Discussion

Updates on Carpenter, Nady and others

Updated: April 22, 2009, 5:44 PM ET
By Stephania Bell, ESPN.com

It's a busy, busy week in the world of sports. The playoffs have started in the NBA and NHL, the NFL draft is upon us and baseball is in full swing all around the country.

What strikes me is that the injuries just seem to keep on coming. Some teams are already looking at possible personnel moves simply to accommodate the rash of injuries they have already sustained. And it's only April!

On that note, here's who we're focusing on this week in the world of baseball injuries …

Chris Carpenter, P, Cardinals: It was just a short time ago when we were celebrating Carpenter's return to the mound after virtually two years of absence due to injury. The celebration was short-lived when Carpenter was again forced to the DL, this time as the result of an oblique strain. The St. Louis-Dispatch reports that an MRI confirmed Carpenter injured a left oblique muscle, and as a right-handed thrower, this is the most commonly observed pattern (opposite side of the throwing arm). The less common aspect of his injury is that he sustained it while batting. Certainly power hitters are known to suffer oblique injuries, but no one would accuse Carpenter of being a power hitter. Pitchers, who rely on their oblique muscles to help generate the torque required to deliver the ball, often sustain the injury during throwing.

Nonetheless, whether the injury is sustained during batting or throwing, the rehab remains essentially the same. On average, an oblique injury is a six-week injury for a pitcher. In Carpenter's case, given his extensive injury history to his throwing arm, there will be no rushing his return. Any weakness in his trunk could result in compensations in his throwing arm, putting him at risk for injury. Expect Carpenter to be out for two months, but expect him to come back strong once he's ready.

Daisuke Matsuzaka, P, Red Sox: Arm fatigue? OK, so it's not a fancy medical diagnosis. But it does a pretty good job of accurately conveying the nature of the problem. Officially termed a shoulder strain by the Red Sox, his ailment manifested itself as a lack of control and command. Based on his recent struggles, the Red Sox wisely chose to place him on the DL to allow his arm some rest, perhaps pre-empting a more serious problem down the line.

Fatigue often leads to a change in mechanics as pitchers try to compensate for less power by an alteration in their delivery. Even subtle changes, over time, can lead to significant injury. Rest now, followed by a gradual, progressive return to throwing, should allow Matsuzaka to work his way back to his normal self within a relatively short time frame. Had he tried to press through this, it might have ultimately translated into a more prolonged absence.

The good news is the Boston Globe is reporting that Matsuzaka has been cleared to begin light throwing (think: playing catch), signaling that his arm felt good enough that very little down time was required. He will work through a typical throwing progression, but barring any setbacks, he should not be absent for a protracted period.

Jed Lowrie, SS, Red Sox: Last week we talked about Lowrie's ailing wrist and the unknown path ahead. After multiple consultations, with the final stop taking him to Dr. Donald Sheridan in Arizona, Lowrie's fate has finally been decided. He opted to undergo arthroscopic surgery Tuesday to address his wrist problem. According to the Boston Herald, Lowrie's procedure involved removal of the ulnar styloid, a projection of bone at the tip of the ulna (the forearm bone that runs from the elbow to the pinky side of the hand). Lowrie told the Herald that he is scheduled to return in six to eight weeks.

The concern with any wrist surgery is not just how long it will take a player to get back into the game, but how long it will truly take for him to return to form, particularly at the plate. It is not uncommon to see hitters struggle to regain their power following a wrist injury. Lowrie fans and fantasy owners will want to plan on having insurance for three months. Meanwhile Julio Lugo, recovering from meniscal surgery, is beginning a rehab assignment at Triple-A Pawtucket on Tuesday. According to the Red Sox's official Web site, he could return within another week or so. Keep in mind that the Red Sox will not rush him simply because Lowrie is out and Lugo is still having some soreness in the knee. Best to plan on at least two weeks for Lugo's return to the lineup.

Alex Gordon, 3B, Royals: It seems like the injury du jour for third basemen is hip labral tears. Mike Lowell started the trend with his injury last season. Alex Rodriguez, who underwent hip labral surgery in early March, is perhaps the biggest celebrity of the group. Gordon is the latest addition to the list.

The Kansas City Star reported that Gordon first felt "tightness" in the hip on Opening Day. Earlier reports suggested that he first injured his hip sliding into second base a week ago, then further aggravated it during an at-bat. Either way, the limitations in his hip appeared to be impacting him at the plate. Gordon had his hip operated on Friday by Dr. Marc Philippon, the same surgeon who operated on Rodriguez. According to the Royals, Gordon is expected to miss anywhere from 10 to 12 weeks. This timetable suggests that the labral repair was the primary issue and that he did not require extensive bone work (like Lowell for instance, who had a rehab timetable that extended for several months).

The good news for the Royals here is that Gordon is young and healthy, which should aid in his recovery. Given his timetable, expect to see him back in the lineup just after the All-Star break.

Vladimir Guerrero, OF, Angels: What was initially described as a pectoral muscle strain (suggesting minor tissue damage) turned into a more serious torn pectoral muscle (suggesting more extensive bleeding and soft tissue injury), landing Guerrero on the DL for at least a month. According to the Los Angeles Times, he may not even return to the outfield once he's eligible to rejoin the lineup. Instead, the Angels may opt to keep him in a designated hitter role.

The risk with any muscle tear is that a return too soon will result in reinjury, perhaps even more serious than the first time around. Depending on the location and extent of Guerrero's tear, the Angels could be concerned that further damage could lead to a surgical situation. He has said that the injury does not affect his swing, but the concern for further injury is likely the reason Guerrero is being forced to completely rest at this time.

Muscle tears can vary widely in terms of healing time, so it is very difficult to project a true timetable from afar. The level of the Angels' concern, though, reflects the seriousness of Guerrero's injury. Fantasy owners should make alternate plans knowing that his return is up in the air.

Xavier Nady, OF, Yankees: It's not as bad as it could have been. That's what the Yankees are saying now that it appears Nady will not undergo what would have been his second Tommy John surgery on his right elbow. The outfielder first underwent an ulnar collateral ligament (UCL) reconstruction in 2001 and was clearly able to enjoy a successful return to baseball. The joy of embarking on a new season in a new stadium was brought to a crashing halt last week, however, when Nady experienced sharp pain in his right elbow while making a throw.

It had all the makings of an UCL tear, and a second surgery seemed imminent. There was definitely cause for concern, since a return to baseball following a second UCL reconstruction has a much lower success rate than the return following a first-time procedure. Team physician Chris Ahmad performed various studies to image the soft tissue and the bone, and consulted with Dr. Lewis Yocum, who performed Nady's original surgery. The decision about how to proceed provided some good news for Nady and the Yankees.

According to the New York Post, Nady does have a partial tear of the ligament, but the decision has been made to have Nady undergo a course of conservative rehab instead of heading under the knife again. Given the lengthy rehab following surgery and the low success rate, this is a very reasonable course of action. After all, consider that the Angels' Ervin Santana is working on returning to pitching despite the presence of a partial tear in his UCL.

Nady is not a pitcher, so the demands on his arm are significantly less, and the Yankees do have the option of bringing him back as a DH initially while he works his way back to the outfield. Also, the presence of scar tissue in his elbow that has built up since his first UCL surgery might help provide some additional stability to the joint despite a tear in the ligament itself. Whether Nady can successfully return remains to be seen, and it will be at least a month before that happens, but at least he and his teammates can hold out some hope that he will be able to test out the new stadium after all.

On the mend

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