulowitzki described it as "the same spot, but a different leg." His status is currently being described as day-to-day, but he did undergo an MRI on his leg.

The hope here is that Tulowitzki will be able to avoid a trip to the DL, but muscle strains have repeatedly shown us that it's not always clear-cut at the outset. In fact, if the injury is near the tendinous attachment, it might be slower to heal. Given the fact that he has a history of a serious injury in the same area on the opposite leg, it would not be surprising if he is brought back slowly. Fantasy owners should make alternate plans for this week.

Joe Mauer, C, Minnesota Twins (back in lineup): Mauer's deep heel bruise has progressed faster than manager Ron Gardenhire expected when he initially called it a "week-to-week" injury. From last week to now, Mauer has shown drastic improvements. He was able to pinch-hit Saturday (although he struck out and didn't have to run), then served as a DH on Sunday and showed no ill effects from the injury. According to the Twins' official website, Gardenhire said of Mauer, "He was fine, swinging, running the bases. ... He said his foot felt really good." It now appears Mauer will resume catching Tuesday.

Nelson Cruz, OF, Texas Rangers (15-day DL, April 27): It took Cruz a while to be placed on the DL as he tried to play through what he described initially as a hamstring "cramp." A few ups and downs later, it was clear that he needed more time to rest the injury, or he risked making it much worse. The extra few days seem to have been a big help. Cruz has been running full-speed for several days and is now poised to begin a brief rehab assignment.

According to the Rangers' official website, Cruz will travel to Oklahoma City on Tuesday and play two games with the Triple-A club. He is then expected to rejoin the Rangers and be activated Thursday or Friday. There's never any certainty when it comes to hamstring strains, but Cruz has had no flare-ups for several days and appears on track to pick up where he left off.

Chris Young, SP, San Diego Padres (15-day DL, April 7): Young is frustrated, and so are his fantasy owners. Young (shoulder) is not close to returning from his DL stint; in fact, he now has more questions than answers.

Chris Young
Mark J. Rebilas/US PresswireChris Young is still in a holding pattern.
The most puzzling aspect is the timeframe of this particular setback. Young had an unusually smooth recovery and rehab. He traveled the road from August shoulder surgery (for a labral debridement) to return to pitching in spring training without so much as a speed bump. But in April, he began experiencing discomfort. Since proactively going on the DL to make sure he did not exacerbate anything in the shoulder, Young has struggled in his most recent throwing sessions and has not been able to get through a rehab assignment game.

In an effort to get to the root of his persistent soreness, Young had a repeat MRI with contrast, according to the Padres' website, and those pictures were forwarded to Dr. James Andrews for a second opinion. (Contrast scans are often utilized in the shoulder to better visualize the joint.) Young also underwent a standard MRI later in the week, the results of which did not offer anything of note. This is simultaneously both good and bad news for Young. It's good in that there is no major structural issue that would compromise his season, but bad in that Young does not get the definitive answers he is looking for. It is unclear at this time whether Andrews' opinion on the contrast scan has come back.

Presuming there are no new findings, this represents an all-too-common scenario in a pitcher's shoulder. The athlete experiences discomfort and a failure to perform without a clear-cut reason. All a pitcher can do in that case is continue with the rehab process and forge ahead, one small step at a time, as his symptoms allow.

Young is too diligent with his rehab and too determined of an athlete for us to write off his season just yet. Sure, he has had some injury challenges, but one of those was a comebacker that broke his nose and caused small fractures in his skull, hardly something that could have been prevented. In the meantime, it might be time for his fantasy owners to replace him on their roster since it will be another few weeks before he is even re-evaluated and could be much longer still before he returns.

Etc.

Ryan Madson, RP, Philadelphia Phillies (60-day DL, April 30): Here's another example for all you young ballplayers reading out there on why not to hit or kick things in frustration. Those "things" have a way of winning a confrontation. Madson recently broke his left toe when he kicked a metal chair after an outing. And he didn't just give himself a hairline crack. No, he managed to break his toe so badly that it required surgery to insert multiple pins to fix it. The healing process will take so long that the Phillies just transferred Madson to the 60-day DL. The hope is that the team has him back after the All-Star break, but keep in mind that it will be a challenge to keep his throwing arm strong while his toe recovers.

Miguel Montero, C, Arizona Diamondbacks (15-day DL, April 11): All was quiet on the western front when it came to news of Montero's rehab -- until Friday. The Arizona Republic reported that Montero is starting to feel better now, three weeks after having meniscus surgery on his right knee. Although Montero says he'd like to return before the six-week timetable the team set initially, it doesn't sound likely. "The trainers don't want to take chances," Montero told the Republic. "And neither do I. I want to be 100 percent healthy so I don't go out there and hurt myself again." Given that he also indicated he has a ways to go with his rehab, six weeks is looking optimistic.

Mike Cameron, OF, Boston Red Sox (15-day DL, April 20): Cameron (abdominal strain) continues to make solid progress. Apparently he looked good enough in batting practice and drills before Sunday night's game that he is heading out on a rehab assignment. The Boston Globe reports that he will DH on Monday for Triple-A Pawtucket and will progress to playing the field Tuesday. He will then be re-evaluated Wednesday.

