Stephania Bell: Ryan Madson



Every Monday in this space, we'll provide updates on a variety of players to help you make your weekly lineup decisions. We'll specifically try to hit the players who are day-to-day, have just gone on the DL or are ready to return, so that you can better decide whether you can count on them or not.

All projected return timelines should be considered fluid.

Hitters

Curtis Granderson, OF, New York Yankees (placed on DL May 25; expected to miss at least a month): When it comes to injuries this season, if the Yankees didn't have bad luck, they wouldn't have any luck at all. Granderson, whose season finally got under way just a few weeks ago, is now out for at least a month with another fracture.

Two hit-by-pitches have resulted in fractures for Granderson, the first a broken right radius (forearm bone) just above the wrist, and now a broken left fifth metacarpal (the long bone of the hand, at the base of the fifth (pinkie) finger). The latest incident occurred Friday night when Granderson absorbed the impact of a pitch to his left knuckle in the fifth inning. In an almost eerie forewarning of this event, Granderson spoke to the Yankees' website just weeks ago during his rehab assignment (from the first fracture) about not fearing the inside pitches. "There's going to be pitches inside, I'm going to get hit again, but you got to stay in," Granderson said. In this case, he stayed in until he was forced out, literally, because of injury.

If there's any good news here, it's that it appears this fracture, like the first, will not require surgery. Broken bones typically require four to six weeks to allow sufficient healing to permit return to play; if Granderson's finger shows good early callus formation (bone healing) and he can grip the bat effectively, his timetable should fit right in that timeframe. That said, he might have to encase his fingers, hands and forearms in bubble wrap when he steps to the plate to get through the rest of the season.

[+] EnlargeBryce Harper
AP Photo/Alex BrandonBryce Harper is becoming known for his "all-out" style of play ... which could lead to missed games.
Bryce Harper, OF, Washington Nationals (day-to-day): Add bursitis to the list of Harper's aches and pains resulting from crashing into walls, but don't expect it to land him on the disabled list if he can help it. Harper's knee bothered him enough to warrant an MRI, which came back clean, according to manager Davey Johnson. The Washington Post reports Harper will be sidelined for several days, although he may be utilized as a DH against Baltimore later in the week. One thing is certain, though: Harper has no intention of changing anything about the hard-nosed way he plays baseball. These intermittent minor injuries have threatened his status for a couple of games here and could be an ongoing challenge for Harper and his fantasy owners.

Shane Victorino, OF, Boston Red Sox (placed on DL retroactive to May 21): Victorino had been battling back spasms in recent weeks yet managed to avoid a DL stint. Not now. This time it's his left hamstring that's giving him fits, and Victorino will be forced to rest until he can run without limitation. Interestingly, Victorino's hamstring started to bother him just days after returning to the lineup following missed time for his back. If these two issues are related, which would not be surprising, this could turn out to be intermittently problematic throughout the season.

Will Middlebrooks, 3B, Red Sox (placed on DL May 24): Perhaps back spasms are contagious in Boston. Middlebrooks left Thursday's game early due to back spasms, something manager John Farrell told reporters might have begun Wednesday night as Middlebrooks came out of the batter's box. The good news is that Middlebrooks said, according to ESPN Boston, that as of Saturday he was already feeling improvement. "I do [think I'll come off the DL when eligible]," he said, adding, "I feel better than yesterday, so if I'm already making steps forward, that's where I want to be." This looks to be a minor episode.

Jayson Werth, OF, Nationals (placed on DL retroactive to May 3): When Werth was first placed on the disabled list, the thought was that he would miss the minimum amount of time. After all, when the decision was made to formally move him, he had already missed eight games and seemed to be faring better. But if there's anything we know about hamstring injuries, it's that they are among the least predictable of all soft-tissue ailments. It is often not until the athlete tests the leg with full-speed sprinting activities that lingering issues make themselves known. In Werth's case, he experienced discomfort when breaking out of the batter's box, according to Amanda Comak of the Washington Times. The persistent discomfort led to an MRI, which manager Davey Johnson told reporters was "alarming." Consequently, Werth's timetable has been extended with a new target date of June 3, according to general manager Mike Rizzo (via the Washington Post). It's worth reiterating, however, that hamstrings remain unpredictable. Let's see what Werth does this week in his workouts before counting on a Monday return.

Chase Utley, 2B, Philadelphia Phillies (placed on DL May 23): Utley's knees haven't really been a topic of discussion this season since they haven't seemed to limit him thus far. Now, however, Utley is dealing with a different type of injury issue: a strained right oblique. The Phillies report it as a Grade 1 or minor strain, and the move to the DL reflects their desire to not allow it to worsen. Phillies GM Ruben Amaro Jr. offered a timetable of 2-4 weeks, which is certainly reasonable, adding, "We do believe and hope that Chase will be ready to play in Philadelphia within 15 days." The average missed time for an oblique strain in a hitter runs right around a month, but the most mild forms have allowed an athlete return after the minimum stay (such as Freddie Freeman earlier this season). Although there is some optimism Utley will be back after the 15 days, there's no reason for the team to rush him, especially this early in the season.

Trevor Plouffe, 3B, Minnesota Twins (placed on 7-day concussion DL May 22; expected to return Wednesday): Plouffe took a knee to the head while sliding last Tuesday and was subsequently placed on the concussion DL. Concussions are the least predictable of all injuries, but based on Plouffe's fairly swift recovery so far, it appears the Twins will get him back the first day he's eligible to return. According to the Minneapolis Star-Tribune, Plouffe passed his neurocognitive (ImPACT) tests Thursday and participated in cardio work Friday, which shows progression. If he is able to perform baseball-related activities early this week without any recurrence of symptoms, it appears he will be cleared to rejoin his team's lineup Wednesday.

Wilkin Ramirez, OF, Twins (placed on 7-day concussion DL May 26): Another collision, another concussion for a Twins player. Unlike the knee to the head Plouffe sustained, Ramirez was concussed making a defensive play in the outfield Saturday when he crashed into teammate Josh Willingham. According to the Minneapolis Star-Tribune, Ramirez was not originally on board with the DL designation, that is until he experienced queasiness during the team's flight home Sunday. Good job by the Twins, who certainly have had experience with complex concussions (think former AL MVP Justin Morneau). Now it will be a matter of waiting to see how Ramirez progresses throughout the next week.

Pitchers

Chris Perez, RP, Cleveland Indians (placed on DL May 27): Perez is sidelined with right shoulder soreness, and he was placed on the disabled list for the first time in his major league career early Monday. He was forced to leave Sunday's game against the Red Sox early because of the shoulder, according to ESPN.com. "It kind of pinched on me and sent a little pain down my arm," Perez said. While any shoulder issue is of concern for a pitcher, this doesn't yet have the sounds of something major. It appears Perez at least needs some down time to let the symptoms settle, and he can then hopefully return to throwing. Hopefully.

Clay Buchholz, SP, Red Sox (day-to-day, expected to start at some point this week): Buchholz was scratched from his Monday start after irritating his right acromioclavicular (AC) joint (the point of the shoulder), something he attributes to falling asleep on his side with his arm wrapped around his young daughter. The impression is that this is just a simple matter of delaying his start to account for the soreness, preventing him from compensating and potentially creating another problem. According to ESPNBoston.com, the plan is for Buchhholz to play catch Monday, and he expects to pitch again later this week.

[+] EnlargeJim Henderson
Jeff Hanisch/USA TODAY SportsJim Henderson is expected to get his closer job back once he returns from his hamstring injury.
Jim Henderson, RP, Milwaukee Brewers (placed on DL May 25): Henderson left Friday night's game in the ninth inning after straining his right hamstring while trying to field a ground ball. After visiting with the team doctor Saturday, the decision was made to place Henderson on the disabled list, which would allow him some additional time off to recover. It sounds like it will be a closer-by-committee situation in Milwaukee until Henderson is ready to return, whether that's in two weeks or slightly longer.

