Under The Knife: Nishioka's break unfortunate but not unforeseen

As the AAA club for the Pittsburgh Pirates, the Indianapolis Indians have seen guys such as Andrew McCutchen, Paul Maholm and Neil Walker come through for stays of varying lengths recently, so it's mostly a new bunch this season.

I know people love trying to find that next great prospect, especially if he's for your team, but it's nearly impossible to cover minor league injuries. The fact is there are just too many teams, the rules are different (seven-day DL), and collecting data is haphazard at best. It's hard enough to get consistent data at the major league level; I know that I can get 100 percent of DL stays and we've barely scratched the surface of that data, so why get ahead of ourselves?

As fast as medical technology and rehabilitation is moving, it's tough to get a read on things. What was season-ending five years ago doesn't even put someone on the DL now. We know more and more, but prevention remains the Holy Grail, and that's elusive. But it's still worth the effort. Powered by Evol burritos, on to the injuries:

Changing positions is riskier than most realize. Changing to second base is even worse. Add in some culture shock on top and it's no wonder Nishioka was at high risk for precisely the kind of thing that happened on Thursday when the Yankees' Nick Swisher broke Nishioka's leg with a slide into second base. Replays make it clear that Swisher slid hard, but clean, while Nishioka left his planted leg on the first base side of the bag. When Swisher hit it, something had to give and it was Nishioka's fibula.

That's the easy part of the diagnosis, and like any bone, it should heal. The question now is whether there are any associated strains or sprains in the ankle. We've seen how difficult it can be with Kendrys Morales and his ankle this spring, so Nishioka isn't an easy return despite his being a bone that doesn't bear nearly as much weight as the tibia. The range is from four-to-eight weeks, so I'm comfortable at this stage putting it in the middle. The change will come if there's any sort of associated damage.

Holliday took swings on Wednesday, just five days after having an appendectomy. He was scheduled to take batting practice on Thursday, which would be the final test before he's back in the lineup. The team is being a bit conservative with his return, to which Adam Dunn snorts, John Wayne-style.

Holliday has had no difficulties in his recovery, with only the hard twisting forces of a power swing as a remaining obstacle. One story I came across worried about him "popping stitches." Like those who expected Holliday to be out a month, this is written from an outdated perspective. Both the incisions and the excision do not use stitches. Surgery and surgical instruments can still look medieval, but there is some amazing technology being used. It's not just on pro athletes, either, with the advances in techniques and the use of robotics bringing things forward at a rapid pace. I hope to have more for you on the robots next week, by which time Holliday will be back in the lineup.

The Marlins tipped us off on Stanton. Not only did they not put him on the DL, the team used him as a pinch-hitter on Tuesday and again on Thursday. That removes their ability to use a retro DL move. The DL is a minimum of 15 days, but a team can retroactively put a player on the list, using the day after he last played. You'll often see teams hold a player back to preserve this unless they're confident he'll be able to return before the original 15-day mark.

Stanton's leg injury doesn't appear too serious, though the conservative nature with which they're handling him does leave some concern. In the longer term, there has to be some effort by the Marlins to get Stanton on some sort of flexibility program. While Stanton isn't visibly "muscle-bound," the recurrent strains should serve as some kind of warning sign. Tight leg muscles can lead to back problems, so maybe someone can catch a Groupon for Pilates classes in Miami or something.

The Cubs will lose Cashner for a month or more after an MRI found a small tear in his rotator cuff. The strain itself is small and incomplete, but the location is a bit worrisome, according to sources familiar with his testing. The concern beyond that is why Cashner had this problem. The rotator cuff acts as a stabilizer, keeping the head of the humerus in place, while also acting as "the brakes" for the arm. The cuff is, in essence, what keeps the arm attached and not whipping toward the batter along with the ball it just threw.

Tearing that is bad enough, but if a loose or compromised cuff allows the humeral head to puncture and tear the labrum, that's even worse. The Cubs didn't mention anything about Cashner's labrum, positive or negative, so we'll have to keep this in mind after he begins pitching. I'm sure the long knives from the Cubs and Cubs fans will come out for this, but believe me, I don't want to do this again.

I'm not sure if it's just the Jays or teams in general that seem a bit reluctant to use the new "Schwartz List" or seven-day DL for concussions. Escobar was kneed in the head on a slide, not unlike how Justin Morneau was injured. He was examined on the field and stayed in, but experienced some dizziness once he got back to the dugout and was removed. He'll have to clear all the new guidelines MLB just put in place, but the Jays aren't yet putting him on the Schwartz List.

The Jays also are dealing with Patterson, who has a "head contusion" rather than a concussion. Patterson is eligible to come off the DL on Saturday, but there's no indication that the Jays are going to do so. I'm not sure that's about the injury as much as it is about the roster spot and his ongoing Corey Patterson-ness.

