Under The Knife: Pujols reaps benefits of clean break, health

By the time you read this, I'll be flying to Long Beach. SABR's annual convention is going to include a medical panel that includes some of the biggest names in baseball talking about the place of sports medicine in the game. I'm hoping to bring you more details or even sound from it on the Inside Fantasy podcast soon, but I'm honored and excited about it. Someday, the work done by people like the ones I'll be sharing the stage with will make this column a lot shorter, a lot cheaper, and maybe a little less necessary. For now, it's going to be another long one, so powered by the long weekend, let's get to the injuries:

I don't want Pujols drug tested. I really just want to know that he has two chromosomes, like the rest of us. I mean, does he only hit like this on worlds with a yellow sun? Let's be clear -- we don't know enough about Pujols' specific injury, its treatment or have enough one-to-one comparisons to say that this is way outside the realm of medical probability. It's fast, yes, but doctors I spoke with say that given world-class, around-the-clock care, it's just fast. What this comes down to sounds very simple -- bones heal. Even bad breaks can be fixed relatively easy, and Pujols didn't have a bad break. The bone broke, but it broke evenly and didn't displace, requiring nothing more than a soft splint and some time. (The Cardinals refused comment, as is standard, when I asked about treatments used.)

Once Pujols was able to hit without creating any problem, as reported by Derrick Goold on Monday, it wasn't going to be long until he was back. Tony LaRussa didn't put Pujols in his Tuesday lineup, likely an assertion of La Russa's status as much as a move to "protect" Pujols, but at this stage, the consensus among medical professionals I spoke with is that Pujols wouldn't be cleared if there wasn't clear medical evidence that a refracture was anything more than a long shot. It should also be said that this was not a "misdiagnosis," as some conspiracy theorists have pitched. There's not a more simple diagnosis to be made in much of medicine as looking at an X-ray and saying "yep, that's broke."

The short recovery timetable does bring up some concerns about his performance over the next few weeks, but there's nothing to go on here. We have no comparables in baseball (there are several in football and hockey, but the skill set is very different); we have only Pujols' track record of playing through injuries. In the most basic sense, this type of injury hasn't led to any long term concerns or loss of power the way a de facto wrist injury causes. We'll have to wait and watch, but the most reasonable expectation is that Pujols is going to go back to being Pujols. In Tuesday's game, La Russa had four PH opportunities, but used Nick Punto instead of Pujols, so there's some discussion about this being gamesmanship, that Pujols really isn't ready. Given the video that we all saw on ESPN's coverage, Pujols is doing a nice imitation of being ready if that's the case.

When Pujols injured his arm, many thought it would affect the offers he gets at the end of the year. That's silly, especially with him coming back this fast, assuming things go well. It's another story for the other big potential free agent, Reyes. Reyes' chronic hamstring issues are the only reason he's not a lock for one of those $100m-plus contracts. An MRI showed a very mild strain, and reports were that he came off the long flight to the West Coast feeling good. (Hey Jose, if you have any tips, I could use the help the next couple days!) He was scheduled to test the leg on Tuesday evening, and if that went well, he'll be back in the lineup on Wednesday. Reyes was a risky play in weekly leagues, but it's likely a better safe than sorry play you won't regret, as Reyes will be limited on the basepaths heading into some extra rest with the All Star break.

The Mets' good news didn't end there. Wright is about ready to start rehab games in Florida, but the All-Star break is keeping things a bit behind. The back looks to be clear, both on imaging and with symptoms, but remember that Wright played through this for an extended period. The bigger issue is making sure that Wright doesn't do further damage. This conservative approach indicates that the Mets are thinking into the future with Wright. There are rumors that both Wright and Reyes have long term offers being prepped by the Mets, but that Wright is the "lower priority," according to one source, due to the extra time on his contract and a desire to make sure that he's healthy. The new money that has come into the Mets appears to be headed to players, something that some in baseball think has Bud Selig's fingerprints on it to some extent. "It's a reach," said one front office type, "but the Wilpons have always followed Bud's lead. If the Wilpons can take David Einhorn's money and turn it into a deal for one of their players, it's another thing that can be said about [Frank] McCourt when that gets going again. Not to mention it's a good baseball move."

Further brightening the Flushing skies is the news that Santana is throwing to live batters down in Florida, and the Mets are starting to plot out a rehab schedule for his minor league stint. They'll probably wait until a week or so after the All-Star break to get him out there, given the 30-day limit on assignments. Santana's at a very fragile stage where the key will be less how he throws and more about how he recovers. Shoulder surgeries like his don't have the predictability of something like Tommy John. Over the next two weeks, he'll be doing side sessions and batting practice with the rehab guys, focusing on how he recovers from those. Making it through this with anything resembling his old stuff will be a huge win for the '12 Mets.

