Stephania Bell: Justin Duchscherer

I didn't get to see first baseman Derrek Lee and second baseman Brian Roberts on the field Wednesday, the two players I was hoping would play in the Baltimore Orioles' contest versus the Minnesota Twins when I planned my journey. But I did get to see O's manager and former ESPN analyst Buck Showalter (who says he prefers his work attire these days to the suit and tie he donned in the studio), and he provided status updates on his two infielders before the game.

Showalter did not seem particularly concerned about either Lee or Roberts. Lee, whom the Orioles acquired this offseason, has not yet played a spring game with his new team. He underwent right thumb surgery last fall and has progressed to the point of taking batting practice, but soreness in his wrist and forearm has delayed his spring training debut. Showalter indicated Wednesday that an X-Ray on Lee's wrist was negative, and although the veteran first baseman was scheduled for an MRI, there was no real cause for concern. Showalter pointed to an area on the top of the forearm, just above the wrist, where Lee was sore, and then reminded us that Lee didn't use some of those muscles regularly for 2-3 months while in a splint following surgery.

[+] EnlargeDerrek Lee
AP Photo/Eric GayDerrek Lee has been working out with the O's, but he hasn't gotten into any spring games.
It's worth pointing out that Lee is 35 years old and also has a history of low back issues. Taking it slowly and cautiously is not the worst thing and the fact that Lee is a veteran gives Showalter reassurance in his ability to get up to speed quickly. That said, if it gets to be another week into March and there's still no sign of Lee, everyone will start to be more concerned. It's not out of the question that he could start the season on the disabled list if he is not 100 percent ready to return. The Orioles want Lee to be pain-free to start the season.

As for Roberts, his ongoing back issues essentially derailed his 2010 season, so hearing that he was scratched from Tuesday's game because of back spasms was disconcerting. According to Showalter, this latest setback is a minor one and not related to the low back problems Roberts faced last year. Apparently Roberts had some upper back spasms ("a knot in there," per Showalter) and even after resting Tuesday, he was still a little stiff Wednesday, so they opted to rest him another day. Showalter was also quick to point out that Roberts has already played in far more spring training games this year than he did last season. True. While there's still reason to be cautious about Roberts' ability to stay healthy throughout the season, there is no major cause for alarm either. At least not yet.

Finally, pitcher Justin Duchscherer was reportedly feeling well a day after pitching two scoreless innings against the Philadelphia Phillies in his spring debut. Duchscherer, most recently with the Oakland A's, is coming off left hip surgery to repair the labrum and resurface the joint, a procedure he underwent previously on his right hip. The increased mobility in both hips might actually alleviate some strain on his low back, which has been intermittently problematic for years. It's too early to say whether Duke will be able to stay healthy, but the outlook is promising. Next up for him is to throw three innings in an intrasquad scrimmage this weekend.


Welcome back! Here's to being back from an extended stay away from the team, settling into the regular routine and finishing out the season on an upswing. No, the salutation is not self-directed, although I did manage to tear myself away from the beaches of Cabo San Lucas in Mexico to get back to the business of discussing injuries. This welcome is directed to Los Angeles Dodgers shortstop Rafael Furcal, who rejoined the lineup Tuesday in Chicago after missing time with a hamstring strain.



After originally looking as if he'd be back when eligible May 14, there was enough concern about some lingering symptoms to postpone the return date until now. It wasn't exactly Furcal's most notable performance (0-for-4 and a couple of errors), but he got through the game just fine. As reported by Tony Jackson of ESPNLosAngeles.com, Furcal said after the game, "I am very disappointed with the way I played. The best thing is that I'm healthy and I didn't feel anything." Very true. Rust can be overcome quicker than reinjury. The biggest test, however, will come during the next couple of weeks as we see just how Furcal and his hamstring tolerate the grind of daily play.

Also returning from injury were Boston Red Sox outfielder Mike Cameron, returning from an abdominal strain, and Minnesota Twins shortstop J.J. Hardy, coming off a bone bruise in his left wrist. Cameron is going to be eased back into play, according to The Boston Globe. He will not be used daily, at least not initially, plus he will spend some time playing left field. The 37-year-old Cameron, whose superb fitness may be a reason he's even been able to return from this injury, may yet require surgery down the line. Hardy's return Tuesday was abbreviated because the Yankees-Twins game was suspended in the fifth inning by rain. That said, Hardy's first at-bat was a double to deep right, so it looks as if his wrist is not a limiting factor.