Something to remember, though, is that there was some discussion initially as to whether Cameron might need surgery. So far he has been able to move forward with the rehab process, but he has yet to truly test the injury by running at full speed. These types of injuries can be deceiving because an athlete can have no signs or symptoms whatsoever ... until he tries to explode at full speed. While there is reason to be encouraged by how quickly he has come along, count me among the cautious until he crosses this final hurdle.

Jacoby Ellsbury, OF, Red Sox (15-day DL, retroactive to April 12): After several days of taking batting practice, it appears Ellsbury is starting to improve. However, according to The Boston Globe, Ellsbury is not quite ready to join teammate Cameron on a rehab assignment. Since this is a pain issue, along with the fact that Ellsbury's four cracked ribs have had a month of healing, this is not necessarily about fear of reinjury. It really just comes down to performance. The Red Sox need assurance that Ellsbury is comfortable making plays when necessary, going full bore and without hesitation. Until he's ready to test the uncontrolled, unpredictable environment of playing in a game, he will continue with the current program.

Carlos Beltran, OF, New York Mets (15-day DL, retroactive to March 26): Beltran claims he's feeling better since receiving a custom-fitted knee brace on his last visit to Colorado. The big issue at that time was that Beltran was not able to run without pain when tested and was therefore not cleared to return to running activities. Beltran told the New York Daily News that he thinks he will be able to start running soon and that the only limitation is, well, running. He says he is hitting the ball well and feeling stronger, but as he points out, "Running is the thing that will dictate everything." How true that is.

While the brace might help shift some stresses in Beltran's knee, the question is whether it will be enough for him to tolerate the high impact of running. Again, the procedure Beltran underwent in January did not fully restore his knee to pristine condition; the goal was to allow him to be functional. If he can't progress beyond his current status in the near future -- meaning if he can't get to a point soon where he can actually run -- one must wonder what the next step will be.

Brandon Webb
Mark J. Rebilas/US PresswireIt's an important week in Brandon Webb's recovery.
Brandon Webb, SP, Diamondbacks (60-day DL, April 4): Speaking of moving targets on return dates, Webb's has been pushed back too many times to count. His last regular-season game was in April -- of 2009. A few weeks ago, Webb said he felt like he had made good strides in his rehab, according to the Diamondbacks' website. It's important for players who are going through lengthy, arduous rehab programs to find the glass-half-full moments since they must keep themselves motivated. Webb's activity this week will tell fantasy owners whether they should be motivated to keep Webb on their DL roster. He is expected to throw from the mound this week, something he has not yet been able to do consistently because of his shoulder. We will be watching closely to see if the results are different this time around.

Yunel Escobar, SS, Atlanta Braves (15-day DL, retroactive to April 30): Escobar is looking to return from a left adductor (groin) strain this weekend when eligible to come off the DL. Escobar has had no setbacks since taking batting practice and running, according to the Braves' official website. Clearly the most challenging concerns with this type of injury at his position are the explosive, unexpected movements. Just like Rafael Furcal with his hamstring strain and Jimmy Rollins with his calf injury, Escobar as a shortstop needs to demonstrate that he can move quickly without pain or limitation. Assuming he continues well, look for him to return to the lineup Saturday.

Rafael Furcal, SS, Los Angeles Dodgers (15-day DL, retroactive to April 28): Speaking of Furcal, don't forget he is eligible to come off the DL this week. He was operating at close to full recovery when he was actually placed on the DL. Fantasy translation: The team just wanted a little more insurance time and his roster spot, and Furcal should come back full-speed when able to return Friday.

If you have any injury questions you want answered in the blog, drop a note in my mailbag, or stop by my Tuesday chats.



Another week, another slew of injuries. This week, though, in addition to adding names to the injury roster, we learned that several players are going to be spending some additional time on the disabled list. Never music to a fantasy owner's ears but it's always better to be prepared.

Mauer
Gary A. Vasquez/US PresswireJoe Mauer may miss a few more games, but he probably isn't "week-to-week" as Twins manager Ron Gardenhire mentioned earlier.
Joe Mauer, C, Minnesota Twins (day-to-day): Mauer has been dealing with a deep bruise in his left heel since Friday night when a sharp lunge to first base left him in pain. It sounded dire by Sunday when manager Ron Gardenhire described Mauer's condition as "week-to-week" instead of day-to-day. Gardenhire also made it clear the Twins would not be rushing Mauer back, telling the Minneapolis Star-Tribune, this injury is "something you don't screw around with."

It now sounds like it's not as bad as it could have been. According to the Twins' website, an MRI confirmed a soft tissue injury (as in, there is no fracture) and the healing will be assessed on a daily basis. Mauer is reportedly feeling better and is running in a pool to maintain conditioning while eliminating impact that could aggravate the situation. It appears that the Twins have avoided a move to the DL for Mauer ... at least so far.

Rafael Furcal, SS, Los Angeles Dodgers (15-day DL, retroactive to April 28): Furcal has been pestered by a hamstring injury for the last week. On Tuesday, the Dodgers determined that more time was needed and the decision was made to place Furcal on the DL. The issue now is how concerned fantasy owners should be. Does the DL just buy Furcal another week of healing time or is this injury enough to keep him out significantly longer?