Chris Sale, SP, Chicago White Sox (day-to-day): Mild tendinitis in his posterior throwing shoulder was the diagnosis for Sale. While any inflammation in a thrower's shoulder is a cause for some concern, the Sox immediately indicated they expected Sale to return for his next start after being scratched last Wednesday. Those plans were confirmed after Sale played catch in the outfield prior to Saturday's game. Afterward, Sale said, "It felt a lot better than I actually thought it would be. Everything is on track, and I will be ready to go Tuesday." He was scheduled to follow up Saturday's session with a Sunday bullpen, and there has been no word of any setback.

If Sale returns without incident, there will be a big sigh of relief from his fantasy owners. But the specter of concern has been raised once again -- last year, there were some questions about whether he was dealing with an elbow injury in May, followed by a reported dead arm period in July -- which must remain in the back of our minds. The bigger question will be whether or not Sale can get through the remainder of the season without this turning into something more substantial.

David Price, SP, Tampa Bay Rays (placed on DL May 16): Triceps tightness originally put Price on the DL, but nobody on the Rays seemed overly concerned. Manager Joe Maddon said he did not expect Price to miss more than two or three starts. Apparently there's now reason to be at least a little more concerned. Despite Price's assertions that his arm feels "great," he hasn't yet begun to throw. According to the Tampa Bay Times, playing catch hopefully will begin within the next few days, but Price will have to proceed through a throwing progression before returning the rotation, which could take an additional few weeks. So much for him missing only 2-3 starts; now there is no official timetable. Until Price actually starts throwing with effort, it's difficult to gauge whether the slow progress is as a result of the Rays taking a conservative approach with him or because of legitimate concern over the health of Price's arm.

[+] EnlargeJaime Garcia
Dilip Vishwanat/Getty ImagesJaime Garcia finally succumbed to his shoulder injury.
Jaime Garcia, SP, St. Louis Cardinals (placed on DL May 18; done for the season): Garcia tried to get through his shoulder injury without resorting to surgery, and he was successful in doing so for a few starts. His shoulder, like those of so many other pitchers before him, exhibited the wear and tear associated with overhead throwing in the form of labral damage. Eventually that damage made it impossible to throw. After consulting with Dr. James Andrews, Garcia is headed for surgery. It appears his operation will be performed by team physician Dr. George Paletta. The recovery typically requires about six months, meaning if all goes well, Garcia should be ready to return when the season gets under way in 2014.

Ryan Madson, RP, Los Angeles Angels (opened the season on DL; no timetable for return): Every time it seems Madson is making progress in his recovery from Tommy John surgery, he seems to have some form of setback, which delays his return. The most recent incident occurred last week, when Madson developed soreness in his arm while throwing. Instead of beginning an anticipated rehab assignment with Triple-A Salt Lake, Madson has been shut down indefinitely. He is now 14 months post-surgery, and while the timetable for return following this procedure has a range of anywhere from nine to 16 months, the multiple setbacks Madson has experienced are discouraging.

Rarely is the road back to competition entirely uneventful, but Madson seems to have been pushed back with various episodes of discomfort a bit more than usual. At this point, the Angels seem to be getting solid production from Ernesto Frieri in the closer role, and it looks as if he will stay there for the foreseeable future. No doubt the Angels would like to see Madson return to the mound this year, but it has already proven to be slow going. For fantasy purposes, it's probably time to move along.

Jered Weaver, SP, Angels (placed on DL April 8; expected to return Wednesday): It's always nicer to see someone returning from the disabled list as opposed to going on it, especially when it's your team's -- real or fantasy -- ace hurler. Weaver has been out for more than a month after sustaining a non-displaced fracture of his radial head as a result of an awkward fall on the mound. His road to recovery has been uneventful, with the latter part primarily focused on building up his arm strength to the point of being able to reclaim his spot in the rotation. The Angels have announced Weaver will return Wednesday to face the Angels' neighboring rival, the Los Angeles Dodgers, and fantasy owners should have no concerns about starting him right out of the gate.

Ryan Vogelsong, SP, Giants (placed on DL May 21; expected to miss eight weeks): Vogelsong had not one break but two in his right (throwing) hand, an injury sustained while hitting last week. He underwent surgery last week which required five pins to stabilize the fractures, according to manager Bruce Bochy, and he will need time for the bone to show evidence of healing before he can resume throwing. He will then need additional time to regain throwing strength. Given the projected timeline, expect Vogelsong to be out until well after the All-Star break.



Every Monday in this space, we'll provide updates on a variety of players to help you make your weekly lineup decisions. We'll specifically try to hit the players who are day-to-day, have just gone on the DL or are ready to return, so that you can better decide whether you can count on them or not.

All projected return timelines should be considered fluid.

Hitters

Jason Heyward, OF, Atlanta Braves (placed on DL April 21, could return this week): Heyward went on the disabled list following an emergency appendectomy, so at least there's comfort in knowing this is not going to be a recurrent problem. Now it's just a matter of when he will return … and when he'll be effective.

Heyward has been on a rehab assignment for several days at Triple-A Gwinnett, and other than some soreness that warranted a day off, his stint has been uneventful from a health perspective. It also has been uneventful at the plate, that is until Sunday, when he finally started hitting. The Braves don't have an exact date for his return, but he's expected to rejoin the team at some point this week.

[+] EnlargeCurtis Granderson
AP Photo/Seth WenigCurtis Granderson could return to the Yankees as early as Tuesday.
Curtis Granderson, OF, New York Yankees (opened season on DL, could return this week): It's only fair that the Yankees actually get a player back from the DL after adding more and more players to it this season. Granderson's recovery and rehab have been totally uneventful, just the way the medical staff likes it. He has been crossing "to do" items off the list during his rehab assignment: He has faced both left- and right-handed pitching, played defense and played both day and night games. Perhaps most importantly, Granderson has not shown any lingering apprehension from getting hit by a pitch this spring. As he told the Yankees' official website regarding his rehab at-bats, "There was no recall of the injury. There's going to be pitches inside, I'm going to get hit again, but you got to stay in."

The Yankees would like it if he stays healthy and stays in. There's every indication he will come back and be productive immediately, and that return could happen any day now, potentially as early as Tuesday, when the Yankees open a series at home.

Coco Crisp, OF, Oakland Athletics (placed on DL April 30, could return this week): Crisp strained his left hamstring trying to run out a ground ball in the A's seemingly never-ending Monday night game nearly two weeks ago. Fortunately, the strain appeared mild and Crisp could potentially attempt to run the bases soon, according to the San Francisco Chronicle. Obviously his tolerance of running will help determine his readiness to return -- manager Bob Melvin told reporters Crisp might not need a formal rehab assignment -- but as is always the case with hamstrings, until he runs in games without a setback, it will be impossible to tell just how healthy he is.

Chris Young, OF, A's (placed on DL April 30, could return Wednesday): The A's hope to get another outfielder with a soft tissue injury back soon. Just as Coco Crisp recovers from his hamstring, Young is working to get past a left quad strain that has sidelined him the past couple of weeks. After passing the necessary rehab clearances, Young is expected to get some at-bats in extended spring training games during the early part of the week, according to the A's official website. If all goes well, he could return when eligible on Wednesday.

Neil Walker, 2B, Pittsburgh Pirates (placed on DL retroactive to April 27, expected to return Monday): Two weeks ago in this space, I wrote about how the Pirates hoped to return Walker within days if he could swing the bat effectively. Clearly he could not, and the decision was made to place him on the DL. After beginning a rehab assignment last Thursday, it seems Walker has shown he has moved past the injury, and his return appears imminent.

Michael Cuddyer, OF, Colorado Rockies (placed on DL retroactive to May 9): Cuddyer had already missed three games with what he referred to as inflammation in his neck, related to a disc problem. Now it's clear he will be missing a few more. This is not Cuddyer's first episode of neck pain, but it appears to be the first time it has forced him on the DL. The hope is that the symptoms are limited to his neck and that it won't progress into his shoulder or arm. Rest is the best option for him in the short term, but given the variability of these types of ailments, a definitive timetable is difficult to determine. The soonest he can return is May 24, if his neck cooperates.

