Stephania Bell: Jose Molina



I just like to start with some good news. Any good news. Trust me, some weeks -- like this one -- it's slim pickings. Nonetheless, I feel responsible to fantasy owners to keep the glass half-full, and so I scoured amidst all the downers of guys headed to the DL (including a record number of repeat customers!) and I managed to find a bit of encouraging news this week.

Jose Reyes could make his return from the DL on Friday. I always recommend the cautiously optimistic approach when it comes to returning from a muscle strain or an "-itis" (as in something inflammatory). In fact, Reyes hasn't had the opportunity to test the leg in a game situation because Tuesday's planned extended spring training game was rained out. So much for the glass being half-full. There is another game scheduled for Wednesday when the Mets hopefully will be able to put Reyes to the test. Until he proves he can run without difficulty, Friday's target remains in the category of wishful thinking.

But let's face it, we want to get to the information about who's hurt. Here's who we're talking about this week in the world of baseball injuries. ...

Josh Hamilton
Aaron M. Sprecher/Icon SMIJosh Hamilton is making his second trip to the disabled list this year, and this could be a lot longer.
Josh Hamilton, OF, Rangers: Hamilton underwent an MRI on Monday in an attempt to clarify the cause of his persistent groin pain, which has been with him since his most recent collision with an outfield wall at Rangers Ballpark. On Tuesday, he met with Dr. John Preskitt, who performed a sports hernia repair on Ian Kinsler last season. According to the Fort Worth Star-Telegram, Rangers general manager Jon Daniels indicated that Hamilton's visit with Preskitt was to help rule out a hernia.

If this all sounds confusing, it is. Arriving at a diagnosis of a sports hernia is really a process of ruling out other diagnoses. Here's what we know so far.

1. First and foremost for fantasy owners, Hamilton is on the DL for the second time this season. That means you have to make alternate plans for at least another two weeks. I would recommend that you make plans for another couple of months. Continue reading.

2. Hamilton's injury started out as a groin strain and was later called an abdominal strain, according to the team's official Web site. This is the case with many of the injuries that are eventually diagnosed as sports hernias. Pain begins near the groin, then moves closer to the lower abdominal wall. With all of these muscles converging to attach at the pelvis, the pain patterns can be similar.

3. It is not a hernia. A true (abdominal) hernia represents a protrusion (herniation) of abdominal contents through a weak spot in the soft tissue around it. The hernia can often be palpable (the examining physician can feel it) and can generally be seen on imaging (via ultrasound or MRI). Since many of the symptoms can be similar, it is important to rule out a true hernia. Many sports hernias do not show any visible findings on MRI. If Hamilton had a hernia, he would be having surgery while I'm writing this column.

4. Hamilton has indicated that he faces the most difficulty when trying to run. The hallmark of a sports hernia is an athlete's inability to run. It can be a frustrating diagnosis in this regard because, depending on the degree of injury, the athlete can actually feel quite good ... until he tries to run. Because of the muscles involved and their attachment near the pelvis, the power required to run places a demand on the area that cannot be met. The athlete typically complains of pain and weakness when attempting to run. According to the Dallas Morning News, Hamilton said "I'm hurt and sore and can't run," estimating his running since the groin injury at 50 percent of normal.

The evidence here would suggest that Hamilton is, indeed, dealing with a sports hernia, which is, in essence, what the team is saying. According to the Ranger's official Web site, assistant general manager Thad Levine "likened the injury to a sports hernia" and hopes Hamilton can avoid surgery after a period of rest and anti-inflammatory medication. Hamilton will be re-evaluated at that point and, if he has not improved, likely will face sports hernia surgery that would require six to eight weeks of recovery. Although Hamilton's mechanism of injury is somewhat atypical (these injuries often seem to come on out of nowhere, with no particular incident as the cause), his symptom pattern has many features that fit the bill.