Before panic sets in, it appears that the answer is the former. Furcal has been progressing well with his hamstring injury but is not quite ready to resume full speed activity. As a shortstop, he needs to make explosive defensive movements. As a leadoff hitter, he is likely to be exposed to more sprinting situations. Consequently, Furcal is at far greater risk of a setback if he returns at less than full strength. Since it's May and not September, there is no reason for the Dodgers to take that chance. The move to the DL appears to have been largely precautionary. Expect Furcal to return when eligible, barring, of course, a setback.

Manny Ramirez, OF, Los Angeles Dodgers (15-day DL, April 23): Speaking of Dodgers placed on the DL for precautionary reasons, Ramirez began a rehab assignment Tuesday and the news is so far, so good. Ramirez, who suffered a Grade I calf strain, has been running without incident for several days. He is eligible to return May 9 and appears on track to meet that target.

Jacoby Ellsbury
Tom Szczerbowski/US PresswireJacoby Ellsbury would like to be comfortable swinging the bat before he returns from four broken ribs.
Jacoby Ellsbury, OF, Boston Red Sox (15-day DL, retroactive to April 12): Ellsbury continues to recover from the pain that comes with having four broken ribs.



From last week's injury blog: Although it can take four to six weeks for a rib fracture to heal, from the standpoint of activity this is a symptom-based condition meaning whatever he can tolerate, he can do. The fact that four bones were broken, however, tells us that it will take longer to tolerate just about everything.



That statement still holds true. The Boston Globe reported that when pressed for a timetable earlier in the week, Ellsbury declined to provide one, reminding everyone that he does indeed have broken bones "and they need to heal." It may feel like forever to fantasy owners, but it's only been three weeks, very reasonable when you consider his injury.



Ellsbury did take a positive step Tuesday when, according to the Red Sox's website, he took batting practice before the team's game against the Los Angeles Angels. Let's see how Ellsbury feels the day after this new activity before we get too excited. And keep in mind, he likely will require a rehab assignment to get his body back in the groove of playing both offense and defense. He may very well be more than just a few days away from returning. The road back may continue to feel slow, but at least we are seeing some tangible progress.

Jimmy Rollins, SS, Philadelphia Phillies (15-day DL, April 13): A week ago, we pointed out that Rollins had not done any explosive movement that would really test his calf; now we know why. According to the Phillies' website, Rollins still feels discomfort in his right calf when he has to move to his left while fielding ground balls. This makes perfect sense from an injury standpoint. As he makes that initial lateral movement to make a play on a ground ball traveling to his left, he is forced to push his full body weight through that calf muscle. While it might not be bothersome in straight-ahead running, making a quick directional movement from a stationary position requires significantly more power. The discomfort Rollins feels is his calf's way of telling him that it's not healed.

Consequently, the Phillies have expanded the time frame for his return from four weeks to six. This is hardly shocking; we have said from the outset that these injuries are unpredictable and easily aggravated. The Phillies don't want him to come back only to be forced out again. The idea is to have him back for the remainder of the season. Fantasy owners should set their sights on the latter part of May.

Kerry Wood, RP, Cleveland Indians (15-day DL, retroactive to March 26): Last week we said that Wood was scheduled to begin a rehab assignment soon. He did. We also said that when pitchers face live hitters, the adrenaline goes up and the body can react. It's also a time for pitchers to work on their velocity and location. Wood had a chance to get some work in and found out what he still needed to work on before rejoining his team.

Wood may have given up six runs in less than an inning in a rehab outing, but on the positive side, he reported feeling good afterward. Wood told the Akron Beacon Journal, "that's the most important thing for me." Certainly given his injury history that couldn't be more true. Wood may require another couple rehab appearances before he retakes the closer role with the Indians but his return date appears close.



Brian Roberts
J. Meric/Getty ImagesBrian Roberts' seemingly uncertain return frustrates many owners.
Brian Roberts, 2B, Baltimore Orioles (15-day DL, April 10): The quote heard 'round the fantasy world: "It could be three weeks, it could be three months" was Roberts' assessment of his situation, according to the Orioles' website. For fantasy owners wondering whether they should still hold out any hope, it's worth noting that Roberts was quick to add that he did not really think it would be three months.

Nonetheless, we have outlined here in past weeks that Roberts' back condition has the potential not only to linger, but to continue to be problematic across the season. Disc problems are notoriously difficult and this is behaving no differently. Roberts is still very limited in his activity as the team brings him along slowly. Because there are many hurdles to overcome, it is hard to establish a clear timeline. That brings frustration for players and fantasy owners. At this point, it's anyone's guess, including Roberts', as to when he'll be able to return.

Curtis Granderson, OF, New York Yankees (15-day DL, May 2): When Granderson pulled up sharply while rounding the bases Saturday and hobbled toward third base. it was obvious he had pulled something, it just wasn't clear exactly what it was. We have learned that he suffered a Grade II groin strain, and according to ESPN's Buster Olney, Granderson is expected to miss a month.