Earlier it appeared that we would be welcoming back another star in this week's blog, Philadelphia Phillies shortstop Jimmy Rollins, but he was back on the DL before we ever got the chance. On that unfortunate note, we turn to some of the key injuries in the world of baseball this week ...

Jimmy Rollins
Miles Kennedy/Getty ImagesJimmy Rollins hit a homer in his brief stint off the disabled list earlier this month.
Jimmy Rollins, SS, Philadelphia Phillies (15-day DL, May 22): Rollins' situation exemplifies the challenge for a medical staff when dealing with an athlete returning to play following a significant muscle strain. No matter how many sprints, drills or running workouts an athlete goes through to test the injured part, there is no guarantee that he is out of the woods when he returns to play. It is impossible to simulate every game situation and perhaps even more challenging to simulate the environment -- such as the intensity, the adrenaline of playing in a major league game -- and those things can factor into how the body responds. The Phillies brought Rollins along at a conservative pace, even holding him back at times as a measure of precaution. Sometimes even the best-laid plans don't unfold as anticipated.

In Rollins' case, his right calf gave him a signal that it was not going to fully cooperate with his agenda. Rollins returned to the lineup on May 17 after missing 30 games with the original injury. Just four days later, the calf bothered him while he ran to first on a single. He was forced to leave the game early and returned to the DL the next day. No fooling around here.



As Phillies general manager Ruben Amaro told The Philadelphia Inquirer, "It might not take [the entire 15-day DL stint], but we can't afford to put ourselves in a position where it gets reinjured and turns into something serious." Hmmm. It looks as though the first part (reinjury) already happened, but the hope is that this does not represent a serious setback. The fortunate aspect is that this strain is reportedly not as severe as the initial injury. The team is referring to it as a Grade I, or mild, strain (the original injury was a Grade II, or moderate, strain) and the team hopes he will not require much, if any, additional time off.



Fantasy owners are understandably frustrated (just think how Rollins feels!), but this is not time to panic.

Andre Ethier, Los Angeles Dodgers (15-day DL, retroactive to May 15):
What a difference a day -- or a splint -- makes! Ethier, who landed on the DL after suffering a fracture in his right pinkie finger while taking batting practice, could have missed up to six weeks with the injury. As it turns out, thanks to the aid of a particular splint, Ethier may be able to return when eligible on Sunday.

The emphasis is on the word "may," however, as Ethier will have to show that he can perform without limitation and that the fracture is indeed healing before he can definitively play. But so far, things are looking good. If he performs well in a simulated game Saturday, he could be activated Sunday.

Andre Ethier
Harry How/Getty ImagesAndre Ethier could be back from the disabled list as soon as he's eligible.
The fracture that Ethier suffered was bit odd, or at least the mechanism of injury was unique. Ethier sustained an avulsion fracture -- when a small chip of bone is avulsed or pulled away where the tendon attaches to the bone -- at the tip of his fifth finger. Typically this type of injury, also called mallet finger, results from hyperflexion (exaggerated bending) of the digit, most often when the finger gets jammed by a ball or by contact with another athlete. In Ethier's case, it occurred while batting, when a slight slip of his pinkie finger caused it to get jammed between the bat and his hand.



As the medical staff discussed what route to take for treatment, the Dodgers' director of medical services, Stan Conte (himself a physical therapist and athletic trainer), made a call to colleague Gary Vitti, longtime athletic trainer for the Los Angeles Lakers. Anyone who has followed the Lakers lately knows they have had their share of finger issues, as is common in basketball. Conte said that Vitti recommended use of the "Pro-Ferred" splint, a splint that uniquely maintains the joint of the tip of the finger in extension (keeps it straight) to allow it to heal while allowing the joint just below some ability to flex or bend. This ability to flex the proximal or near part of the finger is what allows Ethier to be able to handle a bat.

Conte said that the use of the splint, along with some modifications of padding at the knob of the bat to make for easier grip, have enabled Ethier to already begin taking batting practice. While Conte stresses that the Dodgers are not yet sure whether Ethier will be ready to return when eligible, he does acknowledge that they are very pleased with the progress he has been able to make. Ethier would continue to wear the splint even if he does return because the tissue will still be healing.