Jayson Werth, OF, Washington Nationals (placed on DL retroactive to May 3): This doesn't come as a huge surprise after Werth's hamstring continued to bother him despite missing the past eight games. If there is any good news, it's that it can be backdated to the last time Werth saw the field, making him eligible to return May 18. Whether he will be able to actually run at full speed by the end of this week remains to be seen. The Nationals have also indicated they believe dehydration was a factor in Werth's repeated muscle cramping.

The hope is that all will be under control and back to normal by the end of the week, although fantasy owners might want to wait until next week to insert him into their lineup.

Adrian Gonzalez, 1B, Los Angeles Dodgers (day-to-day): Gonzalez has been dealing with a minor muscular strain in his neck, recently aggravated when he and an umpire crossed paths as he was attempting to field a ground ball. An MRI revealed little of significance and Gonzalez returned to play late last week. However, he promptly aggravated it again, then sat out Sunday's game.

This is what falls under the header of "annoying" injuries, frustrating to the athlete because of the come-and-go pattern and difficult to predict in terms of behavior and severity. It does not look as if Gonzalez is in danger of going on the DL, but fantasy owners will want to check daily lineups until he is playing consistently.

Austin Jackson, OF, Detroit Tigers (placed on DL retroactive to May 12): Another outfielder, another hamstring injury. It seems to be quite the injury trend this week. Also a trend: Teams opting to send players to the disabled list for seemingly minor strains early in the season, not wanting to risk a more severe injury. That makes sense. Teams as a whole seem to be offering their players a couple of days to test the effects of rest, but if there are any lingering warning signs, they waste little time scaling the athlete back (in the form of a DL stint). The hope then is that the player will miss the minimal amount of time, and Jackson's case is no different.

[+] EnlargeVictorino
AP Photo/Winslow TownsonShane Victorino (lying down) collided with the outfield wall Sunday at Fenway Park.
Shane Victorino, OF, Boston Red Sox (day-to-day): After missing a week due to spasms in his back, Victorino returned to action May 3. He seemed to be faring well ... until he ran into the outfield wall Sunday, ultimately requiring a trip to the hospital to be examined. As bad as it looked -- and perhaps felt -- Victorino appears to have escaped major injury. According to ESPN Boston, X-rays on his ribs came back negative, and manager John Farrell says Victorino should be ready to play Tuesday after the team's off day Monday. The hope is that this collision will not wake up the painful spasms in his low back again, and so far there has been no word of that. If Victorino does return Tuesday, that will be a good sign that he should be available going forward.

Desmond Jennings, OF, Tampa Bay Rays (day-to-day): Jennings has missed a few games with a minor groin strain, but the Rays seem fairly confident they will have him back Tuesday. Jennings has downplayed the injury since it first cropped up last week, suggesting he could play if necessary. Given that it's May and not September, manager Joe Maddon opted to rest Jennings for several days. The proof that it is not anything to worry about will come when Jennings returns to action for consecutive days without incident.

Pitchers

Zack Greinke, SP, Los Angeles Dodgers (placed on DL April 12, could return Wednesday): When Greinke was injured in the brawl with Carlos Quentin, no one knew what to expect since a clavicle fracture in the non-throwing arm of a pitcher is not exactly your everyday injury. As soon as the Dodgers announced he was undergoing surgery to stabilize the fracture, his prognosis for return actually improved, as it appeared he would not face as much down time from throwing.

Turns out that was an accurate assessment. Despite the Dodgers' (understandably) conservative eight-week projection, Greinke appears poised to possibly return this week, which would mark 4 1/2 weeks post-surgery. He has passed the point of having discomfort and pitched in high Class A ball last Friday. His velocity is up where he left off at the time of injury, and he appears from a functional standpoint to be ready to pitch in the majors. The final remaining hurdle is whether the bone has healed to the point where the team is comfortable with him absorbing contact. (The high Class A outing afforded him the opportunity to pitch with a DH in the lineup; when he returns to the Dodgers, he will need to hit, run and potentially absorb contact should there be a collision). Expect those clearing tests to be performed over the next 24 hours and a decision to be forthcoming shortly after. If the team opts to hold Greinke out of a return to the majors Wednesday, he would likely get another rehab start this week and rejoin the team next week.

Brett Anderson, SP, A's (placed on DL April 30, could return Friday): After originally spraining his ankle in mid-April, it looked as if Anderson could avoid a DL stint with some rest. But he got called into service in the A's marathon game a couple of weeks ago and it set him back, forcing the DL stint. With a pitcher so recently removed from Tommy John surgery, it's probably for the best that he allow the ankle to recover sufficiently to not threaten his throwing mechanics and, consequently, the health of his arm. According to the San Francisco Chronicle, Anderson is likely to rejoin the rotation Friday.

Ryan Madson, RP, Los Angeles Angels (opened the season on DL, could return this week): Madson's return following last April's Tommy John surgery has been delayed due to the soreness he experienced this spring. The delays aren't highly unusual, but it does bode for a gradual progression even as he returns to his major league team. Madson has been pitching in extended spring training and will begin a rehab assignment this week. He might not spend much time there, as the team could bring him up to the majors to build further endurance in that setting. As the Los Angeles Times has reported, he will not be the closer immediately upon return, and how the Angels opt to use him will likely depend on what they see from him as he resumes big league action.

[+] EnlargeJohnny Cueto
Eric Hartline/US PresswireHe's been out of sight, out of mind, but it shouldn't be forgotten that Johnny Cueto finished 13th among all pitchers on the ESPN Player Rater in 2012.
Johnny Cueto, SP, Cincinnati Reds (placed on DL April 15, could return within one to two weeks): Cueto's original ailment was reported as a triceps injury, then was modified to a lat strain (more typical for a pitcher). But as he was recovering from that injury, he developed soreness in his oblique, a pitcher's nemesis, forcing a slowdown in his return schedule. Now Cueto seems to have cleared most of the major obstacles in his recovery and has initiated a rehab assignment. His next rehab outing is slated for Tuesday, and the Cincinnati Enquirer is reporting he could return to the Reds' rotation May 19.

It's entirely possible the team opts for another rehab start, depending on what they see during his outing this week and how Cueto feels after consecutive starts. Either way, it appears that, barring a setback, his return is not far off.

Andrew Bailey, RP, Boston Red Sox (placed on DL retroactive to April 29, could return within a week): Bailey is eligible to return from the DL on Wednesday, but the club could still opt to send him out on a rehab assignment, pushing back that return. Bailey went on the disabled list with a biceps strain, a bit more worrisome than the one that sidelined teammate John Lackey because of the location of Bailey's symptoms (higher, closer to the shoulder). As noted in this space last week, Bailey has been plagued by a series of injuries, but he started the season strong for the Red Sox. With Joel Hanrahan now out for the remainder of the season, it would seem Bailey has the opportunity to recapture his closer role from Junichi Tazawa, if he can stay healthy. Considering his history, particularly in light of this current ailment, that's a big if. Even if Bailey returns without a rehab assignment, the bigger question will be how long he can go without a potential flare-up.

Chris Perez, RP, Cleveland Indians (day-to-day): As he began to warm up Sunday before entering the game in relief, Perez experienced what the team is calling "stiffness" in his throwing shoulder. Manager Terry Francona opted not to press his luck and rested Perez instead. At this point, it doesn't appear to warrant major concern, but it does warrant you keeping an eye on the situation. Unless he's scratched again this week, consider this just a bump in the road.

Jake Westbrook, SP, St. Louis Cardinals (placed on DL May 12): Westbrook becomes the latest pitcher to hit the disabled list with inflammation in his elbow. According to ESPN's Jim Bowden, Westbrook received a cortisone injection in his elbow. Expect several days of rest with a gradual increase in activity to see if he can resume throwing. Until he reaches that point, it will be difficult to project the length of his absence.

Wei-Yin Chen, SP, Baltimore Orioles (day-to-day): After getting his team off to a good start Sunday, Chen was forced to leave the game early because of a strained oblique. He was scheduled to undergo an MRI Monday, and it would not be surprising if this results in a trip to the DL. The typical absence for a pitcher runs on the order of a month, so if it is serious enough to warrant the trip, plan on not having him available for approximately four weeks.

