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Thursday, August 30, 2012
Bautista done for year; Ortiz hopes to return


Not long ago I wrote a blog entry referencing the loss of two big-name sluggers to injury: Jose Bautista and David Ortiz. Here we are just over a month later and they again share a headline. Both players are out again due to flare-ups of their injuries after the briefest of returns to their major league clubs. Bautista is done for the season and is scheduled to undergo wrist surgery. Ortiz is on the DL but still hopes to return before the season is over.

In Bautista's case, he had challenges initially swinging a bat after going on the DL due to lingering discomfort in his wrist. He seemed to have moved past it, though, and hit the ball well while on rehab assignment, flashing signs of power with two home runs and five RBIs in one outing. He seemed ready to return to the majors. Even his first game back seemed to go without incident. But as is often the case with wrist injuries, one swing set him back and the familiar discomfort was enough for him to step out of his second game after just three innings.

At the time of his original injury, the Blue Jays referred to it as a "tendon injury" and Bautista said there was "not much" structural damage. These were my thoughts at the time as to the potential outcome:

While Bautista's comments are certainly encouraging, naturally there is concern when it comes to the wrist of a power hitter. If there is only inflammation and the swelling resolves completely, then he should return to form quickly once he recovers from this episode. If, however, there is minor soft tissue damage that presents any sort of mechanical barrier to normal wrist motion, given the torque Bautista generates through his wrists on his swing, it could at the very least make him inconsistent at the plate. As he pointed out, he is day-to-day as of now and we won't know until he starts swinging the bat again whether there will be any lingering issues.

Turns out that "not much" structural damage was still enough to cause lingering problems for Bautista while swinging the bat. After consulting with hand specialist Dr. Thomas Graham in Cleveland, the Jays announced Bautista would undergo surgery to stabilize a tendon in his left wrist. Bautista told reporters that he felt the tendon slipping while swinging the bat, even though it was not painful. "There's just too much instability in that tendon and it got to the point where risking injuring the tendon was not worth it," Bautista said. "That's why we're opting to do [surgery] now."

The "instability" Bautista refers to is subluxation, or the slipping in and out of position, of one of the tendons that controls wrist movement, most likely the extensor carpi ulnaris (ECU) tendon. (Note: The team has not specified which tendon is involved, but anatomically and functionally the ECU makes sense as the culprit here.) The ECU tendon has a sheath around it that limits the tendon's motion. If that sheath is damaged as a result of chronic minor tearing or an acute traumatic tear, the tendon, located on the medial or inner side of the wrist, can slip during motion such that it rubs against a bony projection on the ulna, one of the two forearm bones. Surgery can help restore the proper anatomy and eliminate the problem. Presuming the tendon itself is healthy, which Bautista says is the case, the rehabilitation is fairly straightforward. Recovery typically takes several months, approximately 10 to 12 weeks before baseball activities can be resumed, with an additional couple of months to return to game shape. If all goes according to plan, Bautista should be able to participate in spring training games.

As for Ortiz, he has been battling a right Achilles injury since July. A stint on the DL and a reported pain-alleviating injection allowed him to return to the majors … for one game. After just one Friday night appearance, Ortiz was not in the lineup the following day. Within three days, he was again placed on the DL due to lingering soreness in his Achilles.

According to The Boston Globe, Ortiz is expected to undergo a PRP (platelet-rich-plasma) injection. The hope is that he will be able to return and contribute before the season ends. Although Ortiz had a similar injection in his knee in 2007, which he believed helped in his recovery from surgery, there are no guarantees that he will have a similar result here. Results have been mixed in the literature but the positive news is there is no apparent downside to attempting the treatment. If it helps Ortiz return to the lineup, it will be a positive way for him to close out the season. It should not come as a huge surprise, however, if in the end, Ortiz remains sidelined.