From a medical standpoint, the more normal motion that can be encouraged while still protecting the injured area, the better the outcome typically is. We often see hitters who struggle when returning from wrist and hand injuries, particularly as they work to regain their motion and strength even if the injury has technically healed. In this scenario, it's quite possible that many of those challenges could be avoided as a result of Ethier's being able to continue to swing the bat relatively uninterrupted.

A little interleague cooperation could prove to go a long way to make fantasy owners really, really happy here. Stay tuned.

Grady Sizemore, OF, Cleveland Indians (15-day DL, May 19): An awkward landing while diving back to first base sent Sizemore to the DL, aggravating a knee injury first sustained near the end of spring training. Sizemore's next step will not be known until he gathers several opinions on his injured knee. The team has termed Sizemore's injury a bone bruise, but based on the locales of the specialists he's reported to be visiting -- Vail, Colo., and New York -- it raises the specter of cartilage damage. Vail is home to Dr. Richard Steadman, a pioneer of microfracture surgery (he performed January surgery on the New York Mets' Carlos Beltran), and there are surgeons in New York with similar expertise in cartilage defects.



The question that every fantasy owner wants answered is whether Sizemore will require surgery. Although the bone bruise likely will have him sidelined for multiple weeks, surgery could keep him out even longer, perhaps even threatening his return this season. Until the team releases more information, a timetable remains speculative, but at the very least, fantasy owners should make alternate plans for the next month.

Josh Beckett, SP, Boston Red Sox (15-day DL, May 19): Beckett and back problems are nothing new. In fact, he has dealt with lower back and upper back issues at different points in recent years. It seems that this year will be no different.

Beckett began having back spasms in early May after taking batting practice, and he missed a scheduled start. Days later, while pitching in rainy conditions, Beckett left his start early with tightness in his back. A DL move was natural and precautionary in trying to prevent this from being a lingering and lengthy situation. Although Beckett is eligible to return on June 3, there is certainly no guarantee that he will. So far he has thrown a few side sessions, and next up comes the bullpen. The Red Sox will want to see how he tolerates the progression to the mound before deciding on a return date.

Jorge Posada, C, New York Yankees (15-day DL, May 20): Posada has been placed on the DL with a hairline fracture in his right foot, the result of absorbing a foul tip off that foot in mid-May. Posada was hoping for just a bone bruise, but imaging tests showed the crack.

Initial projections from the team after the fracture was revealed had Posada out for three to four weeks, but he has taken a bit of a defiant position against that notion. According to the Newark Star-Ledger, Posada believes he will return earlier. "They can say whatever they're going to say. I'll be here before that," Posada said. It's worth noting that he followed up by saying he had never had a problem with his feet before, pointing out that "You've got to be able to put your weight on and all that stuff. You've got to be able to transfer your weight from one side or the other." Right. And he was immobilized in a walking boot when he made the remarks.



Given his position as a catcher where he is in a crouch, placing significant load through his feet while intermittently, explosively moving to full stance, the demands on the foot are high. Not only is he not likely to be back before three weeks, he'd be lucky to be back by then.



A hairline fracture can show evidence of healing more quickly than a complete fracture, but beyond the bone repairing itself, the foot needs to be able to tolerate loading, pivoting and twisting, without causing any symptoms before an athlete is able to return to baseball activities. Then, of course, he has to get back up to the level of playing in games. Until Posada is cleared for impact activities, it's probably too soon to even think of a return date. Fantasy owners should be planning on being without his services for the better part of a month.

Brad Penny, SP, St. Louis Cardinals: (15-day DL, May 22): Penny escaped with a relatively mild injury but was still relegated to a DL stint just to be safe. Penny, who was diagnosed with a strained lat (short for latissimus dorsi, one of the broad muscles of the back), left his Friday start early because of discomfort. Despite delivering a grand slam, Penny was not feeling good and came out of the game as a result.



According to the St. Louis Post-Dispatch, the decision to move Penny to the DL was easy for the Cardinals when considering the big picture. General manager John Mozeliak said, "It just makes sense to DL him, rather than put him out there for the next start and he makes a pitch and goes backward. It's a precaution." The team does not expect him to miss time beyond the minimum DL requirement.

