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Fantasy: Injury Report

Stephania Bell and Michele Steele discuss key injuries around the league, including when Matt Kemp may return.Tags: Fantasy Baseball, Fantasy, Injury Report, Stephania Bell, Michele Steele

Fantasy: Injury Report

Stephania Bell and Michele Steele discuss notable injuries in the news, including Desmond Jennings, Yoenis Cespedes, Austin Jackson, Emilio Bonifacio and Matt Kemp.

Stephania Bell joins the Fantasy Focus Baseball podcast for the latest injury updates on Stephen Strasburg, Michael Morse, Lance Berkman, Allen Craig, Carlos Beltran, Evan Longoria, Kyle Farnsworth and Yoenis Cespedes.

Click here to listen.

It seemed as if St. Louis Cardinals first baseman Lance Berkman was about to be added to the growing list of baseball players whose seasons have been cut short by ACL tears. Not so fast … maybe. Cardinals general manager John Mozeliak announced Monday that the results of Berkman's MRI revealed a torn meniscus, not an ACL tear as originally feared. In an interesting follow-up, Jenifer Langosch, who covers the Cardinals for MLB.com, tweeted the following: "While no evidence of ACL tear came on MRI, it hasn't been ruled out. 'I'm not as optimistic' as team, Berkman said." In other words, it sounds as if the picture is not totally clear. He is expected to get a second opinion this week. At the very least, a meniscal injury would require surgery and subsequent rehabilitation that could sideline Berkman for the better part of two months.

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AP Photo/ Josh Thompson/Cal Sport MediaIt remains to be seen how much time Lance Berkman will miss with his current knee injury.

Berkman is no stranger to knee troubles, including ACL tears. This latest injury is to Berkman's right knee, the same knee in which he suffered an ACL tear back in 2004. Berkman has a history of issues with the cartilage in both knees, and the increased wear and tear that comes with being a veteran ballplayer doesn't help matters. Consider that even after last year's contribution to a World Series championship team, Berkman is on a one-year deal with the Cardinals this year, perhaps reflecting the inherent injury risk he represents. After more than three weeks on the DL earlier this season with a calf strain, Berkman had played in only six games since returning before suffering this setback with his knee.

The complexity of the injury could make a big difference in terms of Berkman's future. According to the St. Louis Post-Dispatch, even Berkman seemed to question what the future would hold if the injury turned out to be serious. "If I've re-torn my ACL or something like that, I'd certainly get it fixed but you don't know how psychologically you're going to come back from something like that," Berkman said. "I'm not talking from the standpoint of being scared of hurting it again. I'm talking about doing everything it takes to come back and play again at an elite level." We have seen an aging baseball star return from a second ACL procedure (Atlanta Braves third baseman Chipper Jones did so in 2011) but it is not an easy task, particularly if there is no guaranteed job at the finish line. Until the evaluation process is complete, the next steps for Berkman are on hold.

Strasburg update

Last week we talked about the incredible run of bad luck the Washington Nationals have been confronted with recently in terms of injuries. Just when it seemed as if they could not possibly be presented with any more bad news, ace pitcher Stephen Strasburg was forced to leave Sunday's game against the Baltimore Orioles in the fifth inning … because of his biceps? At least that's how manager Davey Johnson described the situation.

As for Strasburg, he seemed to downplay the incident when speaking with reporters after the game, relating it to arm fatigue and suggesting it is just a byproduct of returning from his 2010 elbow procedure. "It's all part of coming back from Tommy John [surgery]," Strasburg said. "It's something I have to be smart about."

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Debby Wong/US PresswireStephen Strasburg might bear watching over the next few starts after leaving Sunday's game early.

So is this something to really be concerned about, or is it much ado about nothing? The reality is it might be a little of both. On one hand, Strasburg is correct. It is not uncommon following Tommy John surgery and the associated recovery that pitchers have little dips and dives in their performance, comfort level or both. We often hear of pitchers who develop symptoms such as forearm tightness or stiffness or who suffer from intermittent command struggles and are forced to back off their throwing a bit until they settle. Strasburg also referenced going out of his routine after his previous start, increasing his work in the weight room and the bullpen, something he called "a little immature," according to the Washington Times. It's possible that veering from a structured routine, even minimally, can lead to problems, especially if that structure contributed to a smooth return from surgery with no real setback along the way. Perhaps this is just a minor speed bump as a result of that altered routine.