For those wondering why surgery isn't done right away, this rest period is a step in ultimately arriving at the conclusion that surgery is necessary. Since sports hernia diagnosis is often one of exclusion -- figuring out everything that the injury "isn't" -- the decision to proceed with surgery is easier if conservative measures have failed. Fantasy owners can hope for the best, but should prepare for the worst, in the event that Hamilton is headed under the knife.

Evan Longoria, 3B, Rays: Longoria was serving as the DH for the past couple days as a result of elbow soreness; now there's something of potentially bigger concern. Longoria left Tuesday's game with a left hamstring strain after running out a ground ball, and we know how these injuries can go (read: linger).



He is expected to undergo an MRI on Wednesday to determine the extent of damage, but there are a few notes of encouragement. Longoria's description of what he did NOT experience suggests that the strain is on the minor end. Longoria told the team's official Web site Tuesday after the game, "I didn't feel a pop, I didn't feel a pull, I was able to walk and ride the bike and everything." Longoria added that he considers himself day-to-day. Rays manager Joe Maddon indicated that he will act with caution, so don't be surprised if Longoria is given a couple days to rest, even if the MRI turns up nothing significant.

Edinson Volquez
AP Photo/Jeff RobersonEdinson Volquez lasted just one inning in Monday's start before returning to the disabled list.
Edinson Volquez, P, Reds: Volquez may hold the record for shortest return from a DL stint before exiting a game only to be returned to the DL. Not a record he or his fantasy owners really want. And it's not as though he wasn't recovered from the first problem (back spasms) and aggravated the injury. Sadly, this is something altogether different.

Volquez lasted all of a single inning in his return Monday night before being forced out with what he described as "tingling from my elbow down to my fingers," according to the Dayton Daily News. Volquez went on to say that he had "never had this happen ... never had pain in my arm." Specifically, Volquez experienced the sensation in his ring and pinky (fourth and fifth) fingers in his right (throwing) hand. The location tells us that his ulnar nerve was talking to him, and clearly it was not happy.

According to the Cincinnati Enquirer, Volquez has been placed on the DL with tendinitis in his elbow. In that scenario, inflammation in the soft tissue around his pitching elbow could result in increased pressure on the ulnar nerve (which passes just behind the bony part of the inside of the elbow, coming very near to the surface, making it an easy target for injury). The pressure would then result in irritation of the nerve, which shows up as numbness and tingling in the fourth and fifth fingers in the hand. The ulnar nerve is often problematic for pitchers because of its location and its vulnerability when there are problems at the elbow. If the joint is hypermobile, if spurs are present, if there is any ligamentous injury (yes, ulnar collateral or Tommy John ligament) or even in the presence of swelling alone, the ulnar nerve can be affected.



The hope for Volquez is that this truly is a minor condition and not the beginnings of a major problem with his throwing elbow. The plan is for him to rest for at least a week (no throwing at all) and then be re-evaluated. Stay tuned.

Joey Votto, 1B, Reds: A week ago it appeared promising that the team had been able to identify the source of Votto's frustrating intermittent dizziness. He was reportedly dealing with an ear infection and had been placed on anti-inflammatory medication. The problem, however, was that every time Votto got on a plane, the symptoms were exacerbated the next day.

On Saturday, Votto was placed on the DL with what the team is calling "stress-related issues." It's fairly safe to assume that the stress Votto is experiencing is from the on-again, off-again nature of this dizziness. I can tell you that patients who experience chronic dizziness describe it as an extremely debilitating and frustrating condition. We've all experienced feeling dizzy or light-headed at some point, and I have yet to find anyone who thinks it pleasant. Now imagine trying to do your job and performing at the same level to which you and your co-workers are accustomed, with the world spinning around you. It's just not possible.



This trip to the DL is a good move for Votto until he can truly get his symptoms under control. Let's hope that the 15-day period is all he needs.

Asdrubal Cabrera, 2B, Indians: Cabrera left Tuesday's game against the Twins in the first inning with a shoulder injury. He was clearly in pain when he left the field after taking the brunt of Twins shortstop Brendan Harris' weight on his left shoulder as he slid into second base.

