Under The Knife: Hughes leaves Yanks, doctors looking for answers

But I do have a question for you, and I'm being very serious when I ask -- who didn't use performance enhancers during what is now known as the "steroids era?" We can debate when it started or when (or if) it stopped, but who's beyond suspicion? If we were to look for, say, 103 names that we could match against a list of known users, who would they be and how confident would we really be that they were completely clean? Of course, we have the slippery slope issue with the definition of "clean" at that stage. Does creatine count? Androstenedione? What player would break the heart of baseball? What player would truly surprise you? We could also ask, what players do we wrongly suspect of use? Yes, those are a lot of questions and no, I don't have a single answer, but maybe you do. I know that Dan's on the edge of giving what I think is a very definitive answer to one of the key questions surrounding the issue and I can't wait for it to be published.

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On Wednesday night, the Yankees stated that tests on Phil Hughes found a circulatory problem. This likely means that Hughes has Thoracic Outlet Syndrome, something we've seen in several baseball players over the last few years. New York baseball fans might remember David Cone going through a similar issue, with an aneurysm in his shoulder. Pitchers like Kenny Rogers, Matt Harrison and Jeremy Bonderman have come back from the condition, as have players like Jarrod Saltalamacchia. If a surgical fix is needed, it's unlikely that Hughes could return to pitching this season. Hughes will now head to a vascular specialist in St. Louis for a confirmation and further specialized testing. While this is certainly a blow to the Yankees hopes, they do now understand why Hughes was struggling with velocity both this year and last. This could have been worse. While "dead arm" can be nothing more than muscular issues, it can also disguise a severe labrum tear or a capsule strain. Hughes should be back. The question now is less when than what the Yankees will do to fill his slot in the rotation.

The full exam on Contreras came back "better than expected," according to Phillies team doctor Michael Cicotti. Imaging showed the strained tendon to be just a fraying -- a Grade I strain -- meaning that Contreras will be able to start pitching as soon as next week. Given the results, Charlie Manuel said that he thought Contreras could be back quickly, but sources tell me the conservative pattern from the Phillies medical staff is going to hold true with Contreras, and while they're encouraged, they still think he's going to miss into mid-May with the injury. One of the key things they'll look for as he rehabs is how the arm recovers. While Contreras has relieved before, the game leverage he's facing isn't something he's used to, which could increase stress. Once again, judging how a pitcher recovers and measuring fatigue is one of the great failures of baseball right now.

Morrison had the hard cast removed from his foot on Monday, and doctors liked what they saw. Morrison has both a Lisfranc sprain and a mid-foot strain, a combination that is unusual but seems to be healing well. Morrison is already bearing some weight on the foot and will head to the Marlins' facility in Jupiter to start the rehab process. He could face pitching by the end of the week and seems on schedule for a return at or near the minimum. There's still a lot that could go wrong, so that date is pretty fluid, but despite what seemed like a complex and potentially costly injury, Morrison will be back to playing baseball soon. If he ever injures his Twitter thumbs, then he could have some real issues.

For Longoria, the cure for oblique issues and a rusty swing is biscuits. I guess that should be Biscuits, as in the Montgomery Biscuits. That's where Longoria is headed for a short rehab stint. Longoria made it through a couple rounds of batting practice and now will face live pitching, albeit AA pitching, as the final test. Longoria is expected to play with the Biscuits through the weekend, returning to the Rays lineup next Tuesday. This is a bit later than expected, but not significantly so. The Rays are off on Monday, so it's that kind of a day here, day there thing that's pushed Longoria back more than any sort of slow recovery.

Bill Smith, the Twins GM, said on Tuesday that Mauer wouldn't be back from the DL at the minimum, which would be Thursday. That's not a surprise. What Smith did say was that he felt that Mauer was "about a week behind," based on his leg strength. That's a telling "repeat." It's not something that Smith is doing himself, but is repeating from his medical staff. Leg weakness means that there's some testing being done and that Mauer's not back to normal. This isn't breaking news, but shows what's going on behind the scenes.

