Stephania Bell: Sergio Santos

Pitchers on the mend

March, 29, 2013

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.

Toronto Blue Jays slugger Jose Bautista underwent wrist surgery in September after being shut down last season to repair a torn sheath around his Extensor carpi ulnaris (ECU) tendon. In the 2013 fantasy draft kit injury watch, I discussed the injury and how it typically affects an athlete, in particular, a baseball player who is a power hitter.

[+] EnlargeJose Bautista
AP Photo/The Canadian Press/Nathan DenetteJose Bautista is making strides in recovering from wrist surgery last year.
One of the more fascinating aspects of talking with athletes about their injuries is hearing how they describe everything from their symptoms to their rehab. It never ceases to amaze how their unique descriptions of what they experience can convey an image beyond any technical terms. Bautista was impressive with regards to the detail in which he explained his entire medical journey, from the anatomy of his injury through surgery and rehab.

For starters, he did not feel pain during his swing that fateful day in July. He said his swing got way behind him and as he tried to slow it down he felt a "pop." But it was when he tried to bring his bat forward again that he felt a sharp pain, which he now thinks was the tendon moving out of position (and which can happen with a sheath tear) and he grabbed his wrist instinctively. Even after his DL stint, Bautista knew he would need to get his wrist surgically repaired in the postseason but he was hoping to finish out the year. The problem was that he kept feeling his tendon move or, as he described it, "lift away" from the forearm bone, a sensation he said was not painful but yet conveyed something was seriously wrong. Ultimately he did not want to risk major injury to the tendon itself and was shut down in August.

The protective sheath is thin, or as Bautista put it, "like carpaccio" whereas the tendon is much thicker, "like a rope." The tendon is the contractile portion of the tissue; it moves the wrist in the desired direction and, for a hitter, helps control the swing. The sheath encases the tendon to protect it from friction against adjacent surfaces but does not control function of the wrist. Consequently, the ultimate concern is protecting the tendon itself. Bautista explained how his surgeon, Dr. Thomas Graham of the Cleveland Clinic, a renowned hand specialist who performs these procedures routinely, reinforced the sheath to help ensure the tendon would remain protected, even if the sheath were to be damaged again. He will be left with a visible bump on the pinky side of his wrist to go along with the small incision scar.

As for how he's doing now, Bautista is happy with his wrist, even if he is still working on his hitting efficiency. "I don't have my full, full motion yet," he said, although when he held up his wrists in extension, I was hard-pressed to see the difference. He expects to gain the remaining motion eventually but says he has enough now to swing his bat freely. He has no discomfort whatsoever -- none of that "lifting away" sensation -- and says he is seeing the ball well, swinging well and hitting is not a problem. "I'm working on timing, pitch recognition, the normal spring training things," Bautista said.

When I mentioned that the wrist injury recently suffered by New York Yankees first baseman Mark Teixeira appears to be similar in nature (the injury was also to his bottom hand on a hard swing, it also involves the ECU tendon and he is being immobilized initially to treat it), Bautista sighed knowingly. He talked about the known frequency of the injury in hockey and golf as a result of the wrist having to counteract the kickback force which travels through a hockey stick and a golf club upon impact. As for baseball, he said, "The injury may be more frequent than we even know."

Bautista sought out others who had been through the surgical procedure -- including teammate Mark DeRosa and Tampa Bay Rays outfielder Sam Fuld -- and learned as much as he could about the process. If anything was clear, it's that Bautista has certainly become well versed on the topic. Now if he returns to form this season, which it appears he certainly has the potential to do, he might just become the go-to guy around the league for how to return from an ECU sheath injury.

[+] EnlargeJohnson
Derick E. Hingle/USA TODAY SportsJosh Johnson, often beset by injuries during his career, is healthy heading into his first year in Toronto.
Josh Johnson is off to a solid start this spring and punctuated it with 3 2/3 perfect innings in his outing Friday. I caught Johnson on his way out to practice Saturday and he said his shoulder continues to feel good. "I've been doing exactly the same exercises I did heading into last year," Johnson said. Last year, Johnson told me it was the first time in nearly two years he felt normal post-pitching body soreness as opposed to shoulder discomfort. In that regard, he says nothing has changed. A club source said Johnson has been impressive in all phases since joining the Jays, from bullpens to live pitching and even in terms of leadership among the younger pitchers in camp. Given that perspective and his dominant Friday start, one might say things are even looking up.

• Despite a recent episode of triceps soreness that has him taking it easy this week, Sergio Santos is all smiles when talking about the health of his throwing shoulder. After undergoing labral debridement surgery last July, Santos has been working diligently to ensure his readiness for the start of the 2013 season. In fact, his preparation started before surgery.

