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Nishioka breaks leg; Escobar's concussion

4/8/2011

I posed a question right here in this blog Wednesday, a challenge if you will, to see if we could get through a day of baseball without any additions to the disabled list. It seems like the answer was no, thanks in part to a dramatic injury in the Bronx.

On Thursday, Minnesota Twins new second baseman Tsuyoshi Nishioka was literally taken out on a takeout slide by New York Yankees outfielder Nick Swisher. Nishioka, new to the more physical version of baserunning played in the states, absorbed the impact of Swisher's slide with his left leg, resulting in a fractured fibula (the skinny bone on the outer aspect of the lower leg which runs from just below the knee to the ankle).

Nishioka has been placed on the DL and is expected to miss at least a month, but more should be known after his visit with Dr. John Steubs, team physician for the Twins. There are several variables that can influence the plan of care and the recovery time from this type of injury, including the location of the fracture (high on the fibula near the knee or low near the ankle), whether the fracture is displaced or not (whether the bony ends have moved apart or remain in alignment) and whether surgery is required (more likely with a significantly displaced fracture).

The Minneapolis Star-Tribune reports Nishioka's fracture to be high on the fibula, just below the knee, an important distinction in that he may not require ankle immobilization. One of the compounding issues for a low fibula fracture is the ankle joint; when immobilized for a period of time to allow the bone to heal, the ankle then becomes stiff. Regaining ankle range of motion can be a lengthy process, making returning to running and agility maneuvers more difficult. The best-case scenario for Nishioka would be a non-displaced proximal (high) fibula fracture that could heal with rest. He would be able to resume ankle range of motion and weight-bearing activities sooner. In the meantime he could participate in cardiovascular conditioning and upper-body workouts. His timetable should become clearer after his medical evaluation Friday.

• The other big injury news Thursday was the official diagnosis of a concussion for Toronto Blue Jays shortstop Yunel Escobar. Why so big? Because Escobar is the first player to suffer a concussion since the implementation of Major League Baseball's new concussion policy.

The injury occurred when Escobar's head met the knee of Oakland Athletics third baseman Andy LaRoche as Escobar slid into third on a triple Wednesday. The mechanism of injury was eerily similar to the one that sidelined Twins first baseman Justin Morneau for months with post-concussion symptoms. According to the National Post, Escobar was examined on the field by Jays' athletic trainer Hap Hudson and was cleared to remain in the game. But in the next inning, Escobar developed dizziness (it is not uncommon for symptoms to emerge over time following a concussion) and the decision was made to remove him from the game.

Escobar underwent subsequent tests, including hospital-administered CT scans of the head and neck and neurological evaluation. The imaging tests were negative (they usually are with isolated concussion) and the early news on Escobar is encouraging. According to general manager Alex Anthopoulos, Escobar felt "great" Thursday morning, adding, "If you asked him he'd tell you that he could play today." Of course, Escobar did not play Thursday but he did show enough improvement for the Blue Jays to elect not to make use of the new optional seven-day disabled list stint for concussed players. As per the new protocols, however, Escobar will require clearance not only from the Blue Jays but also from Major Leagues Baseball's medical director, Dr. Gary Green, before he can return. The Blue Jays hope to have Escobar back next week, but as is the case following any concussion Escobar will be evaluated daily.

• The Blue Jays have some more encouraging news regarding Octavio Dotel. The veteran relief pitcher, who started his season on the DL with a hamstring strain that cropped up in early March, is now ready to return. Dotel is probably most likely to be used in a setup role for Jon Rauch. Closer Frank Francisco, on the DL with a right pectoral muscle strain, was cleared to begin a rehab assignment Monday. According to the Blue Jays' website, Francisco likely will need a minimum of three rehab outings before he can rejoin the team. As with any muscle strain, the key will be to see how Francisco responds to a progressively increasing workload. Finally, starter Brandon Morrow (forearm strain) made his rehab debut Thursday, allowing five runs in three innings. His performance may have been less than ideal, but the more important element will be how his forearm held up. If all continues well, Morrow is expected to make another rehab start and could rejoin the team within the next two weeks.

• The Chicago White Sox have to be feeling encouraged when it comes to Jake Peavy's progress following his latissimus dorsi tendon repair. Peavy, who had a very minor speed bump in his rehab road when he developed some rotator cuff tendinitis in March, is now on track to start throwing in minor league games. The Chicago Sun-Times reports Peavy is expected to throw 75 pitches Friday for Class AA Birmingham. Assuming there are no issues, he will be on a structured progression to increase his pitch count and arm strength over the next few weeks. While no one wants to commit to a formal timetable, there is reason to believe Peavy could rejoin the White Sox by the end of April.

• The White Sox could see Adam Dunn this weekend if Dunn has his way. Dunn is still having pain, though, and he will most certainly not be permitted to suit up if there are any concerns about his healing. Given that Dunn is an athlete and not a physician, his goals, while admirable, will not drive the decision. It would not be surprising if Dunn was out until next week, but fantasy owners with daily lineups may want to check before games.

• Meanwhile, Dunn's counterpart in abdominal surgery, St. Louis Cardinals outfielder Matt Holliday, could make an appearance this weekend in a pinch-hitting role, although according to Fox Sports Midwest on Twitter, manager Tony La Russa says the chances of that are "slim." Stay tuned. MLB.com says Holliday is expected to undergo a full workout and batting practice Friday, after which a decision on the next step will be made.

That's the buzz for Friday. Here's to a happy and healthy weekend, everyone! Something tells me, though, we'll still have plenty to discuss as next week rolls around.