This is not dissimilar to the Grade II muscle strain that the Phillies' Rollins is dealing with, other than the exact location of the injury. Grade II, also called a moderate strain, represents the widest range of injury somewhere between a minor strain with no visible tissue damage (Grade I) and a complete muscle tear (Grade III). As we have seen with Rollins, it takes time for the tissue to heal, and the most challenging aspect of recovery is regaining explosiveness and speed, a critical component of Granderson's game. Fantasy owners should hope for four weeks, be prepared for six and know that his timetable could still fall outside of those parameters depending how his rehab goes.

Jorge Posada, C, New York Yankees (day-to-day): Posada's calf strain is being called mild following an MRI this week. According to the New York Daily News, Posada is not expected back before Friday. Let's face it, at age 38, these types of injuries are more apt to occur. The most fortunate thing for the Yankees is that the strain was not more serious, like Rollins' was. It looks like this will not land Posada on the DL, but if it doesn't progress as expected, he won't be an automatic start for the weekend series, even if it is the Red Sox. Fantasy owners need to be sure to check pregame lineups.

Etc.

Cliff Lee, SP, Seattle Mariners: If there were any lingering doubts as to how Lee would fare coming off the DL following his abdominal strain, he seems to have put those to rest. Lee pitched seven scoreless innings in his first start of the season while dishing up eight strikeouts.

Mike Cameron, OF, Boston Red Sox: Cameron seems to be progressing nicely with an abdominal strain that initially appeared as if it might require surgery. In fact, he could be headed for a rehab assignment within a week.

Erik Bedard, SP, Seattle Mariners: Bedard continues to move forward in his throwing progression, slightly ahead of schedule as he recovers from shoulder surgery. After a bullpen session Friday, Bedard was projected to move up to a simulated game this week. According to manager Don Wakamatsu, Bedard has adjusted his mechanics to place less stress on his throwing shoulder. The key will be whether he can maintain these mechanics as he begins to face hitters. The best case has him returning the end of May, but don't be surprised if it stretches a bit longer.

Mariano Rivera, RP, New York Yankees: Rivera shrugged off the stiffness in his left side as no big deal, much as one would expect. Pain on the opposite side of the trunk from the throwing arm always raises the specter of an oblique issue, but Rivera's confidence is convincing. So is the fact he threw a bullpen session before Tuesday's game. This does not appear to be something that will limit him beyond a few days.



Huston Street, RP, Colorado Rockies: As a pitcher returns in his throwing progression, one big hurdle comes when he moves from throwing on flat ground to throwing off a mound. Street overcame that hurdle Tuesday when he threw a bullpen session and experienced no discomfort in his shoulder afterward, according to the Examiner. The plan is for Street to throw in an extended spring training game next followed by a rehab assignment. If all goes well, he should be back with the team within a few weeks.

Jeff Weaver, SP, Los Angeles Dodgers: Weaver has been doing well in his simulated games and is expected to be activated Friday. Apparently the back issue he was dealing with was minor as these things go and he has recovered quickly, as expected.

From my mailbag

Cameron (Atlanta): Are any injuries really freak injuries? I mean, I realize that if a player slips on water in his kitchen and falls on his wrist and breaks it, then that is a freak injury. But, you often hear that somebody pulled their hamstring in a "freak injury." I would have to argue that it is never really a freak injury. I think these types of injuries happen for various reasons, especially in a non-contact sport such as baseball. For example, someone is carrying around extra weight and didn't put in the work in the offseason, they didn't warm up and stretch properly, they have tight quads or hamstrings that cause one or the other to overcompensate that eventually leads to a pull or strain. Or one part of the body has been severely overworked and leads to another part of the body being vulnerable. If any of those situations happen, then technically the injury could have been prevented if the athlete worked harder and took better care of their body. What say you?

Stephania Bell: What a great question! This is one of those philosophical questions where I'm not sure we really ever have a definitive answer. As you point out, the true "accident" such as slipping on the wet floor, or stepping in a lawn divot that is hidden from view, even a car accident in which there is no fault on the part of the injured party ... these could all be described as freak injuries.

At the same time, there are certainly "unusual" (as in uncommon) injuries that occur in sports that may be more likely to happen, as you point out, because of inadequate warm-up, less than ideal fitness or some other contributing factor. In medicine, we always feel that individuals with better fitness tend to recover better and faster from injury. In some cases, the more skilled individual may even be able to avoid an injury that would have felled the average person. To that end, we spend a lot of time encouraging proper fitness and, when possible, tailoring that fitness to the individual's activity. Someone who lifts repeatedly at work needs to be "fit" for that job, just as a baseball pitcher needs to tailor his exercise program to support his occupation.

Great food for thought, though. And if it encourages anyone to spend a little extra time on core strengthening or flexibility to help prevent injury, then we've accomplished something!

If you have any injury questions you want answered in the blog, drop a note in my mailbag, or stop by my Tuesday chats.



Wow! It's hard to believe that May is almost here. Seems like we were just ringing in the New Year and trying to figure out whether to refer to it as "Two Thousand Ten" in the pattern of years past or "Twenty-Ten" like the hip kids we want to be. I don't know about everyone else, but I'm struggling to get used to the sound of either one.