Justin Duchscherer
Tony Medina/SMIJustin Duchscherer currently has a 2-1 record with a 2.89 ERA in five starts this season.
Justin Duchscherer, SP, Oakland Athletics (15-day DL, May 16): After working so hard to get back this season, Duchscherer has to be disappointed in the cards he's been dealt so far this year. He knew that keeping his lead hip healthy was the key to keeping his lower back pain-free and avoiding overload on his throwing arm, which was surgically repaired in 2008. In fact, he told me that very thing in spring training after making his first start of the year coming off pain-alleviating sacroiliac joint (where the low back joins the pelvis) injections. That's why he dedicated extra time to stretching his hips and keeping them loose.



But his anatomy is just not cooperating. Duchscherer, who already endured surgery on his right hip, is now being plagued by similar symptoms on the left side. His prior experience with the right hip is no doubt what led him to tell the San Francisco Chronicle that he anticipates needing surgery on the left hip. That statement came just after Duchscherer returned to the DL in mid-May because of continued hip discomfort one mere day after coming off it.

For the time being, Duchscherer is trying the conservative route to see whether he can delay surgery until the season ends. The Chronicle reports that he has undergone a Synvisc injection, a joint lubricant that may alleviate some of his current symptoms.

Fantasy owners who were holding out hope should probably look elsewhere, however. Synvisc was not ultimately able to stave off surgery when Duchscherer's right hip was bothering him; it's hard to be overly optimistic that this will turn out differently.

Other names to watch

Huston Street, RP, Colorado Rockies (15-day DL retroactive to March 26): Street began experiencing shoulder stiffness in mid-March. After steady progress, Street was throwing in a rehab assignment mid-May and was feeling good. So good, in fact, that he told the Rockies' official website, "I'm close -- dangerously close. I'm close enough to start getting my hopes up, and that's something I'm trying to keep together." Then, as if foreshadowing what was to come, Street added, "I got real excited last time [in spring training], and we had the setback. That set us back six more weeks."

Uh-oh. It happened again. Street suffered a setback just when it appeared he was on the verge of returning. It's important to distinguish, however, that this setback was not to his shoulder; instead, Street suffered a groin injury. Fortunately, it appears that the injury was not as serious as first thought, and Street's return may not be extensively delayed. In fact, Street threw a bullpen session Tuesday, which suggests he could be back in a rehab assignment in the not-too-distant future. Fantasy owners should keep an eye on early June if all continues well.

Brett Anderson, SP, Oakland Athletics (15-day DL, April 27): Anderson has been out since late April with a flexor tendon strain in his throwing (left) forearm. ESPN's Buster Olney originally reported that Anderson was expected to miss a month, and it appears that time frame could be right on the money.



Anderson has been progressing well since his injury and threw three innings in a rehab start in Sacramento on Monday. Although it seems like a relatively short rehab stint, the A's must be pleased with what they have seen so far, because Anderson is expected to rejoin the team Wednesday according to Contra Costa Times reporter Joe Stiglich. The plan is for Anderson to throw off the mound and, if there are no setbacks, pitch Saturday. Despite the short rehab assignment, Anderson has been throwing his repertoire of pitches without incident during flat ground sessions since mid-May, according to the San Francisco Chronicle. Although this is certainly a strong sign, the demands of throwing off the mound are always greater. It will be interesting to see how deep he goes into his first game out after the layoff.

And yes, there are always more injuries than there is room to discuss here. We might even hit on some of them in tomorrow's Fantasy Focus podcast. Next week, we will take a look at some of those "forgotten" players nearing the end of their terms on the 60-day DL. Will they be ready? Check back and see what we're hearing.



Any regular visitor to my blog knows I love to start with some good news. Given that new or recurring injuries are a weekly staple, it's a great feeling when I can counter with news that a guy is getting healthy and coming off the DL. Maybe it's because I feel like the Grim Reaper most of the time, bringing news of the injured to distraught fantasy owners week in and week out. And if we've learned anything this year, it's that no one is safe from the injury bug. Occasionally, though, the sun does manage to shine and athletes exceed expectations in their recovery from injury.



This week is particularly special because I've been looking forward to this announcement since John Smoltz signed with his new team. After enduring a lengthy but steady rehab following offseason shoulder surgery, the veteran righty has finally been assigned a date to debut as a member of the Red Sox. Circle June 25 on your calendar, boys and girls. Smoltz is set to rejoin the rotation when the Red Sox face the Nationals. It will be exciting just to see him back on the mound. While it's worth tempering expectations early on (after all, he is 42), I believe that the acquisition of Smoltz will prove to be a brilliant move by the Red Sox and that he will indeed be the comeback story of 2009. OK. I put it out there. Now we just have to watch and see what happens.

