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Friday, April 12, 2013
Zack Greinke recovery will take month-plus


What is it with the unusual injuries to the nonthrowing arms of Los Angeles aces? Just days ago, we were talking about Angels pitcher Jered Weaver's nondisplaced radial head fracture, the result of a fall while trying to avoid a comebacker.

As odd as that was, there's an even stranger mechanism of injury to the nonthrowing arm of the Dodgers' star pitcher -- a fractured left collarbone (clavicle) for Zack Greinke, the result of a collision with a charging Carlos Quentin after he was hit by a Greinke pitch.

Carlos Quentin, Zack Greinke
Carlos Quentin, center, and Zack Greinke got tangled up Thursday night after the Padres slugger was hit by a pitch from the Dodgers right-hander, leading to a benches-clearing brawl.

Most fractured collarbones are a result of a fall on the point of the shoulder, the force translating through the bone and, most frequently, causing a break somewhere in the middle. In Greinke's case, he lowered his shoulder into the oncoming Quentin and the force of the blow apparently led to a fracture.

Now the big question: How much time will Greinke miss?

Figure on at least a month, but there are some as-of-yet unknown variables that could influence the timetable.

It has not been announced whether Greinke will undergo surgery to insert a small plate to stabilize the fracture. If a clavicle fracture is displaced -- bony ends not in alignment or multiple fragments -- surgery is a far more predictable choice. If a clavicle fracture is of the standard, nondisplaced (bony ends are in alignment), middle-of-the-bone variety, the decision is more complex. Surgery affords early stability to the healing bone, has less chance of a nonunion (failure for the bone to heal) and would potentially allow Greinke to return to throwing sooner.

But surgery doesn't come without its own risks: the standard risk of infection that comes with any open procedure and the possibility that the hardware becomes problematic and requires later removal. If Greinke does not undergo surgical repair, he would have to wait until there is evidence the bone is beginning to repair itself (likely three to four weeks) before he would be cleared to begin throwing. Yes, the injury is to his nonthrowing arm, but there is still motion that occurs on the opposite side. In addition, the downtime during fracture healing would require additional time to build arm strength before returning to the mound.

Unlike Weaver, Greinke plays in the National League and also has to contend with being able to bat when he returns. It's not as if he is dependent on a power stroke, but he does need to be able to perform the activity, including the ability to lay down a bunt, something that will demand motion through his left arm, shoulder and collarbone.

At this early stage, it appears the Dodgers will have to plan on the absence of Greinke for at least a month, with the possibility of that timeframe extending upward toward two months depending on his course of treatment and ability to recover.

Friday (4/12) evening addendum: The Dodgers announced that Greinke will undergo surgery Saturday with Dodgers' team physician Dr. Neal ElAttrache and trauma orthopedist Dr. John Itamura. Greinke will have a rod inserted into his left collarbone.

Without surgery, Greinke would likely have been kept from throwing for at least three weeks to allow for bony healing. Additionally, he would not have been able to run or engage in various forms of conditioning early on because of both pain and the risk of displacing the fracture. The longer Greinke refrains from throwing, the longer it will take him to regain his arm strength. One needs only to go back to the 2011 season when Greinke sustained a rib fracture in February. Greinke was shut down from throwing for several weeks and then required more than a month on a throwing progression before returning to competition.

While surgery sounds dramatic, the rod actually serves to stabilize the fracture and should allow Greinke to resume activity more quickly.

According to a source close to the situation, the hope is that by implanting the rod, Greinke will be able to throw as soon as pain permits, perhaps as early as a week to 10 days post-surgery. The sooner he throws, the shorter the total recovery timeframe. If all goes well between both his surgery and his post-operative rehab course, it's entirely possible Greinke could return in less than the projected eight weeks.