On the other hand, it's worth remembering that Strasburg had shoulder inflammation that sent him to the DL just weeks before he tore his ulnar collateral ligament. The data of pitchers returning from Tommy John surgery suggests there might be a relationship between the elbow procedure and subsequent shoulder issues leading to DL placements (read: Josh Johnson). Is it possible Strasburg could be headed that direction?

It's certainly feasible that any major league pitcher could be beset by shoulder problems at some point in his career; in fact, it is almost expected that given their profession, most pitchers will sustain some form of elbow or shoulder injury. But in Strasburg's case, there has already been a DL placement related to the shoulder, which makes any shoulder-like symptoms now a bit more worrisome. If, in fact, Strasburg has any existing damage to a structure that does not heal independently, such as the labrum, there is an increased likelihood that it will present a recurring problem at some point in time. Davey Johnson said Strasburg's issue was with his biceps, but the specific location within the biceps becomes relevant. If it is the portion of the biceps tendon that attaches to the labrum, it becomes more significant than if it is general soreness or tightness in the muscle belly itself.

There are a number of questions raised by the incident, most of which are not likely to be answered directly. Before we can become either dismissive or obsessive about Strasburg's latest incident, however, it is worth watching to see how he responds. The Nationals have indicated they do not expect him to miss his next start. Amanda Comak of the Washington Times reported via Twitter on Monday that Strasburg was participating in the pitchers' flying disc match (hmmm). In the meantime, expect him to return to his structured routine. If questions remain as to whether the Nationals will adhere to the innings limit originally set for Strasburg at the start of the season, they seem to be diminishing with every yellow flag.

Other injuries

Texas Rangers pitcher Neftali Feliz has been placed on the DL with right elbow inflammation. There was some concern about his health this spring when he was experiencing shoulder stiffness. After backing off his work for a few days he resumed throwing and was able to start the season on time. His performance, however, has been up and down this year as he has transitioned from a closer role to the rotation. It's unclear when the elbow began to bother him but he is being forced to rest it now. An MRI revealed only inflammation, according to ESPNDallas.com, but the pitcher will be shut down from throwing for a month to protect the elbow. Feliz will then resume a progressive throwing program. A more precise timetable is impossible to project until Feliz picks up a ball again and then, naturally, it will be dependent on no further recurrence of symptoms.

Dan Hayes of the North County Times is reporting San Diego Padres pitcher Cory Luebke will undergo Tommy John surgery Wednesday. Luebke had been evaluating his options, including an attempted rehabilitation period, but appeared recently to be leaning toward surgery. It can't be overemphasized that a pitcher needs to be afforded the time and the latitude to carefully evaluate his options before embarking on such an intensive procedure and lengthy recovery process. Once he is fully committed to the idea that surgery is indeed the best option, the road becomes more about going forward than looking back at the what-ifs, a necessary step in a successful return. Luebke should be expected to return at some point in 2013.

Los Angeles Angels outfielder Vernon Wells was expected to be placed on the DL after suffering a thumb injury Sunday while stealing second base. After an MRI Monday, it became clear he would miss more than 15 days. Wells announced via Twitter that he would be undergoing surgery Tuesday to repair a torn ligament in his thumb. Expect him to be out a minimum of two months.

Boston Red Sox outfielder Cody Ross has been diagnosed with a fracture of the navicular bone in his left foot. The team has not indicated yet what the plans are for treatment or how long Ross is expected to be sidelined, but plan for at least a couple of months (six weeks for the bone to hopefully heal followed by rehab games).

Stephania Bell has the latest injury updates on the Arizona Diamondbacks' Chris Young and the St. Louis Cardinals' Carlos Beltran.

Uh-oh. Matt Kemp, one of the game's most durable players, who was off to an amazing start this season with a batting average of .359 through his last game played on May 13, has been felled by a hamstring injury. That most nagging injury of injuries has sent him to the DL, ending his consecutive-game streak at 399, an incredible accomplishment in this day and age. (Consider that next in line when it comes to active players is Prince Fielder with 216, according to Elias.)

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Jayne Kamin-Oncea/US PresswireMatt Kemp hopes to miss just the minimum 15 days.