Oh yes, I know, there are new injuries to discuss. Here are the guys we're paying attention to in the injury world this week ...

Jake Peavy
Scott Wachter/Icon SMIDon't expect Jake Peavy back by late August or early September at best.
Jake Peavy, P, Padres: By now the bad news on Peavy's right ankle has spread far and wide. Peavy could miss 8-12 weeks with a partial tear in his posterior tibialis tendon, according to team athletic trainer Todd Hutcheson, quoted in the San Diego Union-Tribune. My colleague A.J. Mass and I discussed Peavy at length right after the announcement was made, both in terms of what the injury actually is and what it means for Peavy's trade prospects.

Here's the bottom line for fantasy owners: Move on for three months. In the very best-case scenario, Peavy returns after the All-Star break, although an August or even September return is more likely. Any delays or setbacks between now and then could lessen the chance of a return. In the worst-case scenario, if the tendon does not show signs of healing when Peavy is re-evaluated in a few weeks, the prospect exists that surgery could be warranted. That is clearly a less desirable, last-resort type of option, but until we hear that Peavy is making progress, it remains a possibility.



Given that Peavy's ankle has already been slow to heal, despite the fact that he reported feeling better since the initial injury, you can bet that the medical staff will proceed conservatively with his long-term health in mind. In other words, don't bank on Peavy beating the recovery timetable issued by Hutcheson, no matter how optimistic the team wants to be. The good news here is that if the tendon heals properly, whatever the time it takes to do so, Peavy should be able to return to form.

Grady Sizemore, OF, Indians: After resting his elbow for the better part of a week, Sizemore had a repeat MRI on Monday to help assess his progress. Apparently the Indians liked what they saw, since Sizemore was allowed to resume baseball activities this week. Sizemore did some light throwing and took some light swings in his first such activity since going on the disabled list May 31.

Now you know I like good news, but there are reasons not to get over-excited just yet. According to the Cleveland Plain Dealer, Indians head athletic trainer Lonnie Soloff indicated that Sizemore was suffering from synovitis, which is inflammation of the synovium, the smooth tissue layer that lines the joint. This condition can certainly be the type of thing that can flare up repeatedly. According to the Akron Beacon Journal, Sizemore himself said, 'There's a chance it could get worse. It could linger all year."

General manager Eric Wedge summed up the situation best when he said, "As we continue to ramp up with him, we'll know more." In other words, there is not much surprise that Sizemore feels better after completely resting the arm. The bigger question is whether the inflammation will recur as he starts to use the arm or whether he can keep it at bay through the remainder of the season.



The next big test comes this weekend. According to MLB.com, Sizemore will take batting practice and throw from his position this weekend. If he passes the test (read: no pain), then he can begin working his way back toward being ready to play. If Sizemore does experience pain, an arthroscopic surgical procedure likely awaits him. Fantasy owners need to keep their insurance options available for a while as it is simply too early to gauge this one.



Torii Hunter
Cary Edmondson/US PresswireTorii Hunter suffered bruised ribs during this crash into the wall on Monday but could be back in action by the end of the week.
Torii Hunter, OF, Angels: The outfield walls seem to be fighting back against the players who hit them hard this year. Josh Hamilton has been to the DL not once, but twice (including surgery!), after running into walls. Rick Ankiel's neck and shoulder were on the losing end of a battle with a wall. Hunter is the latest to be punished by a wall while attempting to make a play, suffering bruised ribs Monday night. Fortunately for Hunter, X-rays taken of his right rib cage (where he contacted the wall) were negative, indicating no fracture.

Not that that lessens Hunter's pain. Any rib injury is painful. Just ask Hamilton, who ended up on the DL despite early resistance to the idea. Hamilton, who also suffered a soft-tissue rib injury, pointed out that in addition to baseball activities, breathing hurt. Until the pain and inflammation settled, Hamilton was incapacitated. According to AP reports Hunter was in a rib brace Tuesday, which is designed to help limit his overall rib movement. Minimizing movement allows the soft tissue to heal by preventing muscle fibers from getting overstretched. It's virtually impossible to eliminate all rib motion, however, since sneezing, turning, even breathing all result in movement at the rib cage.