When I do the Team Health Reports in the preseason, one of the things that's always difficult to explain is that "red" -- the highest risk level -- doesn't necessarily mean you don't want that player or that it's even a bad thing. Rivera has always been the example I use. Over much of his career, he's had a minor episode sometime over the summer months where he is shut down or even placed on the DL as he gets over it. Before and after, he's fine, the best closer in the short history of the position. Once again, Rivera is having that minor but significant arm problem. It doesn't look like the triceps soreness is a real problem, but any issue at the shoulder (where the triceps attaches) is an issue for a pitcher. The Yankees can make do without him, but with Rafael Soriano and Joba Chamberlain on the shelf, they're much more exposed by his absence. Soriano will test his arm Tuesday and is expected back later this week.

Hughes had a mixed rehab, but given the fact the Yankees really don't know what's going on with his shoulder, it's not a bad result. He's back to the majors more or less on schedule; he showed decent velocity during two of his three starts and dominated minor leaguers the way a major league pitcher is supposed to. The downside with Hughes is that big unknown, that the Yankees aren't really sure what changed. This isn't something where they're not saying what's wrong. Talking to as many sources as possible, they really feel like that famous cartoon. As fast as it got better, it could go "dead" again. The Yanks will be watching Hughes closely, but the focus will be on his recovery as much as his results. I'm going to have a hard time trusting him before his third or fourth on-schedule start, if then.

The Red Sox are sending Buchholz south to Charlotte to check in with a back specialist, Dr. Craig Brigham. Brigham was listed as one of the "50 Best Back Doctors" in a recent survey, so he's got that going for him. Buchholz continues to have soreness and spasms, but the problem is only occurring with pitching. He can go about his normal activities, as far as is known, but up on a mound, the back locks up. Terry Francona had an interesting quote about this: "When we send him out there, we want him to know that even if it hurts he's not hurting himself." Francona's seems to be implying the Sox think Buchholz is going to have to pitch through this and that they think they can keep him from having any sort of cascade injury in the process. Given their access to biomechanics, I have to wonder if they know this rather than just thinking this. For now, Andrew Miller's spot in the rotation is solid, and we don't have a good timeline for Buchholz's return until after Brigham's examination.

The Dodgers pitching staff is having some issues now, ones that might create problems in one planned deal. The Dodgers have started the works to deal Hiroki Kuroda, but if they're losing both Garland and Lilly, the Dodgers might not be able to deal Kuroda and protect the golden young arm of Clayton Kershaw. Garland, brought in for his long record of health, is seeing Dr. Lewis Yocum for a second opinion on his shoulder, but the first opinion was from Dr. Neil ElAttrache, so I'm not expecting there to be much of a difference in opinion. Garland has a "complicated" shoulder issue, according to Dodgers' medical chief Stan Conte, likely meaning that there are multiple structures involved. Most reports have Garland needing surgery, but even if he tries to avoid that, it's unlikely he'll be back this season.

Lilly's issue is mere soreness, but his elbow was enough of an issue to push his start back from Monday to Tuesday. Rubby De La Rosa did a nice job filling in, but the long term implications of Lilly's elbow problems are bigger than one start. Lilly took the ball as expected on Tuesday, so the Dodgers are hoping that the extra rest plus the All-Star break will help get him past this issue.

Brian Cashman's motivational technique for keeping players from getting injured is awesome. Derek Jeter's rehab went off without any issue and he's back with the Yankees, ready to hit the 3,000-hit milestone ... Carlos Gonzalez is going to avoid the DL, but if his wrist isn't ready by Thursday, the Rockies seem willing to play a man down through the weekend in hopes the rest and the All-Star break helps him be ready after it ... Troy Tulowitzki is going to miss the rest of the series with a mild quad strain. He should avoid the DL, but combined with other injuries, it does put the Rockies in a tough roster position ... Ryan Madson isn't ready to come back to the Phillies, but he's throwing and could make a minor league rehab appearance before the All Star break ... Martin Prado will start a rehab assignment on Wednesday. If things go well, he could be back for the key Phillies series this weekend ... Chipper Jones had another cortisone shot in his problematic knee, but he's focused on the All-Star Game as much as he is this weekend's series, which is a bit troubling ... The Red Sox think they could have Carl Crawford back later this week, but are debating whether bringing him back before the All-Star break really makes sense ... The Cubs seem quite concerned with Ryan Dempster's intestinal issue, so his return is a real question mark ... Yunel Escobar is out until midweek with his hand issue ... The Diamondbacks aren't ruling out Jarrod Parker coming up to the team later this year, but they do have him on a hard innings limit for the season, regardless of where they happen ... Jimmy Traina found the video on Fausto Carmona's incident. Even Carmona had to laugh, though his strained quad could cost him a start ... Yeah, I'm on Google+. I'm still not sure how this integrates into the process, but if you want to follow, I'm easy to find.