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All eyes on Lidge's, Sizemore's rehab

Updated: June 10, 2009, 3:57 PM ET
By Stephania Bell, ESPN.com
We lead Tuesday with a few players who went under the knife this week yet hope to return at some point this season.

Rangers outfielder Josh Hamilton underwent surgery to address a partially torn abdominal muscle and hopes to return in four to six weeks. Recovery from this type of surgery (a sports hernia-type repair) can vary, though. Even when an athlete is cleared for full activity, it often takes him longer to return to full speed. Fantasy owners should keep that in mind as they plan around Hamilton's absence. His rate of activity progression during the next few weeks of his rehabilitation will provide important clues as to whether he can meet the projected timeline.

Mets relief pitcher J.J. Putz also underwent surgery this week, but his recovery time will be closer to about three months. Putz had bone spurs removed from his elbow. The good news is that the spurs, which were causing him pain and decreasing his velocity, are now out of the way. The not-so-good news is that the presence of spurs suggests increased shear forces in the joint, often associated with instability (as in looseness in the ligament). We have seen pitchers undergo bone spur removal, only to end up requiring Tommy John surgery down the line (Chris Carpenter in 2007, for instance). This is not to say such surgery is definitely in Putz's future, but it's an observation worth noting.

And here are other players I'm tracking closely this week:

Brad Lidge, RP, Phillies: Lidge was placed on the DL on Tuesday because of a sprained right knee. Typically, a sprain reflects an acute injury to a ligament, but in Lidge's case, this is something that has been coming down the pike for a while as a result of chronic irritation within the joint. It certainly is no secret that Lidge has struggled and that his right knee, which already has undergone a couple of surgeries (including one at the beginning of the 2008 season after he tore the meniscus), has been part of the equation. An MRI earlier this year revealed nothing new. Nonetheless, The Philadelphia Inquirer reports that Lidge will undergo additional tests during this downtime in an effort to get to the root of the problem.

I discussed Lidge's knee in early May, and given his history, this course of events is not unexpected. The big concern now is that if Lidge continues to try to pitch through discomfort, he might end up compensating in ways that impact his mechanics and threaten greater injury, not only to his knee but also to his throwing arm. Given the uncertainty around his situation, it might be more than two weeks before we see Lidge back in the closer role.

Grady Sizemore, OF, Indians: Sizemore is on the DL, but how long will he be there? Will he return when eligible, or will he end up facing an arthroscopic procedure on his elbow? Those are the big questions.

We already know the answer to the first part of that second question. This recovery process will take longer than two weeks, even if he doesn't have surgery. The Cleveland Plain Dealer is reporting that the plan for Sizemore is to limit him to rest and treatment for two weeks, and after that cooling-off period, Sizemore will test the elbow by throwing a ball and swinging a bat. If the symptoms linger, surgery will be the next option.

Pay close attention this week. The answer will make itself apparent in the next few days as Sizemore hits the two-week mark, and there are reasons to be concerned that this might end up a surgical situation. First, Sizemore's elbow has bothered him all season. Chronic inflammation, which usually implies changes in the soft tissue, rarely resolves within two weeks. Sure, Sizemore will feel better while resting, but the true test will come when he tries to restart baseball activity. Second, his symptoms are reportedly most aggravated with elbow extension. If he wants to play, that's something he absolutely cannot avoid, and in fact needs to perform forcefully.

Despite the "no structural damage" MRI report, Sizemore's symptoms, as noted above, are suggestive of changes in the soft tissue as a result of repetitive activity. Surgery would mean an additional six weeks of absence. Sizemore's fantasy owners should take preparations and seek insurance.

Brandon McCarthy, SP, Rangers: The Dallas Morning News is reporting that McCarthy is out indefinitely after an MRI revealed a stress fracture in his right shoulder blade. He will not even pick up a ball for several weeks while the bone heals. The odd feature here is that McCarthy suffered a similar injury in 2007. He missed about one month initially, came back for a handful of outings, then was shut down the season's final week because of subsequent forearm problems.

After an elbow injury and a sprained finger in 2008 limited him to just five starts, McCarthy had to hope that his injury woes were finally behind him. He even began this season with extra bulk on his tall frame in an effort to remain healthy. Not the case. Even during spring training, McCarthy's shoulder was causing him some discomfort, although he seemed to be past the problems as the season got under way.

At just 25 years old, his injury pattern must be a concern for both McCarthy and his team. In the meantime, fantasy owners should seek other options.

Asdrubal Cabrera, 2B, Indians: Early reports last week suggested that Cabrera had dislocated his shoulder. As it turns out, Cabrera separated his shoulder, also known as an acromioclavicular sprain, which likely means he'll miss less time. Cabrera injured himself while breaking up a double play, and the force of the impact of his shoulder's hitting Minnesota infielder Brendan Harris' leg resulted in an injury to the ligaments that link the collarbone to the shoulder blade. Cabrera has been projected to miss anywhere from two to four weeks.

The good news here is that the sprain could not have been too severe because X-rays were initially reported as negative. Even though X-rays show only bony injuries, if there were a significant degree of separation as a result of severe ligament damage, the bony ends would appear out of alignment on film. The sprain itself was revealed in a subsequent MRI, and the timetable also reflects a relatively minor injury. Judging from how painful the injury appeared at the time, Cabrera and the Indians are fortunate that it was not worse. The focus now that the pain has subsided will be on restoring Cabrera's range of motion and strength, with a gradual progression toward baseball activities.

On the mend

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