As recently as two days ago Kemp said, "I'm definitely not going on the DL; that's not going to happen. … The team needs me. I don't think this is a 15-day thing." Kemp was right about one thing; his team needs him. As in, the Dodgers need him for the better part of the season, they may really need him late in the year in the event of a playoff run and they will definitely need him to be at full strength. So the decision to rest him, despite his objections, is wise in terms of the big picture. The hope is to avoid turning what may well be a minor injury that needs only a few days of rest into something that requires weeks or even months to heal. While it is discouraging to see the injury bug catch up with an athlete who has done so well to elude it, the sensible side of managing his health long-term has won out.

Nationals catch run of bad luck

It is difficult to recall a more unusual string of devastating injuries in seemingly back-to-back fashion on one team than what the Washington Nationals have faced this season. They stand out not only because of the number of players who have landed on the DL this season but also because of the serious and unusual nature of many of their injuries. And the catchers are at the top of the list.

Wilson Ramos, who endured a harrowing kidnapping experience in his native Venezuela last fall, suffered a season-ending ACL injury in his right knee Saturday. Ramos was scrambling to grab a passed ball when he had one of those awkward non-contact-knee-collapsing-inward moments that often signal an ACL failure. After he was helped from the field, an MRI confirmed the nature of the injury. The expectation is that Ramos will undergo surgery but the plans for the next steps have not yet been announced by the team.

Leon

Ramos

With Ramos out, the Nationals called up 23-year-old Sandy Leon, a fellow Venezuelan, from Double-A Harrisburg to take his place. Leon, who initially did not know the injury to Ramos was the reason for his call-up, expressed sympathy upon learning the news. According to the Washington Times, Leon said, "I feel bad for him because he's from Venezuela and he's my friend. It's bad for him but it's good for me." Oops. It turned out to be not so good for Leon either, forced from his major league debut in just the fourth inning after a collision at home plate. The team reports the injury as a high right ankle sprain and Leon was immediately placed in a protective boot. Watching the injury called to mind San Francisco Giants catcher Buster Posey's injury last season, when a collision at home plate resulted in a twisting motion of his (in his case, left) ankle, tearing ligaments and fracturing his fibula. No word of the severity of Leon's injury, though.

In addition to Ramos and Leon, eight other Nationals are either on the disabled list currently or have been there this year, and it's easy to see how exasperating the season has been. One minute it's electrifying Bryce Harper highlights, the next minute it's the devastating loss of yet another player due to injury. And most of these injuries have time frames well beyond 15 days. Outfielder Jayson Werth suffered a broken wrist less than two weeks ago and is expected to miss several months. Pitchers Drew Storen (elbow) and Brad Lidge (sports hernia) are recovering from surgery and have begun light throwing. And then there's outfielder Michael Morse who suffered a setback with his torn right latissimus dorsi muscle in April while on a rehab assignment but hopes to return in June. (For a more detailed update on their rehab activities, check out this recent post by Amanda Comak in the Washington Times.)

Duffy is done

The Kansas City Royals can certainly relate to the Washington Nationals in the injury department. They have seen their fair share of players go down with serious injuries and have just added their young up-and-coming pitcher to the list. Danny Duffy, who had complained earlier this season of tightness in his left elbow and had a history of injury to his ulnar collateral ligament, now appears to be headed for surgery.

Duffy exited his most recent start after facing only three hitters. On his second pitch, Duffy felt what he said was "a tugging sensation and pain" in the elbow, according to the Kansas City Star. Duffy had missed a start a couple of weeks prior but seemed to be feeling better over his most recent outings, until last Sunday. Duffy is headed to consult with Dr. Lewis Yocum but it sounds as if Tommy John surgery awaits.

And finally …

Comebackers can be hard on a pitcher … literally. Tampa Bay Rays pitcher Jeff Niemann took one to the right ankle and testing ultimately revealed a small fracture to his right fibula (skinny outer lower leg bone that forms the outer side of the ankle), according to Marc Topkin of the Tampa Bay Times. Niemann likely will be out for well over a month as the bone has to heal, then he will have to build up his throwing. … Meanwhile, Ivan Nova of the New York Yankees also absorbed a comebacker to his right ankle Monday night. He stayed in the game for three additional innings, then seemed to come down awkwardly when fielding a bouncing ball hit his direction. So far, no word of anything broken, but the team has called it an ankle contusion and a foot/ankle sprain. For now he is day-to-day. … Meanwhile, closers continue to drop around baseball. Yankees interim closer David Robertson felt pain in his left side after throwing Friday night. The soreness lingered beyond what was hoped and he underwent further testing Tuesday. The result? A trip to the DL. If it follows the standard time frame for these types of injuries, expect him out for approximately a month.