Pitchers on the mend

March, 29, 2013
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Given the number of pitchers who are entering 2013 coming off injuries to their throwing arms, we decided to craft a quick status update list on some of the more intriguing names as the season gets underway. Given that some of these players still have a ways to go in their recovery, consider the timeline fluid and subject to change. For the purposes of ascertaining where these players stand coming out of spring training however, this is our guide.

With elbow surgery becoming virtually commonplace in pitchers, we almost take for granted that they will return to their prior level of performance. But the complexity of the surgery and the variables which can impact recovery affect each athlete differently and should not be overlooked. For more detail on the process of ulnar collateral ligament reconstruction, commonly referred to as Tommy John (TJ) surgery, please see below.

Starting Pitchers

[+] EnlargeCC Sabathia
William Perlman/THE STAR-LEDGER/US PresswireCC Sabathia's 200 innings last season were the fewest he's thrown since the 2006 season, which is also the last time he's had as few as 28 starts.
CC Sabathia, LHP, New York Yankees: Surgery to address bone spur, Oct. 25, 2012. Sabathia reluctantly went on the DL last year with swelling in his elbow, then underwent offseason surgery to address the source of the problem; his return this spring has been just how he prefers it -- uneventful -- and he is expected to be ready Opening Day; while he is racking up the years and the pitching miles, his overall durability remains impressive.

Brandon Beachy, RHP, Atlanta Braves: TJ surgery, June 21, 2012. Has thrown several bullpens this spring without incident; will continue on throwing progression with targeted return in June/July.

Chad Billingsley, RHP, Los Angeles Dodgers: elbow inflammation and sprained UCL in 2012. Underwent PRP injections in fall and threw eight bullpens in offseason without incident, saying his elbow felt "normal" entering the spring; this spring he has sustained a groin ailment and a bruised index finger; Billingsley is still hopeful to start the season on time or close to it, but the recent history of a partial UCL tear warrants caution.

Jaime Garcia, LHP, St. Louis Cardinals: rotator cuff tear (small), no surgery, injured June 2012. Garcia opted for rehab over surgery and so far it seems to be working out for him; his shoulder has not given him any trouble this spring and he is expected to be ready to start the season as a part of the Cards rotation. The concern is whether his shoulder will hold up to a full season of pitching demands.

Daniel Hudson, RHP, Arizona Diamondbacks: TJ surgery, July 9, 2012. Has been making steady progress and threw his first bullpen the last week of March; targeting a return around the All-Star Break.

C.J. Wilson, LHP, Los Angeles Angels: surgery to address bone spur, Oct. 23, 2012. Has had no issues with the elbow this spring, although his performance has not been up to par; the latter should improve and his overall durability record should be an encouraging sign going forward.

Colby Lewis, RHP, Texas Rangers: flexor tendon repair, July 27, 2012. Progress has been steady and, after throwing bullpen sessions this spring, he is hoping to progress to live batting practice in early April; so far he remains on track for a late May/early June return. If he continues to progress this well, there could be a nice second half of the season in store.

Michael Pineda, RHP, New York Yankees: labral repair, May 1, 2012. Began throwing from a mound in February and added some breaking pitches in March; he won't be ready to return until around the middle of the season but he seems to be committed to the rehab and to being in better shape in general (reportedly having dropped about 20 pounds by this spring); it remains to be seen whether he can rediscover his dominant style but he's young enough that there's a reason to believe he can.

Ted Lilly, LHP, Los Angeles Dodgers: labral repair, Sep. 21, 2012. Lilly has been remarkably durable but all good things must come to an end; his shoulder issues required surgery and at age 37 it's hard to know just how he'll bounce back; his spring outings have been limited by flu complications and he'll likely start the season on the DL with a chance to continue to progress his arm; hard to count on when his status appears uncertain.

Scott Baker, RHP, Chicago Cubs: TJ surgery April 17, 2012. Made spring debut in mid-March but inflammation afterward resulted in a shutdown for at least a month; will have to gradually resume throwing and continue to build strength. No firm timetable but could miss first couple months of season.

John Danks, LHP, Chicago White Sox: shoulder surgery Aug. 6, 2012. The surgery was for debridement of biceps tendon and rotator cuff and to repair a small capsular tear. Danks threw bullpens and live batting practice sessions this spring without incident but, as is often the case, struggled in game outings, particularly with velocity. Will open the season on the DL and it's unclear just how long he'll stay there.

John Lackey, RHP, Boston Red Sox: TJ surgery Nov. 1, 2011. If there's an upside to tearing your ulnar collateral ligament late in the year it's that you benefit from the season schedule to gain extra recovery time; Lackey is now almost 17 months post-surgery so recovery is not an issue, but he'll still need to regain the feel of competitive throwing; results may be inconsistent initially but he should be able to get through a full season.

Cory Luebke, LHP, San Diego Padres: TJ surgery and flexor tendon repair, May 23, 2012. Experienced some pain in his reconstructed elbow this spring, forcing a temporary shutdown. This is not unusual but it reinforces the notion that these recoveries cannot be rushed; his timetable suggests a return around midseason but that could always fluctuate, as could his performance in the early stages.

Relief Pitchers

[+] EnlargeFrank Francisco
Jason Szenes/Getty ImagesFrank Francisco has to contend with both his recovery, and with a challenge to his role as closer from teammate Bobby Parnell.
Frank Francisco, RHP, New York Mets: surgery to address bone spur in right elbow, Dec. 18, 2012. Began throwing from a mound in March and has only recently begun throwing to live hitters; still with some soreness and is likely to open season on DL; could be ready by late April/early May.

Casey Janssen, RHP, Toronto Blue Jays: AC joint surgery Nov. 16, 2012. Progressed slowly this spring but has recently gained ground and appears ready for Opening Day; his overall workload has been light so will need to see how he responds in season, but the Jays have help if he needs an occasional day off.

Ryan Madson, RHP, Los Angeles Angels: TJ surgery, April 2012. Experienced some soreness this spring and had to be scaled back; will open the season on the DL but may not stay there long. Now that the arm is feeling better, he still needs to build some endurance and currently looks on track to return at some point in April.

Sergio Santos, RHP, Toronto Blue Jays: labral debridement surgery, July 24, 2012. Expected to be ready for Opening Day. Other than some minor triceps soreness this spring, has had a smooth progression back to the mound; Janssen is expected to function as the Jays' closer but Santos could get opportunities if Janssen is initially unable to tolerate a full workload.

Joakim Soria, RHP, Texas Rangers: TJ surgery April 2, 2012. This is Soria's second TJ surgery, making the road to recovery less certain, but so far the process has been smooth. He began throwing long toss in early October and from a mound in February, added breaking pitches in March and appears headed for a late May/early June return.

Tommy John Surgery: An updated primer


Ulnar Collateral Ligament (UCL) Reconstruction was originally performed by Dr. Frank Jobe in 1974 and is now known by the name of Jobe's first subject, pitcher Tommy John. It has become such a part of the baseball vernacular that it's a common topic of discussion amongst even casual fans. That doesn't mean there isn't more to learn about optimizing the surgical techniques or the rehab process to help ensure success or, more importantly, how to ultimately prevent or even reduce the incidence of these injuries.

The basics: The UCL is not a simple ligament. It is comprised of three bands which blend together to reinforce the medial (inner) elbow joint and runs from the medial epicondyle of the humerus (a bony prominence on the arm bone) to the medial forearm bone (ulna). Not all tears are created equal. In fact, it is rarely the case where the ligament is completely blown out. A partial tear in a critical location however can make it virtually impossible to throw because of pain, loss of control, or both. This is one of the reasons an MRI does not tell the entire picture; clinical examination will substantiate any instability in the elbow and the athlete needs to have symptoms of a magnitude sufficient to warrant surgery. This is not a procedure one enters into lightly given the intensive recovery time. One of the reasons a trial of conservative therapy is typically the first option when there is a suspected UCL tear (beyond the obvious scenario where the athlete's injury was mild and he recovers enough to return to play), is to validate for all involved the need for surgical repair.