Here's what else is hard to get used to: We're only in the fourth week of the season and the disabled list is deep enough to field a new baseball division. Fantasy owners are well aware of this fact as they try to scour the waiver wire to complete their rosters. I'm struggling to find someone whose team has not been affected by injury.

In this merry-go-round of lineup adjustments, it's important to consider who might be on the verge of returning and who might need a little extra time in the rehab department. There's no time to waste, so we bring you the quick hits version of the injury blog.

Here are 10 players whose injury status may impact your lineup in the next week, or at least your waiver wire activity.

Cliff Lee
Otto Greule Jr/Getty ImagesCliff Lee's regular-season debut with the Mariners will be slightly earlier than expected, and he appears to be in good health leading up to it.
Cliff Lee, SP, Seattle Mariners (15-day DL, April 4): The best part about Lee's rehab is that it has been relatively uneventful. Once he was able to move past the pain of his abdominal strain, Lee has progressed steadily. From his bullpen sessions to his simulated games to his recent rehab start, Lee has looked solid. He is scheduled to make his 2010 (that's Twenty-Ten) season debut Friday, beating the projected first-week-of-May return by a day. And he doesn't even have to worry about that five-game suspension he received during spring training; that's been dropped. Given his consistent recovery, fantasy owners should feel comfortable plugging him in right away.

Jacoby Ellsbury, OF, Boston Red Sox (15-day DL, retroactive to April 12): Initially it appeared that Ellsbury had escaped major injury when he collided with teammate Adrian Beltre's knee in mid-April. Apparently, that was not at all the case. Despite negative X-ray results immediately after the injury, a later CT scan (which was undertaken when Ellsbury failed to show any significant progress) revealed four hairline fractures. While the CT results really don't do much to alter Ellsbury's treatment, they sure do validate his pain!



Although it can take four to six weeks for a rib fracture to heal, from the standpoint of activity, this is a symptom-based condition, meaning whatever he can tolerate, he can do. The fact that four bones were broken, however, tells us that it will take longer to tolerate just about everything. Ellsbury hit off a tee Tuesday, but that's a far cry from the speed and torque required for a true swing. As manager Terry Francona stated on the Red Sox's website, "We're just trying to increase the intensity every day." Don't be surprised if it takes Ellsbury another couple weeks to get his groove back.

Kerry Wood, RP, Cleveland Indians (15-day DL, retroactive to March 26): Get ready to move over, Chris Perez, Wood is knocking on the door. Wood, who missed the start of the season because of a strained latissimus dorsi muscle suffered during spring training, is nearing a return. Wood had a bullpen session Tuesday, is scheduled for another Friday, and according to the Indians' website will then have a simulated game followed by a brief rehab assignment. That would bring Wood back to the team within two weeks, assuming all goes well, which is right around what we projected three weeks ago. The Indians have indicated that Wood will assume the closer role upon rejoining the team.



It's worth remembering that when pitchers face live hitters, the environment changes. A little adrenaline translates to a little more effort on the delivery and the body sometimes reacts. Maybe the command is a bit off, maybe there's a little more post-throwing soreness than usual, any of which could potentially influence the timetable. That said, the Indians appear to have kept Wood on track (remember when their medical staff said this would keep him out for a minimum of six weeks?). Expect to see his season debut around mid-May.

Brian Roberts, 2B, Baltimore Orioles (15-day DL, April 10): If you were wondering whether you should continue to hang on to your second base fill-in knowing that Roberts has already exceeded the 15-day minimum requirement of the DL assignment, the answer is a definitive yes. However, the news for Roberts just got a little worse. As if his herniated disc-related symptoms weren't enough, the Orioles reported on their website that Roberts was scheduled to undergo an endoscopy Thursday after recently experiencing stomach pain along with flu-like symptoms.



Although he was cleared for light exercise recently, he was not anywhere near ready to perform baseball activities. This latest setback certainly won't expedite things. Let's hope for Roberts' sake that there is nothing more serious going on. In the meantime, fantasy owners need to plan on an indefinite substitution in their middle infield.

Jimmy Rollins, SS, Philadelphia Phillies (15-day DL, April 13): By now everyone knows that Rollins suffered a calf strain before the Phillies' home opener this month. The question is, how long will that calf strain keep him sidelined? The strain appeared serious enough from the outset to suggest that he would need more than the 15 day minimum to recover. Our initial projection here of approximately four weeks still appears to be reasonable.



Although Rollins is doing some light running and taking batting practice, he certainly has not done any explosive movement that would really test the calf. He will continue to be progressed gradually, and according to the Philadelphia Daily News, the Phillies will refrain from announcing a specific timetable. This is a wise move as these injuries are very unpredictable and easily aggravated. Once he is able to run full speed, we should have a better clue as to when he might be nearing a return.