Just as the Washington Nationals prepare to welcome third baseman Ryan Zimmerman off the DL (he is expected to return Tuesday after an episode of inflammation in his AC joint), they lose yet another starter to injury … for months. Outfielder Jayson Werth was attempting to make a sliding catch Sunday night when his glove caught in the grass, forcing his left wrist backward into hyperextension. The added load as his body weight came down through his forearm contributed to the immediate fracture of Werth's left radius, the forearm bone on the thumb side that forms part of the wrist joint.

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Greg Fiume/Getty ImagesJayson Werth may not be back until well into August.

Not only is a fall on an outstretched hand the most common mechanism for a radius fracture, the instinctive response of Werth to cradle his left arm against his body as his right hand supported his forearm bones at the wrist is a classic reaction to a break. Still, given Werth's left wrist injury history and the many possible outcomes after such an impact, the specifics of his injury could not be presumed by watching the video. The only takeaway was that this was unquestionably a serious injury that dealt Werth a painful blow.

MLB.com reported Monday that Werth underwent surgery to stabilize the fractured radius and the timetable has initially been presented as at least 12 weeks. Standard repair of distal (meaning near the wrist, as opposed to proximal or near the elbow) radial fractures involves implantation of hardware such as a plate and screws to help position the bone for optimal healing. Consider six weeks for the bone to heal, if all goes well, followed by a gradual return to activity as range of motion and strength permit. Ultimately a rehab assignment will be in order prior to Werth rejoining his team. One of the biggest challenges following this type of injury is regaining normal range of motion following the requisite period of immobilization. The initial timetable of three months is reasonable but certainly could be modified along the way depending upon how Werth is progressing. A sooner return is highly unlikely. A lengthier absence is entirely possible.

Werth's prior wrist history, which began when he was hit by a pitch while with the Los Angeles Dodgers in 2005 and eventually resulted in a 2006 surgical procedure by Dr. Richard Berger at the Mayo Clinic (the same surgeon who performed Monday's surgery, according to the Nationals) to repair a split tear of Werth's ulnotriquetral ligament, is not without importance here. While this latest injury is on the opposite (thumb) side of Werth's wrist, the wrist complex (which includes the two forearm bones-- the radius and the ulna -- their articulations with the eight small carpal bones that form the wrist and the articulations of the carpals with the metacarpals -- long bones of the hand) is precisely that, complex. Superimposing a major injury on an area that has already suffered an injury can be problematic. Although Werth clearly returned to an elite functional level from that initial injury, any alterations in his wrist motion or mechanics, however minor, can present additional challenges with a second injury in the region. Certainly Werth has to feel more comfortable with Berger performing this latest surgery, given his specific familiarity with Werth's wrist. And this is not to say Werth can't make a complete recovery; the expectation, based on the limited available information, is that he can and will. But it won't be fun.

Gonzalez tears ACL

Shortstop Alex Gonzalez has now become part of an unusual club among Milwaukee Brewers, a club whose members are relatively few but one to which no one seeks membership. That would be the torn-ACL club, and Gonzalez will join recently inducted first baseman Mat Gamel as this year's dubious honorees. Pitcher Yovani Gallardo tore his ACL back in 2008, an injury made even rarer by the fact he is a pitcher. Torn ACLs aren't as common in baseball as they appear to be in some other sports, although the potential for occurrence in any athletic endeavor always exists. Apparently this is something the Brewers know all too well.

The two infielders tore their right knee ligaments within the same week but under completely different circumstances. Gamel tore his ACL when he crashed into a wall Tuesday in Petco Park while attempting to make a play on a foul ball. Gonzalez was stealing second in Saturday's game against the San Francisco Giants when an awkward slide did the damage. Gonzalez is in the standard pre-surgery waiting period, but as the Milwaukee Journal-Sentinel reports, general manager Gordon Ash confirmed the end of his season, saying, "Alex is going to have surgery. It's just a matter of who is going to perform it." The rehabilitation program following ACL reconstruction is well established and both players should be physically capable of returning to their sport. The disadvantage for the 35-year-old Gonzalez, however, is that he was playing on a one-year deal with the Brewers. His options may be determined, in part, by how he progresses through this rehab.