The procedure: Typically a tendon is harvested from the forearm (most common) to serve as the replacement ligament. The tendon of choice (palmaris longus) is not present in everyone (hence the reason removing it will not hinder the athlete's function) in which case the option becomes a hamstring tendon. The surgeon drills holes in the bone (tunnels) where the new "ligament" will be implanted. In a fancy method of looping the ligament through the tunnels and tying it together, along with repairing the remaining components of the original ligament for reinforcement, the reconstruction is performed. One tricky element involves the location of the ulnar nerve in the forearm. This nerve runs adjacent to the ligament and supplies the fourth and fifth fingers in the hand. In other words, if the nerve becomes compromised, the athlete could lose feeling and muscular function in that area. (Ulnar neuritis, inflammation of the nerve, is not an uncommon ailment amongst pitchers simply due to the stress on the nerve from pitching.) Surgeons take great care to protect the nerve during surgery and in some cases will actually transpose (move the location of) the nerve to another spot on the forearm. Even when care is taken, complications related to the nerve are a risk factor with this surgery.

[+] EnlargeFrank Jobe
Nancy R. Schiff/Hulton Archive/Getty ImagesDr. Frank Jobe, pioneer of "Tommy John" surgery.
The rehab: As is the case following any new surgical procedure, the post-surgical rehab was very cautious initially. Return timetables approximated 16 months. Over time as more athletes have undergone the procedure and more is known about the healing process, that timetable has shortened to a range of nine to 12 months. The rehab schedule remains fluid as any number of factors can influence the time to return to activity, including whether the athlete is a thrower or non-thrower. Early rehab focuses on regaining elbow motion along with strengthening exercises for body parts away from the elbow and cardiovascular conditioning. Strengthening around the elbow is eventually introduced along with upper extremity coordination activities to retrain the "feel" of the arm in space. One of the biggest benefits of the rehab process is the time away from throwing. Pitchers rarely take such extended down time unless forced to do so because of injury. The rehabilitation following UCL reconstruction allows time to address shoulder imbalances, core muscle weakness, leg strength and any other areas that require attention while throwing is off limits. At approximately four months the athlete can resume light tossing and ultimately moves to a progressive throwing program. The throwing program is modified based on how the athlete responds to each outing and it is not uncommon for the progression to fluctuate at various points in the process. Even after an athlete returns to competitive throwing, it often takes time to reestablish command and consistency. So while a return to competition may occur within a year or less, a return to form can certainly take another six to eight months.

The unknowns: It is unclear just how much an athlete should throw in his first season returning from this procedure. Look no further than the case of Stephen Strasburg in 2012 to find arguments on either side of the Nationals' decision to shut him down early. The fact is there is no definitive research at present to outline a specific number of pitches to target or other such criteria for the first year post-surgery. There is some consensus amongst the medical community that the reconstructed ligament is stronger in the second year following the procedure.

Return to prior level of function, especially at the professional level, is remarkably high. Life expectancy of the reconstructed ligament, however, is unknown and may depend on a number of factors including severity of the injury and whether any of the athlete's original ligament remained intact. In recent years there has been an increase in athletes undergoing a second UCL reconstruction but the numbers are still small making meaningful analysis challenging. Based on preliminary research, it appears the success rate (defined as return to prior level of function) following a second procedure is significantly lower. It also appears that pitchers returning to a relief role fare better than those attempting to return as starters.

The prospect of facing Tommy John surgery is not viewed as career-threatening as it once was but it is still a daunting process. Although many athletes return to their prior level of function, it is not an easy path. Non-pitchers can return at a slightly faster rate, although outfielders may require additional time to make the biggest throws (outfield to home without a cutoff). For pitchers, even after they return to action, there is a high degree of variability as to when they actually return to form. As many similarities as there are among surgical techniques and rehabilitation programs, there are just as many individual variables which make each athlete's recovery unique. Prior injury history, overall tissue health, specific biomechanical demands of the athlete, follow-through with rehab and the surgical procedure itself can all impact the pace and the degree of recovery. In the end, outcomes are largely favorable but nothing should be taken for granted.

Pre-Opening Day injury update

March, 29, 2013
3/29/13
11:38
AM ET


With the regular season just about to start, here's a list of notable injury situations and their timetable for a return. Fantasy owners can and should adjust their lineups or draft strategies accordingly.

Notes:

1. All projections reflect expectations as of March 29 and should be considered fluid after that date.

2. Opening Day ready = Expected to be "active" on Opening Day, not necessarily in lineup on Opening Day. For pitchers, first game depends on where slotted in rotation.

Hitters

[+] EnlargeWright
AP Photo/Charlie RiedelDavid Wright was playing well at the WBC before getting hurt, but he appears to be on track for Opening Day.
David Wright, 3B, New York Mets (Opening Day ready): Wright strained an intercostal (rib cage) muscle during the World Baseball Classic, but rest and rehab seem to have done the trick. Potential for setback in the first few weeks exists, but this guy rarely misses time.

Brett Lawrie, 3B, Toronto Blue Jays (due back April): Intercostal strain will sideline him into the first week or two of the season, but a cautious return should help prevent a setback. Bigger concern is tendency to play with reckless abandon. Fun to watch, but may increase risk.

Pablo Sandoval, 3B, San Francisco Giants (Opening Day ready): An irritated ulnar nerve forced Panda to rest for several days in March, but he claims he's ready to return. I admire his enthusiasm but can't say definitively that this is behind him.

Chase Headley, 3B, San Diego Padres (due back late April): Left thumb fracture will delay Headley's regular-season debut by about a month. The good news is that it shouldn't hinder him after he returns.

Curtis Granderson, OF, New York Yankees (due back mid-May): No surgery needed for Granderson's small fracture. No reason to worry about his ability to produce once he returns to the lineup.

Hanley Ramirez, SS/3B, Los Angeles Dodgers (due back mid- to late-May): Ramirez will miss a couple months of playing time following surgery to repair his torn thumb ligament. The concern is that his performance at the plate could suffer a bit longer.

David Freese, 3B, St. Louis Cardinals (due back April): His back injury doesn't appear serious, but the Cardinals want Freese to see more at-bats before his regular-season debut. Recurrence is possible, but the minor nature of this episode keeps the worry factor low.

[+] EnlargeDavid Ortiz
Jim Rogash/Getty ImagesIt's still uncertain when David Ortiz will be ready for this season.
David Ortiz, DH, Boston Red Sox (no timetable): Ortiz continues to have trouble with his Achilles, despite trying to address it in the offseason. Although he's now swinging the bat, it's hard to imagine him being fully healthy for any long stretches.

Derek Jeter, SS, New York Yankees (due back April): Jeter's post-surgery soreness is not unusual. In fact, it will likely take a few months for his ankle to feel normal again. He may return in April but he may not really return until June.

Mark Teixeira, 1B, New York Yankees (due back May/June): A partially torn tendon sheath is what Jose Bautista had ... and then he had surgery. Teixeira's wrist may heal with rest, but if it doesn't, the power on the left side of the plate won't be there and he may not last long, either.

Corey Hart, 1B/OF, Milwaukee Brewers (due back May): The key to Hart's post-surgical knee staying healthy is not returning too soon. The team has been good about controlling his activity thus far, so don't expect them to rush him now. Late May is the most likely scenario.




Brian McCann, C, Atlanta Braves (due back April/May): He's recently returned to hitting, but restrictions on McCann's post-labral repaired throwing shoulder remain in place. Once he returns, it may take a bit to ramp up, but look for a strong second half.

Alex Rodriguez, 3B, New York Yankees (due back around All-Star Break): If he's rehabbing as diligently as he says, Rodriguez should be poised for an uneventful return. The hip may be healthy, but he's still an aging player with mounting injury concerns.

Starting Pitchers


For a more thorough progress report of pitchers returning from injury or surgery, see this blog entry.

[+] EnlargeZack Greinke
AP Photo/Damian DovarganesZack Greinke has caused much concern this spring with his elbow issues and overall poor numbers.
Zack Greinke, Los Angeles Dodgers (Opening Day ready): Right elbow inflammation in the spring should scare a team that spent $147 million and fantasy owners alike. Greinke says the elbow feels OK, but his performance is shaky. It's not exactly confidence-inspiring.

