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Under The Knife: Twins are finding bad news often comes in bunches

There are times when injuries seem viral, like a flu going around the clubhouse or a video of a penguin being tickled. Oblique injuries seem to spread around the league, but even within teams there are patterns that have defied explanation. Tommy John surgery seems to happen in a hub-and-spoke pattern that some have speculated occurs because when a star pitcher for a team has the injury, it makes it more acceptable for a minor league pitcher to admit his elbow has been hurting as well.

Today, three teams have injuries happening in bunches, including the team we've had too much of a focus on all spring, the Minnesota Twins. This pattern isn't unusual, but it's also not predictable, up to a point. The Twins seem to be having the most problems, and as a flu bug continues to take its toll, they have to hope that the worst is past and that they can pull out of what could very well turn into a "death spiral." With some teams, their medical staffs simply become overloaded by injuries and injury stacks, leaving their preventative work aside and causing tired eyes to miss the signs of an impending injury. Let's hope that all 30 teams can avoid that.

Powered by The Hold Steady, on to the injuries:

Things continue to be very confusing with Mauer. The Twins let head trainer Rick McWane speak to the press, but he didn't clear anything up. In the same conversation, McWane said that Mauer left spring training "unready to handle catching" and was "feeling the best he had felt." That's a conflict that, unless we assume McWane is setting up a push by the Twins to pry the catcher's mitt off Mauer, doesn't make any sense. It's reasonable that Mauer's lack of work in the spring left him feeling good, but it's less clear why a player with Mauer's experience would think he was ready. Did Mauer push the team to let him start the season? That's one possible explanation that sources I spoke with couldn't shoot down.

"He's a catcher, he says, and the Twins aren't doing anything to convince him otherwise, though I don't think they want to," one insider told me.

This means that the Twins -- and the Twins medical staff -- put Mauer in a position where they knew he was unlikely to succeed. Mauer is about a week away from a rehab assignment that, it's assumed, will focus on his catching as much as it will getting him live at-bats. We have to assume that the check on his SI joint and on his surgically-repaired knee came back well and now he just has to get into baseball shape. It's simply a wonder how they let him do that before, which opens the doors to questions about how they'll decide he's ready this time around.

The final diagnosis isn't in yet, but it appears that Hughes is the latest pitcher to have thoracic outlet syndrome. It's a condition that has hit baseball pitchers for years, and while many have come back, including Kenny Rogers and Matt Harrison, as well as Red Sox catcher Jarrod Saltalamacchia, it's not a group where you see a real "all the way back" guy. The condition does more than just explain the dead arm feeling, but also explains the velocity loss that Hughes has experienced over the last couple seasons. For those who want to ding the Yankees for missing this, it's a very difficult diagnosis, requiring advanced and expensive testing. There are hundreds of stories of regular people being misdiagnosed for years, living through the pain. If Hughes' diagnosis is confirmed in St. Louis, he'll likely need surgery, and that would, in all likelihood, end his season. There's a small sample to work with, but no pitcher has returned in season from the procedure.

As if Hughes' shoulder wasn't enough to worry about in The Bronx, Mark Teixeira is still sore from a dive on Tuesday. While it didn't look too serious at the time, there's been some swelling and some pain, so Teixeira has been dealing with that, making him unavailable on Thursday after fighting through it on Wednesday, but then hurting himself on another dive. That probably wasn't the smartest move. The Yankees have enough 1B options that Teixeira can afford a couple days off if that's all it's going to take. Eric Chavez filled in on Thursday, but sources tell me Teixeira is expected to play as soon as Friday.

The Twins waited and waited, both to get the MRI that Young requested and to put him on the DL. After Wednesday's batting practice, Young still wasn't able to play and the Twins finally used a retro DL move. Combined with the confusion surrounding Mauer, this points as much to a trust issue as a physical issue. While Young has been known as a difficult guy through his career, this doesn't seem like that. This is Young telling the medical staff that he's feeling something and them not finding a reason to follow up on it. That can be the correct move if a doctor or trainer really believes the guy is going to be ready, but in this case, the effect is going to ripple out well beyond Young's short DL stint.