Quick Hits

• And stop me if you've heard this one before. Pitcher Huston Street, no stranger to the DL, has made his first visit of 2012, this time for a strained latissimus dorsi (commonly referred to as "lat") muscle, injured during a Friday night appearance. While manager Bud Black told reporters he didn't think it was anything that would require surgery, that's not necessarily revealing since most lat injuries don't. The lat is critical to shoulder function, however, and time out can range from weeks to months, depending on severity. As of now, there is no timetable for Street.

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John Hefti/Icon SMICory Luebke, a popular sleeper pick entering the season, has a 3-1 record with a 2.61 ERA.

• Street's teammate Cory Luebke is out indefinitely with an elbow issue. An MRI reportedly showed damage to his ulnar collateral ligament (UCL) and his flexor tendon along with fluid in the area. Luebke says he is waiting for the inflammation to settle before making a decision. When it comes to deciding about what would be Tommy John surgery for Luebke, it's critical that the player come to that decision fully invested and without question. The rehab is incredibly long and demanding, and surgeons will often say they want the athlete to essentially come to his own decision that surgery is the only option. This is one reason athletes will sometimes take a few weeks of rest, then try to throw again to see how the elbow responds. If it fails to perform, the choice becomes clearer. And so we wait.

• There is some good news, though. Detroit Tigers pitcher Doug Fister will start Monday night in his return from a costochondral strain. After an impressive rehab outing last week, he should be good to go. As noted above, Nationals third baseman Ryan Zimmerman is expected to be back in the starting lineup Tuesday. Zimmerman has been hitting the past few days without pain -- something he could not do initially -- and barring a setback should be ready after a team day off Monday. And Philadelphia Phillies ace Cliff Lee is expected to rejoin the rotation Wednesday, as he returns from an oblique strain. While Lee was not able to come back at 15 days as he originally hoped, he certainly beat the average number of days absent for pitchers with oblique injuries. Perhaps the fact it was a low-grade injury coupled with Lee's experience in dealing with some variant of abdominal issue over the past few seasons has helped him move through the process more quickly. Two pain-free bullpens have Lee convinced he's ready. Believe him.

Tampa Bay Rays third baseman Evan Longoria missed a month last spring with an oblique injury and was hoping for a better start to 2012. He even underwent a procedure in the offseason to address a Morton's neuroma (a condition affecting a nerve between the toes), which nagged him late in 2011, to ensure it would not be a factor this year. It seemed all was on the right track for Longoria, who was batting better than .300 so far this season. On track, that is, until Monday night, when Longoria exited the game with a left leg injury following an awkward pop-up slide into second base.

Originally, Longoria's injury was described as soreness behind the knee, but on Tuesday, the team revealed he had partially torn his left hamstring. Longoria, who said he felt a "tweak" while running from first to second, told MLB.com the slide itself had nothing to do with the injury. Regardless of exactly when or how it happened, the Rays have indicated they expect Longoria to miss between four to eight weeks.

Why the lengthy timetable straight out of the gate? We don't have the benefit of the player being in front of us, nor do we know the specifics of his MRI, but there are a couple of clues. When Longoria reached instinctively to the back of his leg after the injury, he grabbed toward the inside aspect of his knee. If indeed the injury is down low, close to where the hamstring attaches behind the knee, it would suggest the tendon (which anchors the hamstring muscle to the bone) is involved. The tendon does not have the same rich blood supply as the muscle, which results in slower healing. There is also the grade of injury to consider. While all strains are technically tears -- ranging from microscopic to structural tears visible on imaging -- when a team reports an injury as a "partial tear," it usually hints at a Grade 2 or moderate strain, not quite Grade 3 (a complete tear) but more than a Grade 1 (usually inflammation-producing without significant structural damage). The timetable issued appears consistent with a moderate strain.

The primary focus is adequate healing time before returning a player to activity, and that healing time is highly variable. As Rays executive vice president of baseball operations Andrew Friedman told the Tampa Bay Times, "He's always been a pretty good healer," adding, "He's had some hamstring issues in the past and has come back from them pretty quickly, relatively speaking.''

The "quick" version would have Longoria back in the lineup by the middle of June but, as everyone knows, hamstring injuries can be very finicky, and it could be into July before Longoria is ready.

