Stephania Bell: Mike Napoli



Once again following the weekend games, there are some comings and goings in baseball. Some players are coming back from injury while others are departing (in one case potentially for the remainder of the season) due to injury. This week, it appears a few players who have been out for extended time are about to resurface. Wandy Rodriguez returns Monday for the Houston Astros to face the Atlanta Braves after spending some time on the DL with elbow inflammation. The team seems to think he's ready. But will he and the others returning from injury last?



Coming

Hanley Ramirez, SS, Florida Marlins: The Marlins sound optimistic that their ailing shortstop could rejoin the lineup Tuesday night when the team faces the Phillies. Ramirez, currently on the DL for the first time in his career, has been dealing with back pain and sciatica. Even though we did not learn of Ramirez's pain until he was removed from a game in late May, it turned out the back had been bothering him for several weeks prior, which may explain his offensive struggles.

Ramirez did not resume baseball activities until late last week and then engaged in a rehab assignment Friday and Saturday. The plan was for him to work out with the Marlins on Monday (originally Sunday also but that was changed), according to the Palm Beach Post, after which he was expected to be activated Tuesday (his first day eligible). This presumes no setbacks, which, in the case of low back and associated leg pain, unfortunately is not uncommon. While it's encouraging that Ramirez has apparently made enough progress to return after the minimum DL stay, it's not evidence that he's completely out of the woods. Bear in mind that it was just over a week ago when he was forced to cut a workout session short because of pain. The good news is that his swing has reportedly improved which suggests his back is indeed feeling better. Ramirez told the Miami Herald, "My back is better now and I'm going to be able to compete out there." Now the Marlins and Ramirez's fantasy owners will have to hope it stays that way.



[+] EnlargePablo Sandoval
Jeanine Leech/Icon SMIPablo Sandoval was hitting .313 with five homers when he landed on the disabled list.
Pablo Sandoval, 3B, San Francisco Giants: This might also read Pablo Sandoval, 1B, since he is expected to see some playing time at that position as well while Brandon Belt remains on the DL with a fractured wrist. He will not, however, be playing catcher anytime soon. Mostly the Giants hope Sandoval is playing hitter. Period. They have missed his bat in the lineup and with the loss of second baseman Freddy Sanchez (see below in the "Going" section) they need Sandoval to deliver some offense even more urgently.

Sandoval has been recovering from surgery to remove a fractured portion of the hamate bone in his right wrist. The big concern was whether he could effectively hit from the left side of the plate, the more challenging side following this injury given the pressure the bat puts on the surgical site. Even as Sandoval was hitting the ball out of the park on his rehab assignment, he was forced to take subsequent days off because of persistent soreness in his wrist, which is not unusual during the first few weeks of hitting following this procedure. Apparently, everyone is feeling confident that Sandoval is ready to contribute immediately and he is expected to be in the lineup Tuesday when the Giants face the Arizona Diamondbacks.



Ryan Zimmerman, 3B, Washington Nationals: Adam Kilgore of the Washington Post reports via Twitter that the Nationals will activate Zimmerman on Tuesday, presumably in time for the contest against the St. Louis Cardinals. The move would not be unexpected as there were hints late last week that Zimmerman was likely to return soon.

Credit the Nationals for taking the time to ensure Zimmerman's full recovery from surgery to repair an abdominal tear before bringing him back to the majors. According to the Washington Post, manager Jim Riggleman was clear that he wanted to take no chances. "We don't want to push it," Riggleman said. "I really want him to be 100 percent. I don't want any setbacks." The good news is the success rate following this type of procedure is very high. The key is making sure the athlete can perform every aspect of his position without hesitation and without any sensation of pulling or tightness in the surgical area. When Zimmerman first returned to baseball activities, he acknowledged soreness with hard throwing. As his strength and endurance have improved along with the extension of innings he has seen in the minors, it has become less of an issue. Additionally, as the Washington Post reported in early June, Zimmerman has taken advantage of the rehab window to work on his throwing mechanics. There is every reason to think Zimmerman will be able to be effective immediately.