Manny Ramirez
Kirby Lee/US PresswireManny Ramirez's stint on the disabled list apparently will be a short one.
Manny Ramirez, OF, Los Angeles Dodgers (15-day DL, April 23): Hey, while we're talking calf strains, we might as well include Manny. Not to worry. His injury is not as serious as the one Rollins suffered. Ramirez has a Grade I calf strain, meaning the injury is minor enough that there is no significant tissue damage visible on MRI. Inflammation in the area still indicates a problem and it is certainly a condition that can easily worsen. In other words, pushing through it could result in more extensive injury to the muscle, which would translate into more missed time. There's no need to chance that outcome this early in the season, so Ramirez is proactively resting. The good news is that fantasy owners can expect Ramirez to return when eligible.

Brad Lidge, RP, Philadelphia Phillies (15-day DL, March 26): Return alert! It looks as if Lidge will be back in the Phillies' bullpen this weekend after another successful rehab outing Tuesday. Lidge believes he is ready to return on all fronts. He has no pain, his command is solid and his elbow and knee issues appear to be behind him. According to the Philadelphia Inquirer, Lidge is expected to rejoin the team Friday when it hosts the New York Mets.

Jorge De La Rosa, SP, Colorado Rockies (15-day DL, April 28): The Denver Post reported that De La Rosa was placed on the DL with a torn flexor band but will not need surgery. De La Rosa injured the middle finger of his throwing (left) hand during his last outing and initially it was thought to be just a bone bruise. An MRI revealed the extent of the damage. It sounds as if De La Rosa tore a pulley in his finger, one of the ligamentous bands that help to anchor the flexor tendon (a tendon, which as the name implies, helps to flex the finger, obviously a critical function for grip and control). The pulleys are essential to proper function of the hand. It appears that De La Rosa's hand will be rested in an effort to let the tissue heal; if he were to try to press through, this he could end up being a season-ending injury that would require surgery. Stepping away now is a better option, but expect it to take on the order of many weeks, as in more than a month, for him to return.

Nelson Cruz, OF, Texas Rangers (15-day DL, April 27): As soon as his hamstring "cramp" turned into something that forced an early exit from Monday's game, it seemed as if Cruz was headed for the DL. Indeed, that was the decision. There was no need to turn this into a significant season-long injury, as the hamstring issue was just not going away. The hope will be that with forced rest, Cruz will be able to return when eligible.

Ian Kinsler
Mark Goldman/Icon SMI Ian Kinsler is set to return Friday, but how long before he makes another trip to the DL?
Ian Kinsler, 2B, Texas Rangers (15-day DL, retroactive to March 26): When your projection as to how healthy you'll be upon return is less than ideal, as Kinsler's was, fantasy owners have to be a little nervous. Kinsler told the Fort Worth Star-Telegram, "When I return to play, I don't think I'll be 100 percent. But I want to get on the field." To be fair, that comment was made a week ago, but the questions about just how well his ankle will support him remain.



Kinsler suffered a right high ankle sprain in early March and these injuries are always more difficult to recover from than anticipated. Kinsler did steal a base in his last rehab outing, which is encouraging, and he is expected to be activated Friday. Fantasy owners should temper expectations as it may take him a while to return to form. It will also be worth keeping an eye on how his ankle responds to the stress of daily play.



From my mailbag

Arthur (Long Beach, N.Y.): I am in a 10-team mixed league with one DL and four bench spots. I am comfortably in first place (thank you, Mr. Halladay), but sense imminent danger based on a shallow bench. I am carrying both Carlos Beltran and Brandon Webb on my roster. Based on projected value and severity of injury, which player would you recommend keeping? I recognize this is partially based on my roster mix, but if you were drafting today, which player would you choose? Thanks for the fantastic columns.

Stephania Bell: Arthur, thanks so much for writing. Let's get right to the point: You are in that location they call somewhere between a rock and a hard place. While I'm still holding out hope that Beltran is able to return this season, there has been some speculation that he won't. Beltran traveled to Colorado last week to visit his surgeon and was not cleared to run. According to the New York Daily News, he was fitted with a custom brace for his ailing right knee while in Colorado, which in and of itself is not a bad thing and may help his progression. I thought all along that a May return would be premature in light of both the nature of Beltran's injury and the date of his surgery. We have to remember that even post-surgery, he does not have a "perfect" knee and his best chance of being successful is returning in a slow, deliberate manner. No one is saying with any certainty when he will return because this is a day-to-day evaluation, but June appears to be the soonest possible target.

Webb, on the other hand, is still playing catch with no clear-cut targeted return date. It's worth noting that there is no clear explanation as to why he's had so many setbacks, which is most problematic for me. Before we can even begin to consider a return time, we have to see Webb successfully throw off a mound. His prognosis is more questionable in my mind, simply for the fact his problem is ill-defined.

I'd stick with Beltran and then cross my fingers.

If you have any other injury questions you want answered in the blog, drop a note in my mailbag, or stop by my Tuesday chats.



The term "15-day DL" can be so misleading. Sure, we know once a player has been placed on this disabled list we won't see him in the lineup for at least 15 days. But it really gives us no idea as to the true severity of the injury. Some injuries simply require time beyond the allotted 15 days for sufficient healing. For many athletes, returning to play requires restoration of strength, conditioning and timing in addition to recovery from the injury itself, so that can translate to extended time.