Like a sorbet to clear the palate, let me slide some good news in among the Twins problems. Nishioka is recovering slightly ahead of schedule from his fractured leg. He'll have an X-ray on Friday to get a read on the status of the healing. Assuming everything looks like he's testing and feeling, he'll take the next step in rehab. Nishioka is already running and taking swings in the cage. It's not out of the question that he could be on a rehab assignment in the next 10 days if all continues to progress, which would put him back in the Twins lineup by mid-month. I'm going to keep the ERD a bit conservative, but Nishioka could beat it without the slightest hint of "rush."

Pavano's situation is, at least, simple. He has the flu -- or as baseball teams will always say, flu-like symptoms. He's the latest of the Twins to catch the bug, and like most, he's having a hard time staying hydrated due to ... well, I'll spare you the details. The Twins made some roster moves in order to get more pitching given the combination of Pavano's health and an upcoming double-header. Pavano isn't expected to be heading to the DL, but the team will monitor him over the next few days. Roster rules may force things beyond pure medical necessity, though Kevin Slowey's status will factor in as well. Slowey is pitching in XST and could be off the DL this weekend if needed.

The last of the Twins in today's UTK is Thome, who's dealing with a mild oblique strain. The Twins are playing it safe with him after putting Young on the DL and getting a bit of bench help. Thome's strain is "very mild," according to a source, but the thin roster of the Twins is affecting this both ways. They can't afford to sit him too long but they can't afford to lose him either. The medical staff will have to walk the tightrope, hoping they make the right decisions in support of Ron Gardenhire. It's the kind of thing that could tip a "death spiral" ... or pull them up out of it.

The Dodgers said that Broxton wasn't available on Wednesday due to a sore elbow. Broxton brushed it off after the game, saying he has this type of situation "every year." Of course, Broxton hasn't struggled like this every year. It's too much of a coincidence not to look at it and say, "Oh, this is the problem," but Broxton's reaction takes the wind out of those sails a bit. The Dodgers don't seem to be rushing to push him to the DL, a move that would allow them to send him on a rehab assignment, which might also allow him to get some work in. This one bears watching.

The Rangers made the move to put O'Day on the 60-day DL in a hurry, but it was telling. The 60 is as much about roster rules as the length of an injury, but O'Day's acetabular labrum tear is going to take 60 days and then some. The problem is correctable, as several well-known players have had this procedure and come back. Those players -- Alex Rodriguez, Chase Utley, Mike Lowell, Brett Myers and more -- have had almost no problems with returning. The one "failure" is Carlos Delgado. Also, some question whether Utley's knee problems were exacerbated by the hip issue, though that's not specific to the surgery. It's unlikely, but not impossible, for O'Day to return this season. Rodriguez had a "hybrid" procedure, which didn't include the most traumatic portion, allowing him to return quickly, but he remains the only one to come back in season. I'm putting the 9/30 -- the last day of the season, my indication that a player is done for the year -- on O'Day, but this one could change.

Eighty-four. That's the number that people are hanging on Webb, like a weight. First thing you have to know is that Webb was never a velocity guy. I spent an hour today trying to find out if PitchFX was available for Webb (it's not) because it's the sink that matters. If Webb gives up some velocity, leaving it somewhere on a surgeon's table, but keeps that filthy sink, I think he'd be OK with that. I know that there's a low threshold where a RH starter needs to be in terms of velocity, but as we continue to get more data on things like release point, break, angle and other things, we'll see whether the conventional wisdom on velocity can be offset. Then again, none of that matters if a pitcher isn't or can't stay healthy. We've got a lot of learning to do with that as well. Webb has a long way to go, so we'll get plenty more looks.

Joe Blanton was diagnosed with an impingement in his elbow. The Phillies are hoping that he'll be able to avoid surgery. I'll have more details on Monday ... Mark DeRosa is headed back to the DL with a recurrence of his wrist problem. No word yet on any prognosis ... Corey Hart returned to the lineup on Tuesday and is full-go for the Brewers ... The Indians made the conservative move and put Carlos Carrasco on the DL ... The A's think Coco Crisp's quad strain won't need a DL stint to heal up, but they'll be watching closely over the weekend ... Domonic Brown hit a HR in his first rehab game, erasing some concerns about his wrist's recovery ... The Pirates are worried about the loss of velocity they're seeing with Evan Meek. Meek was thought to be a closer possibility, but now he could find himself out of the setup role ... Speaking of penguins, what is Ron Cey up to these days?

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