Wilson is back, but the Giants swapped one late-inning guy for another. If we can agree that the seventh and eighth innings can be as important as the ninth, this is kind of a push. Sure, Wilson's the better character, but let's take a look. Wilson had a gmLI (leverage index when entering a game) of 1.87 while Casilla's gmLI was 1.34. (The starter has an gmLI of 1.0, coming out in the first inning with the game tied 0-0, for comparison.) Surprisingly, Wilson's LI shows that unlike many closers, he wasn't handed many easy saves, which seems reasonable given the team's offense last season. Wilson looked to be struggling with his control in his first outing this year, but that's understandable since he didn't have anything resembling a rehab stint. We have to assume that Wilson should be able to find his control with a bit more work.

On the other hand, Casilla's elbow tenderness is worrisome. There are spare details on the causation, so we'll have to sit back on this one and wait to see how long they keep him shut down. Sources tell me the Giants aren't exactly sure of the cause either, but that means they've ruled out the usual suspects. They'll work to reduce the inflammation and see if they can get to the root cause once he's more normal. An end of month ERD seems reasonable, but remember, it's fluid. (gmLI statistic courtesy of FanGraphs.)

Back in 2003, I read this book and realized that there was something in baseball (and sports medicine) that was a lot like computer networking. The two don't seem alike, but the idea of the cascading failure, of one problem leading to another problem, just made sense. I started calling injury patterns like this a "cascade injury" and it's caught on in this niche. Since I have a lot of new readers this year, it's worth re-visiting some of the concepts, and Wuertz offers a perfect example.

Wuertz came up with the Cubs and was heavily used in several bullpen roles, using a plus-plus slider as an out pitch. He struck out more than a batter an inning for most of his career, but was often unavailable. By the time he made it to Oakland, he was still a solid pitcher, but the workload was gaining on him. His normal arm injuries started to become more serious and spread a bit. His most recent injury is to his hamstring, showing that the injuries seem to be moving down the kinetic chain (shoulder, back, legs).

When a pitcher isn't "right," either through fatigue or injury, he'll try to recruit power in different ways. This is why tired pitchers are at the most risk; they're changing things, either biomechanically or in taxing muscles in ways they're not conditioned to act. That seems to be the case with Wuertz, so while this is a simple hamstring strain, the A's new medical staff will have to show that they can break the cycle.

I hate to use the word "normal" anywhere in a piece regarding Greinke, but with him throwing a side session on Thursday, we do have to look to see what the normal recovery pattern would be. The one unknown here is exactly when the injury took place. Greinke's injury was "hidden," though I'm confident that the Brewers medical staff knew well before the general public and has a better handle on the recovery. Images are easy to get that would show the healing and check Greinke throughout the recovery.

Assuming he's healed and has no residual effects, he'll be working on stamina. A couple side sessions, a rehab game, and then maybe a rehab start. That would put him on track to be back in about two weeks, altogether, though the ERD isn't exact enough to pinpoint a game he's on track for just yet. I'm also unconvinced that the Brewers will send him on a minor league stint.

Even if Greinke isn't up to full stamina, using him for four or five innings has value to a team that's both off to a slow start and "going for it" this season. The bullpen wouldn't be overtaxed, especially if Greinke is paired with someone like Marco Estrada. The worry I have is that Ron Roenicke seems very committed to roles over arms in his pen.

Late word from Philly is they think Brad Lidge is out until the All Star break. I'll be following up on this ... Stephen Drew remains out and the D'backs sound iffy about his availability for the weekend. Still, they don't seem to be ready to put him on the DL ... Michael Bourn blames his groin tightness on cold weather. Ah, the old shrinkage defense. He's day to day ... Jair Jurrjens made it through his sim game well. He'll try it in a AAA game on Monday. If that goes well, he'll be back in the Braves rotation ... Ryan Perry heads to the DL with an eye infection. The retro move will allow him to come back around the 20th ... Erick Aybar is day-to-day with an oblique strain. I'd be curious to have solid numbers on the players that have oblique strains mild enough to avoid the DL ...

Joel Pineiro is throwing again and the Angels hope to see him on a mound early next week. Assuming no setbacks, he could be on a mound in a game before April is done ... Kendrys Morales isn't ready for full-go running yet, so his planned rehab assignment is on hold for now. Once he runs and has no issues, he'll head out for what's expected to be a pretty quick rehab assignment, maybe going 10 ABs ... JJ Hardy was a late scratch with pain in his side. Another oblique? ... Chris Snyder started a rehab assignment at A-ball, in Bradenton. He's expected in Pittsburgh quickly ... Matt Albers has a strained lat and will head to the DL. The Sox will replace him with Alfredo Aceves ... Nick Punto is getting close to a rehab assignment. He had hernia surgery this spring ... I'll be doing my first weekly chat this week. Be sure to join me or submit a question if you can't be there live.