Jaime Garcia, St. Louis Cardinals (Opening Day ready): He opted for rehab instead of surgery for a small (left) rotator cuff tear and has been fine through a handful of spring outings. Starting season strong, but will he last?

Roy Halladay, Philadelphia Phillies (Opening Day ready): Halladay insists there's no injury, but his performance this spring is a concern. Last year he said there was no injury, either. Then he went on the DL and missed nearly two months. This could be the start of the talented veteran's decline.

C.J. Wilson, Los Angeles Angels (Opening Day ready): Underwent arthroscopic surgery in October to address a bone spur and has had no issues with the elbow this spring. Consider this: He's had only two DL stints in his big league career. Aging but durable. Low level of concern.

Phil Hughes, New York Yankees (due back early April): A bulging disc in his back derailed Hughes' spring. He has bounced back quickly, but let's face it, injuries are always going to be a concern with Hughes.

Matt Garza, Chicago Cubs (due back May): Ended last season with stress fracture in right elbow, started this spring with strained lat. Sum total of injuries raises concern.

Shaun Marcum, New York Mets (Opening Day uncertain): Elbow issues last year, now shoulder and neck this spring. Don't like where this is headed. Even if he avoids the DL now, it may only be a matter of time.



Brandon Beachy, Atlanta Braves (due back June/July): On track post-Tommy John surgery. No major concerns, just temper expectations to the typical ups and downs of the first year back.

Relief Pitchers

Jason Motte, St. Louis Cardinals (no timetable, expected to start season on DL): Diagnosed with a "small" tear in his flexor tendon, Motte is reportedly feeling better. He will have to prove he can throw without pain before returning, then hope the injury doesn't worsen across the season.

Ryan Madson, Los Angeles Angels (due back April): After Tommy John surgery last April, Madson is closing in on a return. But the normal inconsistencies that a pitcher first displays after this operation -- and a guy named Ernesto Frieri -- suggest Madson isn't a lock to close.

Casey Janssen, Toronto Blue Jays (Opening Day ready): After November surgery on his AC joint, a slow spring initially threatened Janssen's Opening Day status. He's recently turned a corner but there's still a bit of concern about how an uptick in work (think: frequency) will affect him.

The season hasn't even started, and two closers are already sidelined for the season. Over the weekend, the Cincinnati Reds announced that Ryan Madson, who was signed just this January, suffered a torn ulnar collateral ligament (UCL) and is headed for Tommy John surgery. This news came one day after the Royals announced Joakim Soria would undergo Tommy John surgery (by Dr. Lewis Yocum) on April 3.

While Madson becomes yet another pitcher to fall victim to the almost-commonplace procedure, recent statistics suggest the prospect of a successful return is quite high for him. In perhaps the largest collection of data of pitchers post-TJ surgery, Dr. James Andrews and his colleagues at the American Sports Medicine Institute in Birmingham, Ala., have found that approximately 75 percent of major league baseball pitchers are able to return to what was perceived as their prior level of performance following this surgery.

Joakim Soria
Peter G. Aiken/US PresswireRoyals closer Joakim Soria is headed for his second Tommy John surgery.
In Soria's case, however, the sample size is much smaller. This will be Soria's second TJ surgery, and fewer pitchers exist who have undergone more than one Tommy John procedure, much less returned to the major league level afterward. In a study published in the American Journal of Sports Medicine in 2008, the authors reviewed the cases of 15 patients -- 12 professional and three collegiate baseball players -- who had undergone revision surgery for a retear of a reconstructed UCL. According to the study, only one-third (5/15) were able to return to their previous level of play for at least one season.

Even that number might not tell the whole story. While a major league pitcher returning to the major league level following surgery sounds like a success story, what matters most to teams is whether that pitcher can truly perform at the same level as he did pre-surgery. There is certainly plenty of evidence that suggests pitchers can return to top form following an initial Tommy John surgery, but what about after a second procedure? Stan Conte, senior director of medical services for the Los Angeles Dodgers, tried to answer that question as the team evaluated whether to sign pitcher Chris Capuano, a member of the two-Tommy John procedure club. Conte attempted to evaluate the workload of pitchers returning from a second procedure as a measure of their success. Starting with the somewhat arbitrary premise that a team would want a pitcher to return to the mound for at least 40 percent of his previous workload in order to be willing to carry him on its roster, Conte reviewed the numbers. Under these criteria, a 30-game starter prior to injury would need to deliver at least 12 major league starts to meet 40 percent of his prior workload. For a reliever, since game starts would be irrelevant, the 40 percent of prior workload would be tied to number of appearances.

Conte found that only 14 percent of starters were able to return at a level that met these criteria, but 60 percent of relievers were able to meet the mark. Also worth noting: Two of the starters who failed to meet the criteria for return as starters were still able to return successfully as relievers.

While that data might not be perfect or absolute, it does suggest hope for Soria, who, as a reliever, appears to have better odds of a successful return than he would as a starting pitcher. Soria is only 27 years old and still could have plenty of baseball left in him, as long as his arm cooperates. There is no doubt Soria faces another lengthy road to recovery, but his ability to successfully return from his initial procedure, combined with this positive outlook for relievers, should help.

It's worth noting that Capuano was among that 14 percent of successful returning starters -- he made 31 starts for the Mets in 2011 -- thus making the Dodgers' decision to sign him an easier one. In Saturday's exhibition game, Capuano looked strong as he struck out five and allowed two runs in five innings while making his fourth start of the Cactus League exhibition season. The Dodgers are hoping he'll remain part of that 14 percent.

Joba hurt again


A player suffering two serious injuries within the span of a year just doesn't seem fair. Fair or otherwise, Yankees pitcher Joba Chamberlain, who recently suffered a significant ankle injury while still recovering from Tommy John surgery, will now be rehabilitating his right leg along with his right arm. Chamberlain suffered the injury Thursday and underwent surgery the same night. He suffered an "open" dislocation, meaning the skin was broken in the process, which required immediate treatment to help guard against infection along with the corrective surgery. Chamberlain was able to leave the hospital Sunday.

[+] EnlargeJoba Chamberlain
Noah K. Murray/The Star-Ledger/US PresswireJoba Chamberlain has been recovering from the Tommy John surgery he had in June 2011.
Chamberlain will be in a non-weight-bearing cast for six weeks, followed by a walking boot, according to Yankees general manager Brian Cashman. The keys for the rehab process and his ability to progress are pretty straightforward: Monitor against infection, hope that the tissue heals uneventfully, progress to normal walking as weight bearing is permitted, then gradually resume functional activities with an eye on returning to baseball. Even if every detail of the injury and subsequent surgery were made available, the timetable for recovery would still not be set in stone. How his body heals and whether any unexpected issues crop up (such as infection) will go a long way in determining how swiftly Chamberlain is able to progress. But if there was no significant nerve, vascular (circulatory) or cartilage damage as a result of the injury, if healing progresses at a normal rate, and if there are no major setbacks along the way, the potential exists that Chamberlain could make a 2012 return.

Assuming Chamberlain gets through the initial phase without incident, the other primary challenge will be getting full range of motion back in his ankle. These injuries can be associated with chronic stiffness and scarring in and around the joint and require aggressive work directed at restoring normal movement. There is also the issue of strengthening the muscles in the entire lower extremity, which will naturally atrophy as a result of the extended immobilization. Then there is the matter of regaining balance and proprioception (essentially awareness of where the body is in space), a critical component of a pitcher's balance while in a single-leg stance on the mound. While there is much to overcome, Chamberlain will be focused on little else other than his recovery and can dedicate himself to doing just that. On the positive side, he does not have the demands of a position player, who must routinely field the ball or turn corners while running the bases. While he does have certain fielding responsibilities as a pitcher, those requirements are not as strenuous as they might be for another position.