Santos was actually hoping to avoid surgery altogether. After injuring his shoulder in April (he developed soreness during a closing effort), Santos came in to the training room to rehab six days a week in an effort to strengthen the shoulder and hopefully bypass an operation.

"We all know that the outcome is sort of uncertain after shoulder surgery," Santos said, "so I was trying to do what I could to avoid it. But in the end, I think all the rehab beforehand helped my recovery after surgery."

From a medical standpoint, the rationale for pursuing a strengthening program as an initial course of treatment in most cases is that it will either help resolve the problem completely or delay the need for surgery. In the worst-case scenario, surgery may be inevitable but the athlete still benefits from having trained some of the muscles that will be important in the recovery process. Santos pointed out that he had regained full motion within a few days after surgery and felt as if he continued to progress smoothly over the next six months. He insists the shoulder has felt "great" so far and while Santos says he is sorting out "a couple little kinks as far as command and location," the spring has otherwise been a normal one.

[+] EnlargeBrett Lawrie
AP Photo/Morry GashBrett Lawrie was supposed to play for Canada in the WBC but suffered a rib injury, although he should be fine for the start of the regular season.
• Third baseman Brett Lawrie suffered a strained left intercostal muscle (small muscles between the ribs) on Wednesday, forcing him out of the WBC. Lawrie dealt with several injuries last season, including a right-sided oblique strain that kept him out for 30 games. Naturally, there was some initial anxiety around this early spring setback, but Lawrie insisted it was not as severe as last year's ailment. The Jays do not expect it to be more than a two- to three-week absence and are thankful that it appears to be only a mild strain.

• I caught up with shortstop Jose Reyes earlier in the week in Tampa where he was sporting the uniform of his native country, the Dominican Republic, as part of their WBC team. He says the hamstring issues that have been problematic in the past are not bothering him at all this spring. Reyes credits increased hill workouts at home in the Dominican for helping him stay healthier last year (he played 160 games with the Miami Marlins) and he says he stuck with the same routine this year. When I asked him if he was concerned about transitioning to the turf in Toronto, he said he can't worry about that. "You can get hurt anywhere." It sounds like he's speaking from experience. Reyes added that he's excited to help his new team win games and the excitement in the clubhouse about his arrival would suggest the feeling is mutual.

• Finally, the Jays are thrilled to start a fresh new season after being riddled with injuries last year. In addition to the names above, pitcher Brandon Morrow is healthy after missing nearly two months last year due to an oblique injury. Pitcher Kyle Drabek is over at the team's minor league facility and is nearly ready to throw off a mound after undergoing Tommy John surgery -- again -- last June. Drew Hutchison, also post-Tommy John, is on a similar schedule. And Casey Janssen, officially the team's closer, is coming off November surgery to clean up his AC joint. He had a bit of a setback in late February due to discomfort in his shoulder but has since resumed bullpens and is making progress. He still hopes to be ready by Opening Day but he has not yet faced live hitters. Consider that target date fluid.

This weekend provided plenty of injury news worth discussing:

Santos has sore shoulder

[+] EnlargeSantos
AP Photo/Chris YoungSergio Santos is the latest closer to hit the DL.
On Friday, I noted that with five closers out due to injury, they could form an entire division. That division just expanded in size. As of Saturday, a sixth closer had been added to the DL but the hope is that it will be a short-term visit. Sergio Santos of the Toronto Blue Jays becomes the first of the group to go on the DL because of a shoulder issue.

According to the Blue Jays' website, Santos felt some tightness in his shoulder while pitching in Friday night's game. Although he was able to pitch through it and pick up the save, Santos felt worse when he woke up Saturday. Santos said he could feel "something wasn't quite right" during his outing Friday but when he woke up Saturday with the shoulder bothering him he decided to tell the team. "I came in and let the staff know," Santos said. "Their thought was let's get this over with and not have it drag on, so let's shut it down now and hope that we can catch it early."

Santos is an interesting case because he has only been pitching for a few years, as he converted from shortstop to pitcher while with the White Sox organization in 2009. While his shoulder should have less wear and tear than the shoulder of a lifetime pitcher, Santos has not had the benefit of developmental adaptations to throwing.

The Blue Jays are referring to his condition as shoulder inflammation, which sounds non-specific and not particularly serious. For the time being there is no specific timetable for Santos, but he will be evaluated further by Dr. Lewis Yocum on Monday. Francisco Cordero will serve as the closer while Santos is out.