Sources tell me there's a bit of friction between Mauer and the medical staff, specifically team doctors. The Twins believe (or are at least trying to sell to Mauer) that his weakness was the result of the powerful flu that's swept through the Twins locker room. Mauer and his doctors believe that he never made it back fully from his knee surgery and that previous issues with his back compounded the problems. The difference is that Mauer's approach seems to be more holistic while the Twins seem to believe that this will just clear up on its own. Either way, Mauer should be back late next week if all continues to progress, though he may need a rehab stint. It's not clear whether the stint would come early in the week or whether it would push Mauer's return back. We should have that info by the weekend.

The A's continue to have Bailey working on the side. After his latest session, it was expected that Bailey would be heading out on a rehab assignment, but that isn't happening just yet. It's not a setback, but Bailey simply isn't ready. He hasn't mixed in his curveball yet, though why isn't clear. My guess is that the new medical staff, led by former Rays trainer Nick Paparesta, is showing its conservative bent as they try to instill a new direction. While that might be costing the A's some DL days here, it should keep Bailey healthy once he does get back. The bullpen, especially Brian Fuentes, has been solid enough in Bailey's absence to allow a conservative approach without a cost. Look for breaking balls in Bailey's next session and a rehab assignment in early May.

Matusz isn't on a mound yet, but he's closer. How close? In front of it. That's where Matusz threw from in his latest session, meaning the next step is close. Matusz is throwing all his pitches and has had no problems with his back. The loss of stamina is going to mean that he'll need more of a rehab as he works his way back. Indications are now that he could move to XST as soon as next week and begin a rehab assignment shortly after that. It's tough to put an exact date on a recovery without the full timeline, but it's a reasonable assumption to think that he would need much the same recovery pattern as Zack Greinke, who needed three rehab starts on top of some XST time. That mid-May ERD is a pretty solid guess absent a setback.

If there's ever a trivia question about who the first player to be placed on the 7-day concussion list was, you'll know. Almonte heads to the "Schwartz List" after being hit in the head by a ball during pre-game drills. There was little doubt that Almonte had a concussion since reports are that he briefly lost consciousness. Almonte will be monitored and tested according to the guidelines put in place by MLB, a policy that Brewers trainer Roger Caplinger helped institute. Almonte had been filling in for Corey Hart, so with Hart's impending return, it's not clear what role Almonte will have once he's able to return. I worry that will make it difficult to assess just how well this 7-day list is working, though that's no fault of the policy or the Brewers.

Albert Pujols was held out of Tuesday's lineup due to his hamstring and conditions. He's not expected to miss significant time. He is available to pinch hit ... The Twins updated the media on Tsuyoshi Nishioka's rehab. Things sound like they're going well, perhaps even slightly ahead of schedule, though Nishioka hasn't started baseball activities ... Carlos Carrasco will throw a pen session today and how he throws will determine whether he makes his next start for the Indians. Expect them to be conservative here ... Corey Hart is expected to be activated Wednesday by the Brewers. He'll slot back into RF and shouldn't have any limitations. One thing to watch for is whether Hart is added to the Brewers running game quickly ... Casey McGehee didn't break his thumb on a HBP. He's day to day while the hand heals, with Craig Counsell filling in at 3B while he's out ... Gritty, gutty, scrappy and injured. That's how we'll describe Willie Bloomquist for at least the next 15 days. He's on the DL with a hamstring strain ... The Jays are running more this season, even without Rajai Davis available. He's expected back this week, though a HBP during a rehab game slowed his comeback ... Kendrys Morales contines to have a slow rehab process as he returns from his broken leg ... The Angels could get Joel Pineiro back as soon as Saturday. His shoulder has held up well in side sessions ... Domonic Brown will begin a rehab assignment this weekend. The Phillies aren't in a rush to bring him back, but will let his bat guide them ... The new Explosions In The Sky album is so good, I can't put it into words. I dare you to listen to it while you do something and not have it change the experience ... We'll have a new format for the Video Chat this week and we're turning into more of a mailbag. Use the link at the top to e-mail me at to have your question on the show this week, or Twitter and Facebook will work too.