Matt Holliday, OF, St. Louis Cardinals: It's about as confident a statement as one can hope for from an athlete looking to return from the DL. Holliday told the St. Louis Post-Dispatch, "I have full confidence I'll be ready to play Thursday." Thursday will be the first day Holliday, who has been out with a strained left quadriceps, is eligible to be activated. He has tested his quadriceps in the best way possible, explosive directional running. According to the Dispatch, Holliday performed sprints from home to first base, then first to second. Most quadriceps strains in baseball happen during the first few steps out of the batter's box as the athlete attempts to explode towards first. And while it might seem strange that a muscle strain forced Holliday to the DL when an appendectomy didn't, it reflects the difficulty in returning an injured muscle, particularly one so critical for athletic performance, to full power. There is always a little something extra that the body delivers in a game situation so until an athlete has returned and stayed healthy for several weeks following an injury such as this, it's difficult to be confident that it's completely behind him. But when an athlete sounds as confident as Holliday does in his recovery, it should be taken as a very good sign.

Going

Freddy Sanchez, 2B, San Francisco Giants: Sanchez dislocated his right (throwing) shoulder in Friday night's opener against the Cincinnati Reds while diving to make a play. Not only is he on the DL, Sanchez may be done for the season. Giants head athletic trainer Dave Groeschner indicated that Sanchez suffered damage to both the labrum (cartilage ring which enhances stability of the shoulder) and the capsule (fibrous tissue that envelops the shoulder joint). In other words, after this event, Sanchez's shoulder is undoubtedly less stable. It is likely that he will ultimately require a surgical procedure, but the question is when that would take place.

According to AP reports, Sanchez will consult with the Arizona surgeon who previously operated on his left shoulder. The San Jose Mercury News reports Sanchez will undergo a course of rehabilitation to see if he can return to play and postpone any surgery, at least until the offseason. One of the most challenging issues for anyone who has suffered a traumatic dislocation with extensive damage to the joint is regaining adequate mobility in the arm to make it functional while overcoming the apprehension that it will dislocate again. A one-time dislocation in the absence of severe joint trauma can often do well with rehab alone. The more damage to the joint, however, the less stability (on what is already a relatively loose joint) and even minor subsequent subluxations (where the shoulder slips but does not completely dislocate) can be pain-inducing and cause the athlete to automatically guard the shoulder against movement. In other words, it can be very difficult to return to free and easy play. This will be the challenge for Sanchez who, as an infielder, has to dive without hesitation and throw hard regularly to make defensive plays.



Even if Sanchez does have some success with the rehab course, it would likely be multiple weeks before he could attempt to play. He will need to keep the shoulder immobilized in a sling initially, then gradually resume range of motion and strengthening before returning to any baseball activities. Given that a decision as to whether he could return or not might take some time to play out, fantasy owners would be wise to make alternate plans.

[+] EnlargeBartolo Colon
AP Photo/Paul J. BereswillBartolo Colon was throwing a two-hit shutout when he injured his hamstring covering first base.
Bartolo Colon, P, New York Yankees: Look at it this way. At the start of the season, who would have thought Colon would get this far? When it came to discovering the fountain of youth, pitching was one thing. Attempting to run to cover first base proved to be quite another. Colon strained his left hamstring on just such a move, which reminded us that he is indeed 38 years old and, well, shall we say, less than the model of fitness. The Yankees have placed him on the DL and according to ESPN New York, Colon indicated (through an interpreter) that he does not think the injury is serious and he expects to return at the end of the 15 days. Given the way he's pitched so far this year, the Yankees would love to get him back that quickly, but it's his landing leg that's injured. That left leg has to support Colon's body weight and slow down the momentum of his upper half following ball release, which is not a small task. Stay tuned.

Mike Napoli, C, Texas Rangers: Napoli is going to be missed by his teammates and fantasy owners alike, but everyone is hoping he won't have to be missed for long. He is being placed on the DL with a left oblique strain; however so there is no telling at this point just how long his absence might be. There is some encouraging news, though, that Napoli may have jumped on this injury early before it became more severe. According to the Fort Worth Star-Telegram, Napoli first felt discomfort Friday that worsened during Sunday's game. Napoli seemed to recognize the potential for a more severe injury, telling the Star-Telegram he was concerned about continuing to play and aggravating the condition. "I didn't want to do that and miss eight weeks instead of two weeks," Napoli said. Given that statement it sounds as if Napoli may have avoided the type of injury which results in a four-week (or more) absence but naturally it remains to be seen how long before he can ease back into baseball activity.

Aaron Harang, P, San Diego Padres: The foot issue Harang has been trying to work through for the last couple weeks has proven to be painful enough to force him out of service for a while. The Padres have placed him on the DL due to persistent pain in his right foot which has been present since early June. The team website reported negative findings on X-ray and MRI, and said Harang is not sure how he injured it. Nonetheless, the pain in the top of his foot is sharp enough to be bothersome. Harang said of the pain, "It kind of sends a quick shock through my foot." Harang's last start came June 9, so he should be eligible to come off the DL by late June, presuming the foot pain has resolved.