The Cleveland Plain-Dealer is reporting that Cabrera suffered a dislocated left shoulder that was "put back into place." X-rays taken at Hennepin County Medical Center were reportedly inconclusive and Cabrera is scheduled to undergo an MRI Wednesday. The description makes it sound as if Cabrera actually subluxed his shoulder (in which it slips slightly off the joint but quickly pops back in) because a true dislocation is often difficult to reduce (put back), unless the athlete has a very unstable shoulder with a history of repeat dislocations. As far as I can tell, this is not the case with Cabrera.

Cabrera also told the Plain-Dealer that he did not think he would need to go on the DL, another sign that he may not have suffered that severe of an injury. It's worth noting though that players often feel far worse the next day once there is post-injury pain and inflammation. There's still a chance, either with or without a complete dislocation, that Cabrera could have suffered enough soft tissue damage to require a minimum two-week absence. Let's see how Cabrera feels over the next few days. That will probably go a lot further in determining just how long it will be before he's back in the lineup.

On the Mend


Alex Gordon has to be pleased with the results of his latest visit with his surgeon. According to the Royals' official Web site, Gordon, who is recovering from surgery to address a torn labrum, got "glowing reports" on his trip to Colorado. His latest activity includes limited tee swings and very light, easy ground balls, so he is still a ways from truly testing his hip (hard swings, fielding bunts, throwing across his body and, ultimately, sliding). Although Gordon was originally given a timetable of 10 weeks (which would mean a return in late June), I have suspected all along that a return after the All-Star break would make the most sense. It seems that Gordon's progress has him on track for that so far.

• Rays ace Scott Kazmir is recovering from his quad strain while simultaneously addressing mechanical faults he attributes to last year's elbow injury. There is no official timetable for his return, but according to the St. Petersburg Times, Kazmir is throwing in the bullpen and hoping to avoid a minor league assignment. It's possible he could be back within another two weeks. Between the quadriceps recovery and the adjustments Kazmir is making, the hope is that his performance will improve when he rejoins the rotation.

Brandon Webb continues to work his way back gradually from the shoulder problem that has kept him out since Opening Day. According to the Arizona Republic, he's throwing on flat ground (with another session planned for Wednesday) and will hopefully progress to a bullpen session Saturday. Don't get too excited; the Diamondbacks haven't brought him along this slowly only to speed him up now. Due to all the missed time, Webb likely will be brought along through every step in the standard return to throwing progression, including several minor league starts to build up endurance. The most encouraging words are from Webb himself, "It took a while to get there, but I feel like we're moving forward." I would not expect much before the All-Star break, but assuming he continues well, it would be a good time to think about picking him up.

Xavier Nady
G Fiume/Getty ImagesXavier Nady likely isn't done for the year, but he isn't coming back in the near future, either.
• In the not so smooth recovery department, Yankees players have endured a couple of setbacks. Outfielder Xavier Nady, who suffered an injury to his previously reconstructed ulnar collateral ligament in April, threw for the first time on Monday and it apparently did not go so well. According to the Newark Star-Ledger, Nady experienced discomfort in his elbow when attempting throws from 50 to 60 feet. Although manager Joe Girardi indicated he would play Nady even if he wasn't at full strength, it's a recipe for disaster if the player and the manager are uncertain whether every throw will result in pain. Nady did throw Tuesday and, according to Newsday.com, only felt minor discomfort this time. When he's throwing consistently without any discomfort, then we can really be encouraged. Until then, everyone should temper expectations.

• Meanwhile, Nady's teammate Jose Molina is having a repeat MRI on his injured left quadriceps after being pulled from an extended spring training game Monday. Those results are expected to guide the next steps. Even without the results, just the fact that he had to be pulled because the muscle became painful tells you what you need to know. He will not be ready to return anytime soon.