Hunter's targeted return of Friday suggests the injury is not serious, but it may very well require additional time in order for him to move as necessary to play his position.

Coco Crisp, OF, Royals: Crisp was finally placed on the DL with what the team is calling a rotator cuff strain in his right (throwing) shoulder. Crisp has been bothered by a sore shoulder since late May, but several days of rest intermittently have failed to alleviate the problem, so the team decided to give him an extended break. According to the Royals' official Web site, manager Trey Hillman was hoping that a recent six-game break -- four absences because of the shoulder, plus an additional two to attend his great-grandmother's funeral -- would be enough to allow Crisp to return at full strength, but that has not been the case. Crisp has reportedly struggled most with batting from the left side of the plate and with throwing.



From the sound of things, Crisp may require some extended time away from baseball activities, focusing on rehab alone to clear his symptoms. Given that six days of rest was not sufficient, expect Crisp to rest longer before resuming hitting and throwing, meaning he may not be ready to return at the 15-day mark.



Ervin Santana, P, Angels: Uh-oh. Santana, who missed time at the start of the season with a sprained ulnar collateral ligament in his throwing elbow, was scratched from his Tuesday start with tightness in the same elbow. After lasting just 4 2/3 innings in his last start, should fantasy owners be concerned?

There's definitely reason to be concerned, but this may not quite signal the demise of Santana's season. Santana told the Los Angeles Times that the pain he's experiencing, which actually has been described as forearm tightness, is not in the same area as his original symptoms. "That was on the inside of the elbow. This is on the outside. I know I'm going to be OK." It's good to know he's confident.

Apparently manager Mike Scioscia has confidence as well. "If I hadn't seen him throw as well as he did in Detroit and hadn't seen his stuff pick up like it has, I wouldn't be as comfortable with where he is," Scioscia said. Nonetheless, Santana is under the very watchful eye of the medical staff as they evaluate next steps. Even if the symptoms are different, the fact that he is feeling discomfort in his throwing elbow/forearm so soon after his return is somewhat worrisome. The Angels hope Santana will be able to start June 23, but if he is unable to go at that point, he could be facing a return to the DL.

On the mend


• Last week we said A's pitcher Justin Duchscherer's back had calmed, allowing him to resume his rehab activities. So much for that. Turns out Duchscherer's spine is behaving like many spines do and is flaring up again. Rehab has again been put on hold until the symptoms settle.



• The St. Petersburg Times reports that Rays lefty ace Scott Kazmir is expected to make a minor league start Wednesday. Kazmir has been feeling good and thinks his mechanics are under better control. In fact, he sought out advice from friend and former Mets pitching coach Rick Peterson as to which drills would help him maintain his improved mechanics. Several rehab starts should give him a chance to test out his improved quadriceps muscle and delivery. Although there has been no specific date given, if the rehab outings go well, Kazmir could rejoin the team by the end of next week.

Asdrubal Cabrera's left separated shoulder is feeling better. He is now taking practice swings and doing some fielding activities. According to MLB.com, the Indians should have a better idea of when he'll be able to return by the end of this week.

• Royals third baseman Alex Gordon continues to make steady progress toward his return to the lineup after right hip labral surgery. He has taken some swings this week against live pitching, according to the Kansas City Star, and has returned to light jogging. Gordon is also fielding ground balls, which ultimately may be one of the more challenging activities for him to resume full force. The team still appears to be targeting a return near the All-Star break. I suspect it won't come until after that, but the good news is that Gordon's rehab is going according to plan.

• Finally ... Angels pitcher Kelvim Escobar has been placed on the DL ... again. Somehow this seems like a good move strategically. Escobar did experience some challenges when he rejoined the rotation in early June, and the Angels had indicated he was headed to the bullpen. With Escobar experiencing some fatigue in his surgically repaired shoulder and the Angels needing to add another starter in place of Santana this week, the DL move appears to be a good option. As the Los Angeles Times reports, manager Mike Scioscia said he would be "very surprised" if Escobar was not in the bullpen next Monday, the first day he is eligible to be activated.

All eyes on Lidge's, Sizemore's rehab

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On the mend

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

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

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

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

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

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

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

Posada, K-Rod and Jeter headline injuries

April, 12, 2008
4/12/08
1:19
PM ET


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

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

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

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

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

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

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

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

In brief


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

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

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

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

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

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