Both Philadelphia Phillies first baseman Ryan Howard and second baseman Chase Utley are on the move, a sign that there is some forward progress in their rehabilitation efforts.

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Jeff Curry/US PresswireThere still is no definite timetable for Chase Utley or Ryan Howard to return to action.

Howard, who ruptured his Achilles tendon in the team's final playoff loss to the St. Louis Cardinals, has been hampered by a superficial wound infection, which stalled his progress. Following a minor surgical procedure in late February to clean out the infection, Howard was returned to a walking boot for additional time and restrictions were placed on his physical activity. Wound specialists were consulted to help ensure that healing continued as expected. Recently, Howard was given the green light to move forward with his activity and he is heading to Clearwater, Fla., to try to do just that. The plan is to gradually increase baseball activities and continue to build strength in the leg. The Phillies are naturally staying away from any timetable for Howard to rejoin the team.

Utley began this season much as he did the last one, on the DL due to discomfort in his knees associated with patellar chondromalacia, a softening of the cartilage under the kneecap. He has been working with a physical therapist in Arizona and mostly staying out of range of the media. When the Phillies traveled to Arizona last week, Utley joined his teammates for some batting practice and even spoke with reporters. According to the Philadelphia Inquirer, Utley said he is feeling good and is stronger than at this time last year. "Last year, I went with the mindset of getting everything loose and not trying to make my legs tight," Utley said. "Right now, we're trying to gain strength and continue to keep my legs loose."

Phillies general manager Ruben Amaro Jr. told the Wilmington News Journal that Utley is expected to rejoin the team within the next week, but only to perform pregame workouts and continue his rehab with head athletic trainer Scott Sheridan, nothing more. Once Utley is ready, he will then head to Florida and work his way back toward more rigorous baseball activity including eventual game play. It would appear he is still quite a ways off from game action and he remains without a formal timetable. Each advancement is predicated on Utley remaining relatively symptom-free from one phase to the next, something no one can predict. Still, the Phillies are encouraged that Utley will soon be one step further along in his recovery path.

The bottom line is that there is no more definitive return date for either Howard or Utley than there was a month ago. There are still multiple hurdles for each player to overcome and with those come the possibility of setbacks, but there is also something now that brightens the picture for both: progress. Real, tangible progress.

Nationals now down two closers

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Rob Grabowski/US PresswireBrad Lidge was just 2-for-4 in save chances sharing the closer's role with Henry Rodriguez.

The Washington Nationals lost Drew Storen to an elbow issue before the season even started (he then underwent surgery in April to remove a bone fragment and he continues his rehab efforts). Now Brad Lidge has joined Storen on the DL. Lidge, who had been dealing with vertigo not so long ago, now has an abdominal strain. According to The Washington Post, Lidge actually began feeling discomfort in the lower abdominal region earlier this season, but the pain recently took a turn for the worse. Lidge was headed to Philadelphia to consult with the surgeon who operated on teammate Ryan Zimmerman last year for a similar injury. That surgeon is Dr. William Meyers, widely regarded as the leading expert on injuries of this nature, commonly referred to as "sports hernias." In fact, Meyers is encouraging a shift away from that term to the term "athletic pubalgia," which as he notes, "is harder to pronounce but probably more accurate in its description," in that it describes pain in the pubic region (groin, lower abdomen) typically experienced during athletic activities. These symptoms can be attributed to a variety of causes, including but not limited to muscular tears, so the detailed workup Lidge will undergo in Philadelphia will help clarify the nature of the problem.

There has been no word on the results of Lidge's visit as of yet, so it is too soon to speculate whether surgery will, in fact, be in order. Even if surgery is recommended, the length of time to return to baseball will depend to some degree on what structures are involved. In the meantime, closer duties have now shifted to Henry Rodriguez full-time (after he had shared the role with Lidge). The Nationals have to be hoping from a health perspective that the third guy's the charm.

For more analysis of injuries to Carl Crawford, Michael Pineda and Ryan Zimmerman, check out this video update from last Friday.

This weekend provided plenty of injury news worth discussing:

Santos has sore shoulder

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AP Photo/Chris YoungSergio Santos is the latest closer to hit the DL.

On Friday, I noted that with five closers out due to injury, they could form an entire division. That division just expanded in size. As of Saturday, a sixth closer had been added to the DL but the hope is that it will be a short-term visit. Sergio Santos of the Toronto Blue Jays becomes the first of the group to go on the DL because of a shoulder issue.