There is that small matter of Chamberlain simultaneously returning from Tommy John surgery, however. Fortunately for him, he was quite far along in that recovery process when the ankle injury occurred. Chamberlain was already throwing in the bullpen and had even begun mixing in some breaking pitches, indicating that the bulk of his remaining recovery centered on increasing his workload. While the throwing sessions are obviously going to be interrupted for some time, there is plenty of upper-body and core work that Chamberlain will be able to maintain. The primary measure of protecting his arm will be ensuring that he has sufficient leg strength before returning to throw.

Naturally, there is no way to definitively determine whether Chamberlain will be able to pitch this season or even whether he will pitch again. That said, it is also too soon to rule out the possibility that he not only returns, but he does so in this calendar year. "He was saying he could be back on the mound in July, that's what the doctors are telling him," Cashman told the New York Post, adding, "That's the optimistic side." Chamberlain, who is still just 26 years old, was already demonstrating a steady progression in his return from Tommy John surgery and, in the eyes of many, was ahead of schedule. Optimism could be just what he needs to get through this latest obstacle.

Age is but a number ...


Rarely do we hear about pitchers in the twilight of their career opting for Tommy John surgery. Even less frequently do we hear about their comeback afterward. Between the time necessary to progress through the various stages of rehabilitation and the energy required -- both mentally and physically -- to commit to the recovery effort, the hill is often too steep to climb for those who know the end of their playing career is drawing near anyway. So why did Jamie Moyer elect to undergo surgery and attempt a comeback? After all, while the overall success rate of a pitcher's first Tommy John surgery is quite high (see above), Moyer's age (49) makes him an outlier, not only in regard to those who undergo the procedure, but among all baseball players.

[+] EnlargeJamie Moyer
AP Photo/Marcio Jose SanchezJamie Moyer was sharp in Thursday's spring start.
But Moyer has always been an outlier. Never known for his velocity, Moyer's results have depended more on finesse and mechanics, location over heat. And he's still getting it done; from 2008 to 2010, he posted a respectable 37-26 record with a 1.29 WHIP.

Moyer, a southpaw, suffered the injury to his left elbow in 2010, then sat out the entire 2011 season while rehabilitating. During that time he worked as an analyst for ESPN, even providing firsthand insight into the recovery process during the baseball season. In January 2012, Moyer signed a minor league deal with the Colorado Rockies, and at the age of 49 he's competing for a spot in the starting rotation. Moyer has had several starts this spring, the results of which have been mixed, but Thursday's outing, which I attended, was particularly solid. Moyer pitched four perfect innings, throwing 30 of his 45 pitches for strikes, and netted four strikeouts. While the radar gun readings registered variants in the 70s, Moyer has never been known for his velocity (even he acknowledged his lifetime ceiling was probably 83 mph). And that, says Moyer, may be one of the traits that has allowed him to stay in the game so long. "I don't have to throw as hard as some guys do to come back, because I have never been that guy," said Moyer.

Last year Moyer acknowledged that the rehab process was far more extensive than simply the elbow. In fact, beyond regaining range of motion and strength about the elbow, the bulk of rehabilitation focuses on things away from the elbow, such as upper back, shoulder, core and leg strength, conditioning, flexibility, neuromuscular training and, as one begins to pick up the baseball again, proper throwing mechanics. These are all things most pitchers never have the chance to fully address while healthy because they don't have enough downtime to do so. But once injured, they are forced to reassess and rebuild.

Moyer has taken full advantage of that opportunity. Beyond the formal rehabilitation work he did immediately following surgery, along with additional training he did at the Phillies' facility in Clearwater, Fla., Moyer worked closely with a physical therapist in Southern California. "His name is Yousef, and he is an amazing man," said Moyer, adding, "I don't know if I've ever met someone who cares so much about each and every patient." Moyer was well-versed in the specifics of his particular program, explaining the attention to detail with which he conducted each exercise, even as he continues them independently. Moyer pointed out to me that the majority of the exercises are for his scapula (shoulder blade) and shoulder, noting that he has been working on strength deficits that have been present for years. And he's seeing progress. He also spent time working on conditioning in the dunes near Torrey Pines. "No running downhill, only uphill climbing," said Moyer who has a fractured patella (kneecap) in his injury history as well. Moyer knew he needed to be in superior cardiovascular shape to be able to compete, and he appears to be.

Moyer says the workout combination had him feeling "just right" before he headed to spring training. It certainly looks like it's paying off as Moyer appears calm and confident, yet intensely competitive, as he awaits his fate with the Rockies.



• We didn't have to wait even one full day after the All-Star Break to have another injury scare with a star player. The Toronto Blue Jays' Jose Bautista left Thursday's game after twisting his ankle by catching a cleat in the dirt on a slide into third base. Video replays show that his foot and ankle quickly invert (roll so the sole of the foot points inward) when his spikes caught the dirt, a common mechanism for a lateral ankle or foot sprain. X-rays were negative, but there is a possible MRI looming. The best case scenario is that this is a minor issue that causes a big scare but doesn't result in much missed time. Of course, there is the New York Mets' Ike Davis situation to remind us that occasionally injuries that appear minor translate into something far more serious.

[+] EnlargeJose Bautista
Icon SMIJose Bautista's first game after the All-Star break wasn't what he expected.
• Speaking of Davis, who has been sidelined since early May with a bone bruise in his left ankle, ESPN New York reports he has visited with a specialist in North Carolina and has also received a cortisone injection. The decision as to whether the Mets first baseman will need season-ending surgery will be made after another three weeks of prescribed rest. The issue has been -- and continues to be -- that when Davis attempts to run, he experiences pain in the ankle either during or afterward. Thus, the potential of surgery to address cartilage damage remains. The persistence of pain more than two months post-injury is certainly not encouraging, but no decision about his status has yet been made.

• Teammates Jose Reyes and David Wright continue to recover from their respective injuries. Reyes, who missed a third All-Star Game as the result of injury, is nursing a left hamstring strain. Although the injury was described as minor, there is a strong likelihood that he will not come off the DL immediately when eligible. According to ESPN New York, the Mets want to be cautious with their speedy star, who had an amazing start to his 2011 season but is also no stranger to hamstring injuries. Reyes' history, combined with the fact that his game is dependent on his speed and explosiveness (and therefore his hamstrings), prompted general manager Sandy Alderson to say, "This is a two- to three-week injury, probably closer to three than two, given his style of the play and the importance of his legs and his explosiveness. We'll probably be careful with him." In other words, he'll spend a little longer away from the game now in the interest of protecting him for the latter part of the season.

• Meanwhile, Wright is expected to begin a rehab assignment Friday. He has tested his back with running, hitting, sliding and all types of baseball activities. Now comes the time to put it all together in a game situation. If all goes well, Wright could be back within another week or so and should be much stronger following this rehab and heading into the second half.

[+] EnlargeAlex Rodriguez
Bennett Cohen/Icon SMIAlex Rodriguez opted for knee surgery right away instead of trying to play through the injury.
New York Yankees third baseman Alex Rodriguez also missed the All-Star Game as he underwent surgery in Miami on Monday to address a small meniscus tear in his right knee. There had been some discussion as to whether Rodriguez would try to continue to play through the injury or have the surgical procedure. Ultimately, the decision to fix it won out. It was probably a wise move, as it eliminates the uncertainty not only about how Rodriguez would perform in the presence of the injury but also around the possibility that it could progress.



With the injury being to his right knee, the one Rodriguez pivots on every time he swings the bat (which contributes to his power), any limitation could certainly impact his effectiveness at the plate. Plus, there's the business of running (which aggravated the knee previously) and playing defense. The time frame of four to six weeks to return is certainly reasonable and although Rodriguez could return sooner, the goal is to ensure that he does not have lingering knee issues, for this season and beyond. The procedure may have been straightforward, but there is still a joint recovery involved. The Yankees have demonstrated their willingness to be patient with their stars in order to get them back healthy and the same approach seems to be in order here. Much will depend on how quickly he regains his range of motion and strength in his quadriceps followed by assessing how his knee responds (i.e. swelling, soreness) as his activity is increased.



