Preseason injury watch: Shortstop
The 2013 fantasy baseball season is right around the corner. Along with tracking which players have traded uniforms and ballparks, gauging the health of those with injury concerns is of paramount importance. Each position has a few key fantasy players -- we've addressed only those players in the Top 150 for now -- with question marks by their names entering the spring.
Although teams limit the details of players' medical histories, there is still significant information to be gleaned from an understanding of the athlete's condition and status report updates as to his activity. As the season approaches, these situations will evolve because many players recovering from injury or surgery will progress their activity accordingly or, in some cases, encounter delays or setbacks.
Hanley Ramirez, Los Angeles Dodgers (updated March 22): Ramirez injured his right thumb in the final game of the World Baseball Classic on a diving play and now will be sidelined for approximately eight weeks while it heals. Ramirez tore the ulnar collateral ligament (UCL) in his thumb and will undergo surgery immediately to repair it. He is expected to be immobilized for three weeks and will then undergo physical therapy to restore motion to his thumb and strength in his hand and forearm. The key to his return will be when he is able to grip the bat and swing effectively, along with being able to make hard throws across the infield. Following surgery, there is not a significant risk of reinjury; it's primarily a matter of restoring function.
The UCL spans the inner aspect of the base of the thumb, running from the first metacarpal (the long bone that sits just above the small wrist bones on the thumb side) to the proximal phalanx (adjacent to the first metacarpal, it's the nearest of the two bones that comprise the thumb itself). When the UCL is injured, it can result in pain and swelling, and a tear typically results in significant instability of the thumb joint. This ligament is typically injured either when sliding headfirst into base or on diving defensive plays, as was the case with Ramirez, as the thumb gets forced away from the rest of the hand.
The good news for Ramirez is that there are plenty of examples of players who have returned without incident following this type of surgery. Perhaps most comparable, given the demands of his position, is Philadelphia Phillies second baseman Chase Utley, who sustained a similar injury in 2010. Utley was injured on a headfirst slide, underwent surgical repair and was able to return in just under seven weeks post-surgery. Of course, Ramirez can always look to teammate Dee Gordon for advice since he suffered the same injury just last year. Gordon, like Utley, injured his thumb sliding, underwent surgery, and returned at approximately nine and a half weeks post-op. The good news for Ramirez is that he saw a number of at-bats this spring. If his rehab progresses smoothly, the hope is that he will be able to return to swinging the bat effectively within the scope of his projected timetable.
Troy Tulowitzki, Colorado Rockies: Tulowitzki played in only 47 games in 2012 due to what was initially labeled a groin injury. He headed to the disabled list in May, and after undergoing surgery to repair a "core muscle injury" on his left side in June, Tulowitzki was not able to recover to the point where he was comfortable returning before the season came to a close. The surgery also addressed the removal of scar tissue around a nerve in the area, undoubtedly the byproduct of the numerous left-sided hip and thigh injuries Tulowitzki suffered between 2008 and 2011. The most significant of those was the initial injury, described as a tear of the left quadriceps tendon (proximal, near the hip), which caused him to miss two months early in the 2008 season. Although he didn't require surgery at the time, the substantial tissue damage Tulowitzki sustained likely contributed to his recurrent symptoms, culminating in last year's procedure.
If all goes as hoped, this may be the turning point when it comes to Tulowitzki's hip. After functioning at less than full health since the original injury, he has had an opportunity to retrain the core muscle groups from the ground up, and he likely will have increased flexibility after the removal of scar tissue. His slow progression back reflected his apprehension in pushing too fast after experiencing multiple setbacks over the past few years.
Taking the additional recovery time allowed him to develop confidence, which appears to be showing itself early on at spring training. In mid-February, Tulowitzki ran the bases at full speed, and it was his description of how it felt that was the most telling. Tulowitzki told the Denver Post it was "the best I've felt in years," adding, "It's not like I am faster. It just felt free and easy."
That's not to say Tulowitzki is completely out of the woods. The real test will come when he must react to game situations while moving at full speed. Still, there is reason to be optimistic that he is entering this season the healthiest he has been in five years.
One of Jeter's signature attributes has always been his durability, even as he entered his late 30s. After a DL stint in 2001 because of a shoulder dislocation, Jeter did not revisit the DL until 2011 for a calf strain. Last year, he was slowed late in the season by a bone bruise in his left foot that made running difficult. But that was minor. Then, in the first game of the American League Championship Series, Jeter went down awkwardly while trying to field a grounder and had to be helped off the field when he couldn't bear weight on his ankle. It turned out Jeter had sustained a fracture in his left ankle -- the specifics as to where the fracture occurred have not been disclosed -- which ultimately required surgery to implant a plate and screws.
Renowned foot and ankle specialist Dr. Robert Anderson performed the surgery in mid-October, and Jeter has been rehabbing diligently ever since. After a period of limited weight-bearing -- Jeter said he used a motorized scooter to cruise around his homestead in the early phases -- he gradually resumed walking and controlled running. As of the start of spring training, Jeter has begun fielding ground balls and taking batting practice. He has been cleared for full activity but still has to run on grass and resume full agility work. His progress throughout the spring will help gauge his readiness for the season, although Jeter has indicated he expects to be in the Opening Day lineup.
Jeter expressed little concern for re-injury, which is justified; bone is perhaps the strongest healing tissue in the body. The bigger challenge following an injury such as this comes in regaining full range of motion and functionality of the joint. As a shortstop, his lateral mobility and power (explosive pushing off and pivoting through the ankle, for instance) will need to be retrained. Jeter's work ethic has never been an issue, and while he will turn 39 in June and is perhaps more susceptible to the occasional sprain or strain, his injury risk doesn't appear to have escalated significantly.
Rafael Furcal, St. Louis Cardinals (updated March 4): Furcal came into the spring as an injury question mark after his 2012 season ended early due to a sprained ulnar collateral ligament in his right (throwing) elbow. Furcal undertook a rehab course this offseason, but his first true test came when he had to make aggressive throws in spring training. His elbow failed that test.
Last week, Furcal began to have pain in his elbow every time he threw and, as a result, is no longer throwing. The Cardinals have shut him down while he undergoes further medical evaluation. He had another MRI Friday and was examined by team physician Dr. George Paletta on Monday. Even before any official word came as to the result of Monday's consultation with Paletta, the long faces around the facility while I was there seemed to say it all. The Cardinals have indicated Furcal will obtain a second opinion from Dr. James Andrews on Wednesday. The next step, it seems, will be dependent on whether or not surgery is recommended for Furcal. The natural follow-up question then is: At 35 years old, on the second year of a two-year deal and with a storied injury history (which includes back surgery, hamstring strains and thumb surgery), would Furcal really be prepared to undergo another lengthy post-surgical recovery to return to play? That answer should come soon.
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