According to the Blue Jays' website, Santos felt some tightness in his shoulder while pitching in Friday night's game. Although he was able to pitch through it and pick up the save, Santos felt worse when he woke up Saturday. Santos said he could feel "something wasn't quite right" during his outing Friday but when he woke up Saturday with the shoulder bothering him he decided to tell the team. "I came in and let the staff know," Santos said. "Their thought was let's get this over with and not have it drag on, so let's shut it down now and hope that we can catch it early."

Santos is an interesting case because he has only been pitching for a few years, as he converted from shortstop to pitcher while with the White Sox organization in 2009. While his shoulder should have less wear and tear than the shoulder of a lifetime pitcher, Santos has not had the benefit of developmental adaptations to throwing.

The Blue Jays are referring to his condition as shoulder inflammation, which sounds non-specific and not particularly serious. For the time being there is no specific timetable for Santos, but he will be evaluated further by Dr. Lewis Yocum on Monday. Francisco Cordero will serve as the closer while Santos is out.

Another abdominal injury for Lee

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AP Photo/Marcio Jose SanchezCliff Lee is no stranger to abdominal injuries, but it's even more bittersweet since it comes after he threw 10 shutout innings.

There were consequences after Cliff Lee's impressive, scoreless, 10-inning outing against the San Francisco Giants on Wednesday that he even tried to lobby to extend into the 11th. The Philadelphia Phillies' loss that night may have been the insult; however, Lee's subsequent oblique strain made it even worse. Lee was placed on the DL on Saturday with a left oblique strain, an injury with which he has become somewhat familiar. Lee has dealt with various abdominal injuries over the years, even starting his 2010 season on the DL for that reason. That injury was termed a lower abdominal strain and Lee, then with the Seattle Mariners, received a platelet-rich-plasma (PRP) injection to support the recovery process. Lee was able to rejoin the team in late April (about five weeks after the injury occurred) and held up the remainder of the year.

This February, Lee skipped a bullpen session after experiencing some abdominal soreness. Although he made it out to be no big deal at the time, Lee acknowledged to the Philadelphia Inquirer that his history was a factor in taking a day off. "In the past I've had ab strains and it was a little sore," Lee said, "so I decided to skip my bullpen, which is a minor deal and just basically play it safe at this point." That rest seemed to pay off as Lee was able to resume his normal throwing schedule later that week and, until Wednesday night, had been fine. The Inquirer reported Lee hurt himself in the 10th inning but he and Phillies general manager Ruben Amaro Jr. denied the lengthy outing played a role, citing higher pitch count outings in the past with no complications. (It's debatable whether throwing the same number of pitches in fewer innings results in the same physical demand as the 10 innings Lee delivered Wednesday night.)

Amaro also said this injury in the rib cage area is higher in the abdomen than Lee's prior injuries. Regardless of exactly where the injury is in the abdomen, the average oblique strain costs a pitcher 34.5 DL days as noted in a 20-year retrospective study of professional baseball players published this year in the American Journal of Sports Medicine. Given Lee's history of prior abdominal injuries, his age and the ease with which these injuries are aggravated, caution is certainly warranted. Although the team has indicated it does not expect Lee to miss more than a few starts, his return ultimately will be dictated by how quickly he heals and how soon he can return to throwing without any discomfort. The data on multiple pitchers over time -- which includes Lee's prior appearances on the DL with abdominal injuries -- speaks for itself, though. While an early return would be welcome, with the way Lee has been pitching, the Phillies undoubtedly would rather have him available for the bulk of the season than risk a chronic injury. He should not be counted on until late May.

D-backs' Hudson lands on DL

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Mark J. Rebilas/US PresswireDaniel Hudson is just the latest addition to the Diamondbacks' DL.

Daniel Hudson is joining Arizona Diamondbacks teammate Chris Young on the DL, also with a shoulder problem, albeit not the result of a crash into a wall. Hudson has been diagnosed with a shoulder impingement, really a fancy term for "pinching." A number of structures can become impinged in the shoulder of an overhead athlete, and the pain typically results from inflammation developing in and around the area. The narrow space at the top of the shoulder where several soft tissue structures pass underneath the bony projection of the shoulder blade (acromion) becomes even smaller during overhead motion. Thickening of the soft tissues and the presence of inflammation can further decrease the available space, creating even less room. Any friction or pinching (impingement) can create pain. The initial goals are aimed at decreasing the pain and inflammation by eliminating the painful motion (shutting down the thrower). Treatment can include anti-inflammatory medication along with physical therapy directed at pain relief along with exercises targeted at reinforcing proper muscular balance around the shoulder. Sometimes cortisone injections are indicated.