• Another Yankee who missed the All-Star Game is closer Mariano Rivera, who has been dealing with triceps soreness in his throwing arm. Although he returned after a few days of rest to pitch an inning on July 9, Rivera elected not to throw in the All-Star Game because, as he told reporters, he wanted to do "what is right," and ensure he is fully healthy. Rivera acknowledged that this might be something he needs to manage across the season yet he does not appear overly concerned. This is an athlete who appears to have a keen self-awareness of his body and his abilities, yet he's also aware that he is indeed 41 years old. Managing this may be precisely what he needs to do, but there appears to be no reason to panic, at least not yet.

• The Boston Red Sox also had a couple of notable All-Star absentees. Pitcher Jon Lester was placed on the DL with a strain of his latissimus dorsi muscle, an injury which Lester downplayed from the start. After resting for several days, the Boston Globe reports Lester threw from 60 feet Thursday. Although there is still quite a distance to go in his throwing progression, manager Terry Francona's comment that the session went "really well" suggests this will not be a long-term injury. Nonetheless, fantasy owners should anticipate that his return date could extend beyond next Friday, when he is eligible to come off the DL.



[+] EnlargeCarl Crawford
Kim Klement/US PresswireCarl Crawford is expected to play a couple of rehab games for Triple-A Pawtucket this weekend before returning to the Red Sox.
• Teammate Carl Crawford is expected to make his return from a hamstring strain on Monday. Crawford had been progressing well before the All-Star Break but the Red Sox exercised caution in bringing him back. It's hard to argue with a few extra days rest when it comes to hamstrings, and maybe Crawford, who's anxious to get back in the lineup, will be a more productive Crawford in the second half.

• The Philadelphia Phillies placed Placido Polanco on the DL on Friday, citing inflammation in his lower back. Although this move did open a spot for the returning Ryan Madson, it's unclear whether Polanco's back is more problematic than originally thought. Polanco has been trying to press through the back condition for over a month. Although he has not played in a game since July 4, he acknowledged playing through pain since June. He has had trouble swinging the bat because of pain, and the Philadelphia Inquirer reported in early July that Polanco had been experiencing numbness radiating into both sides. Despite resting his back, Polanco was unable to participate in the All-Star game and will now be out until at least July 20, when he is eligible to return. Fantasy owners should not be surprised if this extends longer however given the troubles he has been having and the unpredictable behavior of low back pain.



• In the meantime Madson, who has been on the DL with inflammation in his pitching hand after getting hit by a comebacker, is expected to reclaim his closer job from Antonio Bastardo right away. Madson had been experiencing issues with gripping the ball despite continuing to pitch and ultimately, when numbness in one of his fingers was lingering, a brief course of rest was recommended. Soon enough it will be evident whether those issues are behind him.

• And finally, keep an eye on Colorado Rockies outfielder Carlos Gonzalez, who continues to have pain in his bruised wrist. After recently receiving a cortisone injection, it's possible he could be rested for several days. The Denver Post reports Gonzalez has fluid in the wrist, which is contributing to his lingering soreness. The Rockies are calling him day-to-day but resting through the weekend would not be a surprise.



Another player returns from the disabled list on Tuesday! According to the Atlanta Braves' website, Tommy Hanson is expected to start Tuesday's game against the Seattle Mariners at Safeco Field. Hanson went on the DL with tendinitis in his throwing shoulder but has commented on how good his arm has been feeling the past few days. It appears the rest has helped; now the key will be to see how he feels over the next few major league outings. The St. Louis Cardinals are also getting a key player back Tuesday night. Third baseman David Freese, out nearly two months following surgery to repair a broken bone in his left hand after being hit by a pitch, was activated Monday and is expected in the lineup against the Baltimore Orioles on Tuesday. Freese has had enough successful at-bats during his minor league rehab outings to convince everyone he is ready to return. Given how well he was hitting the ball at the time of his injury, if he can return quickly to that type of productivity, everyone (Freese, Cardinals, Freese's fantasy owners) wins.

Quick hits

[+] EnlargeRyan Madson
Howard Smith/US PresswireRyan Madson proved last season that he can be one of baseball's most dominant closers.
• The Philadelphia Phillies have placed Ryan Madson on the DL with a bruised right hand, their third closer to be sidelined this season. The team started the year without Brad Lidge because of a rotator cuff injury, and his return date is still in question. Jose Contreras is currently on the DL with a flexor tendon strain in his forearm and is expected out for over a month. Madson was originally injured May 20, when he was hit by a ground ball during a game against the Texas Rangers. He has had intermittent pain since that time but has been able to pitch through it -- and pitch effectively -- until recently. Madson has not pitched since June 18 and his DL stint will be retroactive to that date. After receiving a cortisone injection Friday, the hope is that inflammation in Madson's hand will settle and this will not be a long-term issue. In the meantime, it appears Antonio Bastardo will fill the closer role.

• There is some encouraging news about New York Yankees shortstop Derek Jeter, who has begun baserunning drills at the team's spring training facility in Florida. According to reports, Jeter ran from home to first four times, first to second three times and first to third once. This is a significant step, as baserunning presents one of the biggest challenges when returning from a calf strain. Still, running bases in drill format is not quite the same test as running in a game situation in which reaction, hesitation and directional changes exist. This is why Jeter will not be returning from the DL when eligible Wednesday but instead will continue to increase the vigor of his activity. The team is smartly refraining from setting a timetable and is watching Jeter's response to each incremental challenge.

Cleveland Indians outfielder Shin-Soo Choo underwent surgery on his broken left thumb Tuesday. Choo, out since last Friday after being hit by a pitch from the San Francisco Giants' Jonathan Sanchez, is expected to be out for two to three months. Keep in mind that it could be well over a month for good bone healing; then there is the matter of getting the hand strong enough to swing the bat. Fantasy owners would be wise to make roster moves as it is entirely possible Choo could miss the remainder of the season.

• The latest injury catastrophe for the Minnesota Twins happened Friday, night when outfielder Delmon Young ran into the outfield wall. The wall apparently won that battle, and Young, unable to put weight through the lower leg, was carted off on a stretcher. The team has since referred to the injury as a right ankle sprain but is still awaiting the results of an MRI taken Monday. Looking back at the replay video, Young's foot is visibly forced into an awkward position upon impact against the base of the outfield wall. His toes appear to be bent backward (towards him) as his ankle is forcibly flexed toward him. His foot locks into position while his right knee is bent and the momentum of his body weight continues to move forward until the wall stops him and he falls. It is one of those plays that doesn't look like much in real time but when it is played in slow motion and viewed frame by frame, it's easy to see how it could have been a very painful and potentially damaging injury. Young is already on the DL and it's worth noting that severe sprains, depending on the precise structures involved, can be slow to recover. Despite being a youthful 25 years old, Young has already been on the DL once this year with an oblique injury and struggled with a left turf toe issue during spring training.



[+] EnlargeJose Tabata
Jeanine Leech/Icon SMIJose Tabata had to be carted off the field after suffering his injury on Sunday.
• Young wasn't the only player to leave the field on a stretcher over the weekend. The Pittsburgh Pirates' speedy outfielder, Jose Tabata, strained his left quadriceps muscle Sunday while running out a bunt single. He has now been placed on the DL and you can bet the Pirates will be careful with him. Not only is Tabata known for his speed, making him dependent on power from his quads, the Pirates have already experienced delays and setbacks from a quadriceps injury with third baseman Pedro Alvarez. Alvarez, originally injured in early May, tried to continue to play only to aggravate the injury to force a DL stint later in the month. He suffered further setbacks during his rehab time and is just now starting to appear in minor league games. While they are not the same style of player nor are any two injuries identical in terms of severity or how they heal, the Alvarez situation certainly serves as a reminder that it is often easier to go backward than forward.

• It appears Texas Rangers shortstop Elvis Andrus will not be making a trip to the DL for his sprained left wrist, an injury he sustained Friday when sliding into second base. The Fort Worth Star-Telegram reported early X-rays on Andrus' wrist were negative but when he actually returns to the lineup remains in question. While his return could come as early as Tuesday night, fantasy owners should consider Andrus day-to-day until proven otherwise.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Etc.

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

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

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

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

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

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

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

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

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

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

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

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