• On the other coast, Angels pitcher Kelvim Escobar faced challenges of his own as he recovers from surgery last year to repair a torn labrum. After being ahead of schedule throughout his rehab, he had a setback near the start of the season that has delayed his return. Escobar's shoulder is recovering and he is throwing without pain, but his latest rehab start Monday revealed that he does not have full control of his delivery. The Los Angeles Times reports that, as a result, Escobar has stopped throwing the slider for now. From a rehab perspective, how his shoulder feels is the most important thing. The fact that he is not experiencing pain is critical. A slider is one of the more physically demanding pitches, so it makes sense that it would take longer to get it back. Look for Escobar to rejoin the rotation within the week, perhaps Saturday, but without his slider.



• And finally ... expect John Smoltz back in mid-June. No one will commit to it, but he looks good. Get ready, he's going to be great.

Angels starters very close to returning

May, 12, 2009
5/12/09
6:54
PM ET
It's about time we started with some good news for a change. We have some key players close to returning.

Josh Hamilton is expected to return to the Rangers' lineup Tuesday night, completing a stint on the disabled list caused by a strained rib-cage muscle. Hamilton played in two rehab games for Triple-A Oklahoma City and sounds confident that he's completely healed, telling the Fort Worth Star-Telegram that he tested his ribs in a multitude of ways: "I swung the bat. I had to run from first to third. In the outfield, I had to throw. Getting out of breath and breathing heavy, that was good. So we're all good." Also, the Star-Telegram pointed out that Hamilton slipped in the outfield Sunday, landing directly on his ribs, but was able to continue without hesitation. Fantasy owners should feel confident that this injury episode is behind him.

Meanwhile, the Angels have to be excited that both John Lackey and Ervin Santana could rejoin the rotation within the next week. Both aces began the season on the DL because of arm injuries -- Lackey had a forearm strain and Santana had a sprained elbow -- and both have had quiet, uneventful rehab progressions. When we don't hear much about players while they're undergoing rehab, it's usually a good sign. That means they're moving quietly from one rehab phase to the next without calling much attention to themselves. Both Lackey and Santana have made rehab starts, working on increasing their pitch counts.

The Los Angeles Times reports that the Angels will study tapes from Lackey's and Santana's most recent rehab starts to assess their readiness to return, but all evidence points to those return dates' coming sooner rather than later. And their uneventful rehab progressions make a good case for their ability to be successful upon their returns. The bigger question is whether Lackey and Santana will be able to last the remainder of the season. So far, there is good reason for their owners to be cautiously optimistic.

On that note, here are a handful of players I'm tracking this week in the world of baseball injuries:

Chipper Jones
Joe Robbins/Getty ImagesSeems like we have heard this one before: Chipper Jones is injured.
Chipper Jones, 3B, Braves: Jones sat out Monday night's game as a result of a hyperextended elbow, but he expects to return to the lineup Tuesday. Jones told the Atlanta Journal Constitution that he has been dealing with a "pretty serious case of tendinitis" in the elbow all year, and after hyperextending it during a strikeout swing Sunday, his elbow was "jacked up." Although the latter is not exactly a medical diagnosis, it pretty well conveys how Jones was feeling. Jones' injury history shows that he will press and play on through injuries whenever possible until he feels he can't perform as he should. In this case, Jones couldn't make the throw from third base to first because of the elbow, and therefore removed himself from the game. His assessment was that a little rest and anti-inflammatory medication should get him back fairly quickly, which is not an unreasonable prediction.

Jones' owners most likely knew (or should have known) when they drafted him that he is a physical player who is going to be dinged off and on throughout the season. Translation: He will miss games from time to time, but he has been fairly adept at avoiding the DL for the majority of his injuries. This incident appears to fall in the category of the one-to-three-game absences, but it's worth noting that the tendinitis has been bothering him all year. If he continues to aggravate it, this could crop up again. And next time, it could last longer.