Another abdominal injury for Lee

[+] EnlargeCliff Lee
AP Photo/Marcio Jose SanchezCliff Lee is no stranger to abdominal injuries, but it's even more bittersweet since it comes after he threw 10 shutout innings.
There were consequences after Cliff Lee's impressive, scoreless, 10-inning outing against the San Francisco Giants on Wednesday that he even tried to lobby to extend into the 11th. The Philadelphia Phillies' loss that night may have been the insult; however, Lee's subsequent oblique strain made it even worse. Lee was placed on the DL on Saturday with a left oblique strain, an injury with which he has become somewhat familiar. Lee has dealt with various abdominal injuries over the years, even starting his 2010 season on the DL for that reason. That injury was termed a lower abdominal strain and Lee, then with the Seattle Mariners, received a platelet-rich-plasma (PRP) injection to support the recovery process. Lee was able to rejoin the team in late April (about five weeks after the injury occurred) and held up the remainder of the year.

This February, Lee skipped a bullpen session after experiencing some abdominal soreness. Although he made it out to be no big deal at the time, Lee acknowledged to the Philadelphia Inquirer that his history was a factor in taking a day off. "In the past I've had ab strains and it was a little sore," Lee said, "so I decided to skip my bullpen, which is a minor deal and just basically play it safe at this point." That rest seemed to pay off as Lee was able to resume his normal throwing schedule later that week and, until Wednesday night, had been fine. The Inquirer reported Lee hurt himself in the 10th inning but he and Phillies general manager Ruben Amaro Jr. denied the lengthy outing played a role, citing higher pitch count outings in the past with no complications. (It's debatable whether throwing the same number of pitches in fewer innings results in the same physical demand as the 10 innings Lee delivered Wednesday night.)

Amaro also said this injury in the rib cage area is higher in the abdomen than Lee's prior injuries. Regardless of exactly where the injury is in the abdomen, the average oblique strain costs a pitcher 34.5 DL days as noted in a 20-year retrospective study of professional baseball players published this year in the American Journal of Sports Medicine. Given Lee's history of prior abdominal injuries, his age and the ease with which these injuries are aggravated, caution is certainly warranted. Although the team has indicated it does not expect Lee to miss more than a few starts, his return ultimately will be dictated by how quickly he heals and how soon he can return to throwing without any discomfort. The data on multiple pitchers over time -- which includes Lee's prior appearances on the DL with abdominal injuries -- speaks for itself, though. While an early return would be welcome, with the way Lee has been pitching, the Phillies undoubtedly would rather have him available for the bulk of the season than risk a chronic injury. He should not be counted on until late May.

D-backs' Hudson lands on DL

[+] EnlargeHudson
Mark J. Rebilas/US PresswireDaniel Hudson is just the latest addition to the Diamondbacks' DL.
Daniel Hudson is joining Arizona Diamondbacks teammate Chris Young on the DL, also with a shoulder problem, albeit not the result of a crash into a wall. Hudson has been diagnosed with a shoulder impingement, really a fancy term for "pinching." A number of structures can become impinged in the shoulder of an overhead athlete, and the pain typically results from inflammation developing in and around the area. The narrow space at the top of the shoulder where several soft tissue structures pass underneath the bony projection of the shoulder blade (acromion) becomes even smaller during overhead motion. Thickening of the soft tissues and the presence of inflammation can further decrease the available space, creating even less room. Any friction or pinching (impingement) can create pain. The initial goals are aimed at decreasing the pain and inflammation by eliminating the painful motion (shutting down the thrower). Treatment can include anti-inflammatory medication along with physical therapy directed at pain relief along with exercises targeted at reinforcing proper muscular balance around the shoulder. Sometimes cortisone injections are indicated.

Hudson underwent an MRI which did not reveal any specific structural damage, according to manager Kirk Gibson. The goal is to prevent this from becoming a bigger issue for Hudson by not having him press through a painful shoulder. At this point it is too soon to know if he will require more time than the minimum 15 days.

Odd injury for Dempster

Here's one you don't see every day. A pitcher has been placed on the DL because of a quadriceps injury. Ryan Dempster strained his right quad (the large muscle on the front of the thigh) while throwing a bullpen and is still experiencing soreness. Dempster is not a complete stranger to unusual injuries. Remember back in 2009 when he inadvertently broke his right big toe while climbing over the dugout railing? This latest injury doesn't fall quite in that category, but it is atypical for a pitcher, where we're more accustomed to seeing injuries of the shoulder, elbow or oblique variety.

According to the Chicago Cubs' website, Dempster's DL stint was backdated to April 18, and he is expected to miss only two starts. In other words, the good news is this strain is considered mild, and Dempster is expected to return when eligible in early May.

Beltre's hamstring again

Last July, Adrian Beltre had a left hamstring injury that cost him 37 games, but according to, he says this one isn't as severe. "I don't think it's quite as bad as last year," Beltre said. "It didn't grab me that much. I don't think it's that bad. Hopefully, that's the case."

Beltre, who left Saturday's game early with the injury, is scheduled for an MRI on Monday. Regardless of how significant the actual injury is, the concern it raises going forward is legitimate, given the 33-year-old Beltre's history.