To further complicate matters, the date the decision is made to place an athlete on the DL may not be the day the countdown clock starts ticking. A team can make a DL designation retroactive to the day following the last game in which the player appeared. Sometimes this happens when an injury that initially seemed would limit a player for just a few days turns out to be a little more problematic. It may also be used when a team wants to give a player who is progressing well a little extra time before returning to competition. In other words, a move to the DL does not necessarily indicate that an athlete's injury is worrisome.

How to make sense of it all then? Except for obvious injuries (such as broken bones or knee ligament tears) that immediately force a player to the DL, there are often clues that emerge before a team decides to place an athlete on that list. There are also hints throughout the course of an athlete's rehab that signal whether he will require additional time beyond those 15 days before returning to the lineup. We look for those clues and share them with you right here, week in and week out. After all, your fantasy roster is only as good as the guys who are actually playing.

We start this week by looking at the injuries that have befallen middle infielders around the league and ask the question, "Just how concerned should you be?"

Jimmy Rollins
Kim Klement/US PresswireExpect Jimmy Rollins to miss about four weeks with a calf injury.
Jimmy Rollins, SS, Philadelphia Phillies (15-day DL, April 13): When he pulled up with calf pain during pregame sprints in the outfield Monday, Rollins had to be thinking to himself, "I was out there warming up just so this type of thing WOULDN'T happen ..."



But, alas, it did. Rollins strained his right calf muscle and subsequently underwent an MRI on Tuesday which, according to the Philadelphia Inquirer, confirmed the severity of the injury. He has been placed on the 15-day DL, but the Phillies are acknowledging up front that they expect this injury may require more time, indicating that Rollins is likely to be sidelined for two to four weeks.

Rollins is sporting a protective boot that controls ankle movement and allows the calf to rest. Since rest is a critical element of recovery, it would not be surprising to see this injury keep Rollins out closer to the four-week end of the timetable.



The calf muscle is necessary for any hitter to push off when running, particularly when driving out of the batter's box or when getting a jump on a steal. The explosive defensive maneuvers Rollins has to make at his position also place high demand on the calf. Once the initial inflammatory phase has passed, many athletes feel as if they are ready to return to competition, only to discover that explosive movements still lack power or cause discomfort. The risk at that point is that it is easy to overdo those movements and suffer a setback, turning a few weeks of recovery into potentially months. Fantasy owners and Phillies fans will need to be patient with Rollins' return in the hopes that once he's back, the injury is truly behind him.

Brian Roberts, 2B, Baltimore Orioles (15-day DL, April 10): There was concern this spring that Roberts' ailing back might prevent him from being able to start the season. That turned out to not be the case.

Less than a week into the season, Roberts suffered a different injury, an abdominal strain. He hurt himself while stealing second against the Toronto Blue Jays on Friday, and he also managed to aggravate his lower back in the process. As a result, Roberts received an epidural injection Monday, according to The Baltimore Sun, his second this year to help calm symptoms associated with the herniated disk in his back. Roberts has been advised to rest for several days to allow the symptoms to calm down. He will then gradually be reintroduced to exercise with an eventual progression toward baseball activities.

Manager Dave Trembley has already warned that Roberts is expected to be out longer than the 15 days, not surprising given the nature of his injuries. The bigger concern is just how reliable Roberts' health will be once he does return. Disk problems are notoriously chronic in nature and Roberts has really not been 100 percent healthy this year. He entered spring training with back pain and, despite making significant improvements as Opening Day neared, he clearly was not completely out of the woods. His will likely be a tenuous situation and even when he does return, fantasy owners should keep a backup stashed on their bench.

Aaron Hill
Jeff Griffith/US PresswireAaron Hill's attempt to match his 36 homers from 2009 has taken a short break.
Aaron Hill, 2B, Toronto Blue Jays (15-day DL, retroactive to April 6): Hill was placed on the DL because of a strained right hamstring, but according to ESPN reports, Hill indicated that if it were a different point in the season he "could" play. While acknowledging that his hamstring was tender enough to keep him from going at full speed, Hill, who ran the bases Monday before game time, did not seem overly concerned about his injury. At this point, it appears Hill will come off the DL when eligible next week.

There's every reason for the team to err on the side of caution with this one. A mild hamstring strain can certainly benefit from a little extra rest. Aggravating it by pushing too fast can just as easily turn a mild ailment into a season-compromising injury. The good news for Hill owners is that the conservative approach taken by the team here may pay off down the road.



Mark Ellis, 2B, Oakland A's: Another second baseman, another hamstring injury. Ellis was hurt Sunday trying to beat out a grounder in the eighth inning. Soreness in his left hamstring kept him out of Monday's game.

On the plus side, Ellis himself said he expected to be out for only "a couple of days." According to Susan Slusser of the San Francisco Chronicle, Ellis reports that the hamstring is feeling better and he could return to the lineup Thursday. On the minus side, Ellis had some hamstring issues during the spring as well, so fantasy owners should be mindful that this may not be the last of it.

Jayson Werth, OF, Philadelphia Phillies: There were a couple of minor injuries this week that struck outfielders (more listed below). Werth injured his left hip running out of the batter's box in the fourth inning on Monday. According to the Philadelphia Inquirer, Werth said his removal from the game was precautionary. He added that he expected to miss only a few days, calling the injury "no big deal."