Aramis Ramirez, 3B, Cubs: The Cubs have definitely been DL-challenged this year, with a new name seemingly added every week. Just when it looked as if Ramirez was recovering from a stiff back that had bothered him in spring training and, more recently, a calf strain that caused him to sit out a couple of games, he dislocated his left shoulder Friday night while diving to try to make a play at third. Ramirez summed it up perfectly to the Chicago Tribune: "Seems like I can't be out there right now this year. I've been hurt all the time."

Well, he's certainly right about not being able to be out there right now. A dislocated shoulder means at least a month of rehabilitation, and seeing as this was not a stable shoulder to begin with (Ramirez hyperextended the same shoulder during his rookie season in 1998 and aggravated it again in 2000), it likely will take even longer to restore enough strength around the shoulder to allow him to play with confidence. Fantasy owners need to plan on utilizing a replacement at least through the All-Star break.

Derrek Lee, 1B, Cubs: The good news is that despite his neck issues, Lee likely won't require a trip to the DL. At least not right now.

An MRI this week confirmed what was already known about Lee's neck: He has a bulging disc, which is likely responsible for the pain and spasms he has been experiencing of late. But the Cubs' decision not to place Lee on the DL can be interpreted as an encouraging sign, and the Chicago Tribune reported that Lee would return to the lineup either Tuesday night or Wednesday. The Chicago Sun-Tines reported that an anti-inflammatory injection was not deemed necessary and that the most recent MRI results "revealed no additional damage and nothing to suggest long-term injury."

While it's some relief to know that there appears to be no progression of Lee's neck problem on MRI, it is arguable that this injury is indeed long-term. Consider that Lee originally injured his neck two years ago and has dealt with this type of pain intermittently ever since. A disc problem is not the type of thing that typically goes away completely; it is more likely to be the type of condition that flares up from time to time. The treatment goal is to do as much as possible in terms of strengthening and stabilization to prevent the recurrence of symptoms, and when those symptoms do crop up, to manage them as efficiently as possible. Working in Lee's favor is the fact that the symptoms have remained localized to the neck area. In the case of a severe disc bulge, there can be accompanying nerve involvement that can manifest itself as numbness, tingling and/or weakness in the arm. The further down the symptoms progress, the more problematic and the more disabling they can be.

The fact that Lee is likely to return soon is definitely a good sign, and it is possible that this will be his only episode of neck pain this season. It is also possible, however, that these symptoms will return, if not this year then in the future, as has already been the pattern for him over the past two years. Fantasy owners need not panic, but it is worth being aware that this issue can linger beneath the surface.

Dustin Pedroia, 2B, Red Sox: Pedroia was forced to leave Sunday night's game early after straining the right side of his groin while swinging. According to the Boston Herald, Pedroia originally injured the groin earlier in the month, perhaps during cold and wet conditions at Yankee Stadium, and had been playing through it. But clearly Pedroia aggravated the injury Sunday night when, according to Pedroia's account in the Herald, his cleat "kind of got caught, and it was an inside fastball, so I tried to turn on it, and obviously it hurt." Manager Terry Francona planned to hold him out Tuesday but maintained that his return to the lineup Wednesday would be "very realistic."

Pedroia already has had one muscle strain this season, an abdominal injury that forced him to exit early from the WBC. Nonetheless, he was back in full swing within a few days and has shown himself to be not only tough, but also a quick healer. He spent much of the offseason doing intensive physical conditioning and that too might play a role in why his injuries are not as debilitating as they otherwise could be. Although there is always the concern of exacerbating a strain once it exists, Pedroia appears to have avoided serious injury thus far.

Kevin Youkilis
Jim Rogash/Getty Images"Yuuuuuuke" (Kevin Youkilis) should return to the lineup soon.
Kevin Youkilis, 1B, Red Sox: Will he or won't he? That is the question Youkilis fantasy owners have been asking over the last week in reference to whether Youk would be headed for the DL because of his "sore side." Here's the answer: Yes. This was a bit of a surprise. The Boston Herald reported Monday that Youkilis could potentially be available to play Tuesday evening. By Tuesday evening, the Boston Globe was reporting that Youkilis had just been placed on the DL. Apparently he aggravated his condition during batting practice, and the team decided he needed some extra time off. The move is retroactive to May 5 since Youkilis has been out of commission for a week already, leaving the door open for him to return in another week if he is truly healthy.

