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Under The Knife: Arm injury likely to cost Pujols power potential

After a week in New York, I'm back in Indy and back in the normal pattern of work. You'll see the fruits of some of that labor here in the next few days -- including why the Mets medical staff doesn't deserve the blame it gets -- but for right now, there are a lot of injuries to catch up on so let's get right to it:

It's a fantasy nightmare. While Pujols doesn't have the MVP-type numbers we're used to seeing over the last decade, his 2011 hasn't been bad at all. His 2.2 wins is certainly good production, but we're not used to seeing Albert Pujols looking up at anyone, let alone a whole page that includes names like Gaby Sanchez (2.8 wins) or Alex Avila (2.5 wins, though much of that is positional value.)

Pujols' season got worse on Sunday when he collided with Wilson Betemit at first base and left the game after writhing on the ground in pain. It appears that Betemit ran into the hand, rather than the glove, which could have created more leverage (or had enough give to prevent injury.) Pujols was holding the wrist stable as he walked off the field with trainer Greg Hauck, suggesting that he felt it was unstable at that point. A key image was watching Pujols seated on the field while it appeared that his pinky finger was twitching.

Ken Rosenthal of Fox Sports has reported that imaging showed a small fracture in Pujols' arm. The Cardinals later confirmed that the fracture is a non-displaced fracture of the radius, one of the large bones of the forearm. This is a bit of a surprising result, especially if there's no other associated damage. Neither the Cardinals' release nor Rosenthal's report has mention of a sprain or any other soft-tissue injury, which would be surprising given the mechanism. The four to six week time frame seems reasonable as a return from a large bone fracture, which is simpler and easier to monitor than a smaller bone, such as the hamate. Anatomical wrist injuries, such as the one that Pablo Sandoval recently had, are easy to come back from, but cost four to six weeks and some short term power., so even when he comes back, we may see Pujols stay below his normal levels as he heads into free agency.

Crawford's season seemed to be coming around, but he'll have to start over after the All Star break now. Crawford was placed on the 15-day DL by the Red Sox on Saturday after straining his hamstring in Friday's game against the Brewers.

Crawford has been relatively healthy over his career, with only minor injuries along the way. While Crawford is among the fastest players in the game, he's not a pure "speed player," relying on his legs for his value. Instead, Crawford's legs are only a part of what the Red Sox paid for, a complete package that didn't seem to come complete to Boston. While many wondered whether Crawford was hurt during his early season struggles, Crawford steadfastly said he'd fix things and he did. Most think that Crawford was pressing, but the Houston native isn't a fan of the press and is very steadfast in his pregame routines, which both found big changes in Boston. Crawford switched from a Red Sox-suggested pregame routine at the end of April, which coincided nicely with his return to form.

This hamstring strain is not serious, but as with Derek Jeter, the team knows that Crawford has a huge work ethic and is protecting him from himself. Hamstring strains can be made significantly worse if not allowed to heal. Crawford should be fine at the minimum, which would be just before the All Star break, so many are speculating that the team will hold him out through the break to get him just a bit more rest. Crawford was replaced Sunday by Drew Sutton and on the roster by prospect Josh Reddick, who will be among the mix-and-match options for Terry Francona over the next couple of weeks. Neither is a great fantasy option. Crawford should be shifted to the DL if possible, but should not be dropped in all formats.

The Red Sox have always been cautious with Buchholz. They moved him slowly through the minors, holding him there until they felt he was completely ready for the majors, despite having thrown a no-hitter. The caution seems to have worked for him, as compared to other young pitchers, though I still wonder how many innings and wins were lost for his career and for the Red Sox, compared to who they had. It's a very tough calculation. Buchholz will miss a couple weeks with a strained back. It's not considered a serious injury, but the Sox want to avoid the kind of cascade that they saw last season with Josh Beckett. The timing is also fortuitous, as it allows the Sox to use Andrew Miller for at least a couple of starts. The former Marlin and Tiger had an out clause in his minor league deal that was coming up. Buchholz shouldn't be out much longer than the minimum, though the Sox tend to be very conservative with pitchers.

Hanson has been really good lately, so it was a surprise when he was first scratched and then placed on the DL. In ways, this feels a lot like Josh Johnson's situation, where he went from dominant to DL, a place where he's lingering. With Hanson, it's more a matter of prevention, safety and depth. The Braves know how good he is and a minor complaint of soreness led them to shut him down. One source tells me his dominant 14 K-performance was actually a problem. "He overthrew that game," he said, leading to more than normal soreness. "He needs to not only learn how to strike guys out, but how to be efficient." The Braves have enough pitching depth to get by without Hanson, so much that they haven't needed to use Julio Teheran more than planned. Hanson should be back at or near the minimum, but as with many players now, the All Star break comes into play on timing.