Seriously. I think Major League Baseball just set the record for the highest number of players being placed on the disabled list in a given week.

Of course, I don't have any official statistics to back that up. In fact, I'm fairly confident that such a statistic has not been tracked to date. But when your job is to track who is moving onto and off the DL, and the movement is happening so fast and with such a high volume that your head spins, you kinda get a hunch that a record might be broken. Sheesh.

Of course, when you're playing fantasy baseball and you lose a key guy to injury, that feeling is less of a gut feeling and more like a punch in the gut. And when you have so many players at different stages of their injuries, it's hard to know sometimes who's coming and who's going. Let's try to make sense of a few recent injuries:

Matt Capps
Jim McIsaac/Getty ImagesMatt Capps' shoulder injury sounds bad, but at least he'll avoid surgery for now.
Matt Capps, RP, Pittsburgh Pirates: Right shoulder problems reportedly will sideline Capps for the better part of two months. The first part of the diagnosis issued by the team is bursitis, or inflammation of the bursa, a small fluid-filled sac that serves to decrease friction between adjacent tissues. There are many bursae throughout the body, but those in the shoulder are commonly associated with throwers' injuries. Bursitis is also an everyman's injury, in that you certainly don't have to be a ballplayer to suffer from it.

But what about the second part of Capps' diagnosis? According to the Pittsburgh Post-Gazette, general manager Neal Huntington indicated that Capps also has internal rotation deficit, a less familiar term that describes a condition primarily associated with baseball pitchers. External rotation describes the position of the shoulder joint where the head (top) of the humerus (arm bone) is rotated to face outward. Internal rotation is just the opposite, where the head of the humerus rotates inward. Normal range of motion for the average person is a roughly equivalent distribution of external and internal rotation. In order to pitch a baseball effectively, however, an athlete requires external rotation above and beyond that of a nonpitcher in order to get his arm in a position to achieve maximum windup. There is only so much total rotation within the shoulder joint. When an athlete achieves excess external rotation, he typically sacrifices internal rotation.

Why does this matter? Well, because the body requires balance to stay healthy. A thrower will almost always have more external rotation than internal rotation. It is important for the health of the throwing shoulder, though, that the total motion in the throwing shoulder joint (external rotation plus internal rotation) is relatively equal to that of the nonthrowing joint. In other words, 120 degrees of external rotation and 60 degrees of internal rotation in the joint of an athlete's throwing arm, and 100 degrees of external rotation and 80 degrees of internal rotation in the same athlete's non-throwing arm are considered equal. If the total motion on the throwing side is less than that on the nonthrowing side, with the deficit being primarily on the internal side, it is considered internal rotation deficit. In the example above, an athlete with internal rotation deficit might have the same range of motion in his nonthrowing arm, but his throwing arm might have 100 degrees of external rotation and 40 degrees of internal rotation, resulting in a 40-degree differential from one arm to the other.

What causes it and what can be done about it? There is some debate within the medical community as to what, in fact, causes internal rotation deficit. Some believe that tightness in the rotator cuff muscles, which sit on the back of the shoulder and therefore are stretched when the shoulder internally rotates, is responsible. Others believe that the joint capsule, the fibrous tissue that encases the joint, is tight and does not allow the humerus to move freely within the joint. And of course it could be a combination of these two variables. The primary treatment consists of stretching, either stretching muscle tissue or joint tissue, and then following that stretching with a set of exercises designed to enhance strength in the new range of motion and to maintain the motion. Either way, Capps is looking at a significant period of time away from the game (the team expects him to be out until at least September). The good news, however, is that this is a nonsurgical approach, and he should be able to manage the condition after he returns.

Alfonso Soriano, OF, Chicago Cubs: Soriano (fractured fourth metacarpal in his left hand) took his first batting practice Saturday and has been making a case for returning in time to play in the All-Star Game. The good news: According to the Cubs' official Web site, Soriano reported having no pain at all in his hand. The bad news: He did acknowledge that his hand still felt weak, making it unlikely that he would be able to appear in the All-Star Game next Tuesday. Originally projected to be out six weeks, Soriano may yet be able to beat that timetable, but there is no incentive to bring him back early. The Cubs would prefer to have him healthy and at full strength down the stretch.