Hudson underwent an MRI which did not reveal any specific structural damage, according to manager Kirk Gibson. The goal is to prevent this from becoming a bigger issue for Hudson by not having him press through a painful shoulder. At this point it is too soon to know if he will require more time than the minimum 15 days.

Odd injury for Dempster

Here's one you don't see every day. A pitcher has been placed on the DL because of a quadriceps injury. Ryan Dempster strained his right quad (the large muscle on the front of the thigh) while throwing a bullpen and is still experiencing soreness. Dempster is not a complete stranger to unusual injuries. Remember back in 2009 when he inadvertently broke his right big toe while climbing over the dugout railing? This latest injury doesn't fall quite in that category, but it is atypical for a pitcher, where we're more accustomed to seeing injuries of the shoulder, elbow or oblique variety.

According to the Chicago Cubs' website, Dempster's DL stint was backdated to April 18, and he is expected to miss only two starts. In other words, the good news is this strain is considered mild, and Dempster is expected to return when eligible in early May.

Beltre's hamstring again

Last July, Adrian Beltre had a left hamstring injury that cost him 37 games, but according to ESPNDallas.com, he says this one isn't as severe. "I don't think it's quite as bad as last year," Beltre said. "It didn't grab me that much. I don't think it's that bad. Hopefully, that's the case."

Beltre, who left Saturday's game early with the injury, is scheduled for an MRI on Monday. Regardless of how significant the actual injury is, the concern it raises going forward is legitimate, given the 33-year-old Beltre's history.

Not-so-fun fact

Did you know …

… there are so many top closers sidelined indefinitely right now they could comprise an entire division? Yep, it's true. Three are out for the season (Ryan Madson, Tommy John surgery; Brian Wilson and Joakim Soria, both on their second Tommy John surgeries) and two are out for an extended period (Drew Storen, post-bone chip removal from elbow, no firm timetable for his return; and Kyle Farnsworth, elbow strain, out at least a month). That's a total of five, or one-sixth of the league's closers, now out of commission. All we can do is hope this closer injury rate doesn't continue.

DL-bound

Yankees outfielder Brett Gardner has already been placed on the disabled list because of a bruised right elbow. The Yankees made the move Wednesday after an MRI showed a bone bruise and a strained forearm muscle. The involved muscle (extensor) affects grip and extension, and although Gardner is a lefty, the injury could compromise his grip of the bat and his ability to achieve full extension on his swing. According to ESPNNewYork.com, Gardner suffered the injury when he landed awkwardly, bending his wrist under him, while making a sliding catch in Tuesday's game. Gardner reportedly had difficulty swinging the bat Wednesday, hence the decision to rest him. It's unclear at this point whether 15 days will be sufficient for Gardner to fully recover.

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Mark J. Rebilas/US PersswireThe Cardinals have placed Lance Berkman on the DL because of a strained calf.

St. Louis Cardinals first baseman Lance Berkman has also been placed on the DL after suffering a setback Wednesday with his strained calf. He had a similar injury in 2009, came back prematurely, and then missed three weeks. As Berkman told the Post-Dispatch, "So, you think I would have learned. I tried to play with it, and it kind of did the same thing." Well then, maybe it will take about the same amount of time to recover.

The key for Berkman is getting the calf fully healthy to avoid dealing with a chronic issue throughout the season. After all, he is three years older now, and these injuries can be particularly tricky for 30-somethings. Just ask Derek Jeter and Jimmy Rollins.

Upton is up

How about some good news for a change? As in, someone who is actually coming back to the lineup instead of leaving it. That someone would be B.J. Upton, who has rejoined his Rays teammates and is expected to return to the lineup Friday. Upton was injured this spring when he collided with teammate Desmond Jennings and (understandably) had some lingering back soreness as a result. The extra downtime proved helpful, and after several uneventful minor league outings, Upton is ready to upgrade. There's no reason to think he will have any particular issues going forward, based on what we've heard about his progress thus far.