The exact nature of Youkilis' condition has been a little puzzling, but manager Terry Francona described it as a deep bruise that turned into spasms after Youkilis was hit twice in the back by pitches. Youkilis however told the Boston Globe that being hit by pitches was not the cause, and that the injury had actually occurred a couple of weeks prior, although he did not specify when. He also pointed out that the tightness he was experiencing was more in his side as opposed to his lower back. It now appears that the team is classifying it as an oblique injury.

Jose Molina, C, Yankees: Last week, Yankees catcher Jorge Posada was addressed in this column after being placed on the DL because of a Grade 2 hamstring strain. This week it was Molina who was placed on the DL because of a thigh muscle strain; in this case, it was a quadriceps injury. The quadriceps muscle, or quad as it is often called, is the large muscle group that constitutes the bulk of the front of the thigh. It is made up of four separate muscles that come together in a common tendon to attach at the shin. The quad provides the bulk of the power necessary for running, but in the case of a catcher, the quad is critical for maintaining the crouch position and being able to explode out of it when necessary.

The good news is that the team does not expect Molina to miss much beyond the 15 days. Muscle strains can be hard to predict, though, so we will check on Molina's rehab status again next week.

Joakim Soria, RP, Royals: The closer was placed on the DL because of a rotator cuff strain to his right (throwing) arm. Soria has been dealing with stiffness and soreness in his throwing arm for a few weeks, and attempts to give him a few days' rest here and there were not enough. At this point, the team has not indicated exactly how long it thinks Soria will be out, but fantasy owners should plan on some insurance at the closer position for the next month or so.

The good news is that an MRI has not indicated any specific damage. The not-so-good news is that the pain is in the back of his shoulder where the rotator cuff musculature is located. Soria last pitched Thursday, and although his shoulder reportedly did not bother him during the inning, the Royals' official Web site reported that he did feel it the next day. In the scheme of things, next-day soreness is less worrisome than soreness during activity and far less worrisome than constant soreness, even at rest. The Royals are taking a proactive approach in trying to provide Soria enough downtime to hopefully resolve the issue. Although Soria believes he can be back in 15 days, the team might opt to bring him back a little slower and place him on a graduated (read: rehab) assignment. Either way, the hope is to have him for the long haul, and that looks to be a realistic goal.

On the mend

Cardinals ace Chris Carpenter is inching closer to a return. He is scheduled to throw from a mound Tuesday, and if that goes well he will throw simulated innings, according to the St. Louis Post-Dispatch. Given that he has maintained his conditioning, the team does not anticipate a rehab assignment, and he could return as early as sometime next week.

Yankees pitcher Chien-Ming Wang is scheduled to make a rehab start Tuesday. Wang, who clearly struggled at the start of the season, was found to have lingering weakness in his hip muscles following foot surgery, but it appears this latest rehab period has really helped him. Depending on the results of his outing, Wang might be able to rejoin the Yankees' rotation within the next week.

Daisuke Matsuzaka has had two rehab starts already and is expected to have another this week. Expect him to be back in the mix when the Red Sox return from the West Coast for a homestand next week.

Angels outfielder Vladimir Guerrero can hit off a tee now. This is good progress, but he still is not throwing. The Angels have made it official that when he returns he will serve as the DH initially. That could happen within the next few weeks. Stay tuned.

And finally ...

Diamondbacks shortstop Stephen Drew could return either Tuesday or Wednesday from a hamstring strain. He played in rehab games the past two days and came out feeling OK. The slow progression appears to have worked, at least so far, and fantasy owners should plan on his being available very soon.

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