So far Werth's assessment appears accurate in that he is expected back in the regular lineup Thursday following a pinch hitting appearance Wednesday. The Phillies are hoping that one player to the DL this week is enough.

Chris Young
Christian Petersen/Getty ImagesChris Young is back on the disabled list, but don't be alarmed by the move.
Chris Young, SP, San Diego Padres (15-day DL, retroactive to 4/7): Before fantasy owners start griping that this is the injury-prone Chris Young from years past, take a deep breath and remember that not all DL stints are created equal.

Remember, Young is coming off offseason surgery to debride the labrum in his throwing shoulder. He had an uneventful rehab and steady return to throwing, and had a successful first outing in the Padres' home opener. After that game, Young felt some discomfort and was sensible enough to recognize that he did not need to push it now. As he pointed out, these mini-setbacks typically happen during spring training but his just happened a little further into his throwing progression.



Caution in the early season could well be the difference in keeping Young on the mound more than off it this year. He expects to be ready to take his turn in the rotation when eligible.



Brian Fuentes, RP, Los Angeles Angels (15-day DL, retroactive to 4/6): This is one of those situations where the date is important. Although the move was announced Wednesday, it has been made retroactive to eight days prior. Fuentes, who has been placed on the DL because of a back strain, is eligible to return next week. The Angels can't be especially concerned about Fuentes' injury given the retroactive date but likely feel he will benefit from a few more days off. Fernando Rodney is the closer in the interim but it sounds as if the team does not anticipate that lasting long.



Mike Gonzalez, RP, Baltimore Orioles (15-day DL, retroactive to 4/10): Gonzalez has had a rough start to 2010; the Orioles decided Wednesday to place him on the DL. After an up-and-down spring training Gonzalez struggled early in the season, picking up a pair of blown saves. Now we learn that he has a shoulder strain. While the seriousness of his current injury is unclear, it's worth noting that Gonzalez dealt with issues in his back this spring that seemed to impact his velocity. The hope is that he has not suffered an injury as a result of some compensatory adjustments. His status is worth watching.

Extras


Boston Red Sox outfielder Jacoby Ellsbury dodged a bullet -- but not teammate Adrian Beltre's knee -- Sunday. The collision was enough to take Ellsbury's breath away and he ended up with a rib contusion but fortunately no fractures. Lingering soreness has caused him to miss a few days but he should be able to avoid a trip to the DL.

Colorado Rockies outfielder Carlos Gonzalez is another player dealing with "tightness" in his hamstring, leaving Sunday's game early after feeling the discomfort in his left hamstring. He has not played in the two games since. According to The Denver Post, Gonzalez was available only for emergency situations, as he could still not run the bases effectively. While so far it appears that he will avoid the DL, there are no guarantees as to when he may return to the starting lineup.

• The Seattle Mariners' Cliff Lee is hoping he will debut for his new team in early May. Lee has thrown a couple of bullpen sessions where he has looked strong and been pain-free. The next goal is a simulated game late this week. He will still need to build up his arm endurance, but so far, so good.

• Los Angeles Angels pitcher Scott Kazmir, who started the season on the DL with a mild hamstring strain, is expected to start Thursday against the New York Yankees. Nothing like jumping in feetfirst.

From my mailbag

Lance Berkman
Mark Cunningham/Getty ImagesLance Berkman's return is still up in the air, as are his stats when he returns.
Luke (Monroe, Conn.): Hi Stephania, I'm trying to decide if Lance Berkman is just dead weight, even on my DL. I am in a 10-team mixed league with 2 DL slots, and right now I am carrying Berkman and Erik Bedard on my DL with Ted Lilly occupying a bench spot even though he is on the DL. My staff is good enough that I can get by with Lilly on the bench for a few weeks, but the more I read about Berkman, the more it seems to me like he is not going to be nearly the player he has been for his career, and maybe not even the player he was last year. ... What kind of player to you project Berkman to be this year, assuming he comes back fully healthy and has no complications? In other words, best case scenario? If he's anything less than a 25-HR, 100-RBI guy, I doubt he's worth my bench spot since I don't have anywhere to play him full time.

Stephania Bell: You are certainly right about there being a lot of questions about Berkman, given the start to his season. This week there were some encouraging signs in that he has made some progress with his activity. After having persistent issues with fluid in his left knee following March arthroscopic surgery (which required having his knee drained multiple times), Berkman was able to begin some light running Monday. The key to him returning next week will be whether the swelling stays down as he continues to increase his activity. And that's a big if ...

Your question is a tough one because I'm not convinced his return will be completely smooth. While there may not be any obvious outward signs of trouble once he is able to get back in the lineup, he could be in a situation where the team opts to rest him more frequently to protect the knee. He may also have less power at the plate initially if his leg strength is not 100 percent. He may be well enough to play but it still may take him time to perform like the Lance Berkman you drafted. I'm not convinced he'll reach the targets you've set for him, so you may want to re-evaluate your bench spots.

If you have any other injury questions you want answered in the blog, drop a note in my mailbag, or stop by my Tuesday chats.

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