Johnny Damon
AP Photo/Julie JacobsonJohnny Damon has been placed on the DL for the first time in his career.
Johnny Damon, OF, New York Yankees: Every now and then, this space will detail the injuries caused by an outfielder sacrificing his body and running into a wall or fence. Well, you can add Damon to that list after a weekend crash into the Yankee Stadium fence Friday forced him to the DL for the first time in his career. Damon has what the Yankees are calling a sprained and contused (bruised) left shoulder, and the 34-year-old is adjusting to the idea of being out of the starting lineup for a while. The New York Times reported Damon's injury as a sprained AC (acromioclavicular) joint, which is the joint formed where the clavicle (collarbone) meets the point of the shoulder (acromion). A sprain (ligament injury) in this area, when severe enough, is often called a separated shoulder because if there is enough ligament damage, the two bones can move apart, or separate. It really is a question of degree, and we likely won't get that answer officially. In the end, the treatment is essentially the same. Rest, get rid of the inflammation, and gradually work on increasing the range of motion so Damon can do what he needs to do. Damon indicated he could not raise his arm above his shoulder after the injury because of the pain, which is typical for this type of injury. Two weeks to return to full activity is optimistic for this type of injury, and I would not be surprised if Damon cannot play the field for an additional two to three weeks beyond that. He might be able to hit sooner if his arm recovers well, though, so you might see the Yankees bring him back initially as a designated hitter. We should know more about his status after the All-Star break.

Elijah Dukes, OF, Washington Nationals: Speaking of an outfielder sacrificing his body while running into the outfield wall, Dukes did just that Saturday and came away with a torn meniscus (fibrocartilage disk in the knee) and a partially torn patellar tendon (the thick tendon that anchors the quadriceps muscle to the lower leg) in his right knee. According to the Washington Post, Dukes had arthroscopic surgery Monday and is expected to miss at least the next four to six weeks. This might be a conservative estimate, depending how his rehabilitation goes. The tendon must be at full strength to handle the forceful contractions of the quadriceps muscle, particularly when decelerating or jumping and landing, such as one does when leaping into an outfield wall. How disappointed the Nationals must have been to see yet another youngster go out with a significant injury.

Mike Napoli, C, Los Angeles Angels: Napoli was placed on the disabled list Sunday with what the Angels are calling right shoulder inflammation. According to the Angels' official Web site, Napoli was scheduled to undergo an MRI on Monday to help determine the nature of the problem. For his part, Napoli said he has been having good days and bad days for a while now, but that on the bad days it hurt just throwing the ball back to the pitcher. The nonspecific nature of his injury makes it difficult to project how much time he will need to recover. Once his MRI results are known, there might be better clues as to what the club plans for him. Stay tuned.

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Jeff Suppan, SP, Milwaukee Brewers: Looks as though the arrival of C.C. Sabathia is coming just in the nick of time for the Brewers, who just placed Suppan on the DL with irritation in his right elbow. Sabathia will take Suppan's place in the rotation and is expected to make his first start for the Brewers on Tuesday. Suppan told the Los Angeles Times he initially injured his elbow during an at-bat on May 23 and that it just wasn't getting better. For his part, Suppan says he wasn't sure whether the injury was affecting his pitching or not; he just knew the problem was not improving. It makes one wonder, though, how much Suppan's elbow has been bothering him, given his poor performances recently. Control issues for a pitcher are often a sign that something is amiss, and Suppan's situation appears no different. The timing is good for Suppan to give the elbow a rest, with the arrival of Sabathia and the All-Star break. In fact, he could return just after the All-Star break, with little harm done to the rotation. A pitcher's elbow can be a little tricky, but at this point there is no evidence that this is something more serious.

And in the good news department ...

Felix Hernandez, SP, Seattle Mariners: It looks as if the return of the King is imminent. After an uneventful bullpen session Monday, he is expected to start Friday. This will be his first start since he sprained his left ankle on June 23.

David Ortiz, DH, Boston Red Sox: Before you get too excited about him returning, note that he still has some time before he's back in the Red Sox lineup. But the news is encouraging here. Big Papi took live batting practice Monday for the first time since injuring his wrist in late May. He still has some hurdles to cross but is feeling good swinging the bat. Despite his election to the All-Star roster for the American League, Ortiz will not be able to play, since the wrist is still healing.

Let's hope the All-Star break will come just in time to give the injuries a chance to heal, not to mention slow down the pace of new injuries the league seems to be on now! Stay healthy everyone.

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