The Brewers have a hard and fast rule about pitch counts, but it's not one like many teams. Instead, the Brewers don't like high pitch count innings. Anything above 30 raises a lot of eyebrows and when someone gets to 44, all eyebrows are up, from the dugout to the front office. Marcum clearly didn't have his best stuff, but was it the result of his hip flexor strain or was that something that came up afterwards? That's unclear, but we'll have to see if Marcum makes his next start. His side work will be key if Ron Roenicke is going to put Marcum back on the mound, since he'll want to have some "eyes on" confidence and the nod of the medical staff. Early indications are positive, but that side session is the key. Given Marcum's stuff, it's not the worst idea to bench him this week and put in your backup starter, assuming you have that option.

Jimenez got his first win at home this season, an incredible sentence to be writing in mid-June. The downside here is that he left early with cramping in his calf. It could have been worse, but as other pitchers show, including Danny Duffy on Sunday, the summer heat and humidity can lead to cramping. You'd think that at this stage, hydration would be the easiest part of sports medicine, with almost everyone agreeing on its importance and sponsors providing all the product players need to make it easy. Instead, players forget, especially pitchers who don't seem to register it. Some teams are looking at time on bench. Shorter times offer less rest and seem to indicate less hydration. Jimenez shouldn't have significant problems in his next start, though the Rockies will be keeping a close eye on him.

LaPorta's injury shows just how connected things can be for a team. The repercussions go back to last season, when Carlos Santana had a play at the plate and came away with "just" a torn ligament. At the time, Manny Acta told me that the Indians were looking to put Santana on the "Victor Martinez plan" anyway, giving him some time at 1B and DH to take the load off their young catcher. LaPorta's high ankle sprain could keep him out as long as a month, especially if his pattern of slow healing (or actually, longer rehabs, which is as much a function of his swing as his healing) holds. LaPorta is a fantasy conundrum at this stage and one of the weak links that GM Chris Antonetti and his staff will have to address at the trading deadline if they want to contend.

I got the chance to talk with several people in person on Wednesday regarding Jeter. The conversations confirmed what I'd been hearing, that Jeter's calf strain is not significant, but was enough of a concern over the first week that the Yankees, knowing Jeter so well, decided he would be better served with an enforced rest rather than pushing himself to get back. Watch for discussion of bilateral strength to show that the Yankees are using strict criteria for when Jeter can come back, rather than his word or running for the coaches. "Girardi couldn't have kept his name out of the lineup," one person told me in the clubhouse. Jeter should be back at or near the minimum, and I say near only because of the upcoming milestone of 3,000 hits. It makes sense to do it at home, though Danny Knobler of CBS pointed out to me in the press box that the Yankees let Mariano Rivera get his 500th save at Citi Field. The schedule and the impending All Star break will be a big factor in when Jeter comes back. Once he does come back, don't expect any problems or limitations.

Phil Hughes started for the Yankees on Sunday. It's the Staten Island Yankees, but it's something. Things look good early with reports he hit 95 ... The Yankees are saying Alex Rodriguez has a "minor" shoulder issue. I'm looking more closely into this one ... I don't think there's anything wrong with Tim Lincecum that a couple days of rest won't help ... Mike Stanton is out indefinitely with an eye infection. He'll see a specialist on Monday ... Orlando Hudson came off the DL and is back at 2B for the Padres. Don't expect much in the way of steals this first week back ... Jed Lowrie's sore shoulder has progressed to a point where Dr. Lewis Yocum will be taking a look on Monday. Surgery is "more a likelihood than a possibility" I'm told ... If Hunter Pence's sprained elbow didn't involve ligament damage, as some reports stated, what did it involve? Pence's minor sprain (which did involve a ligament, for the record) will have him out a few days. That's an inconvenience to scouts more than it is to the Astros ... Brad Lidge played catch last week, but there's a chance he won't make it back at the All Star break ... Darwin Barney ruptured his PCL, but he should be back near the minimum. He won't need surgery, but there's going to be some issues with lateral stability. The brace he'll need might be an issue ... Danny Valencia will get a couple days off after straining his biceps ... Sad to see Edwin Rodriguez go out like that. The Marlins are said to be looking for a permanent manager, not an interim. They're willing to go with Brandon Hyde for an "extended period" to find the right guy, though you've probably already heard Jack McKeon's name bandied about ... Hong-Chih Kuo is off the DL and back in the closer role. That's as good a sign his anxiety issue is fixed as anything ... Josh Willingham is dealing with a recurrence of his Achilles strain. The DL is a possibility ... Mike Napoli hasn't started swinging a bat yet, so the June 27 return date is a bit fluid right now ... Rick Ankiel heads to the DL with a rib cage injury. It's a roster situation as much as the injury ...Congrats to Larry Starr, the former Reds and Marlins trainer, who will be inducted into the NATA Hall of Fame this week ... There's still a couple slots available on the Midwest Plus tour that I'll be hosting, but you're running out of time and availability. It's not cheap, but it's going to be awesome.

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