Under The Knife: Injuries sending key hurlers home for the season

I spent some of Tuesday afternoon putting together a long intro about the value of knowing more about a team's development staff when placed into a fantasy context. When injuries started coming in fast and furious, that intro went out the door ... or rather, copy-pasted over to Friday's UTK file ... and I started heating up the iPhone. There were a lot of injuries to a lot of players, with lots of them happening late and to star players. I won't waste time with much more about me. Let's get right to the injuries:

The worrisome comp for Buchholz's injury isn't another pitcher. It's not David Wright, who missed two months with a very similar stress fracture in his lower back. No, the comp the Red Sox would rather not hear is Jacoby Ellsbury. Last year, the team seemed to lose a bit of confidence in their medical staff when Ellsbury's rib fracture was "missed." To be fair, the miss was because Ellsbury's pain was "referred," a term that means the pain was away from the location of the actual problem. The best known example of referred pain is sciatica, where the actual problem is in the back, but the pain travels down the nerve into the leg.

Buchholz's injury was, like Wright's, presenting as a simple strain with spasm and tightness. It was responding to treatment. It walked like a duck and quacked like a duck, but this was no duck. In fact, the location of the fracture (L2 vertebrae) is an unusual one, with one study pegging this type of injury as occurring in only 1-3 percent of cases, with more happening in the lower back. Once the condition recurred, further options were investigated and imaging locked in the stress fracture. This condition, which is technically a spondylolysis, but let's not bother trying to pronounce that, especially with a Boston accent, usually occurs over a period of time rather than through a traumatic origin. It's quite possible that Buchholz has been pitching with this for quite a while. At this stage, it really doesn't matter.

It's going to take two weeks of rest, minimum, before activity can start up. As we saw with Wright, it can be longer. That's tougher for a pitcher, who not only loses stamina, but has to use his back on each and every pitch. If Buchholz is able to come back, he'd likely have to go to the pen, which has its own perils. It's unlikely that Buchholz will return this season, but in the long term, this should not be an issue once the stress fracture heals. I'm putting his ERD as 9/30, indicating I believe he is out for the season, but I'm writing it in pencil.

The Mets liked what they saw from Santana during his rehab and during his first rehab start. His scoreless, three-inning stint was seen as a positive by everyone I spoke with. It's the recovery that's been the issue, though it doesn't appear the problem was immediate. Sources tell me that Santana felt "normal soreness" the day following his first competitive outing, but that it didn't get better over the next few days. Santana will go back to New York for an examination with team doctors, but predictably, Mets fans seem to be headed for bridges and ledges. Comparisons to Chien-Ming Wang or even Mark Prior are coming out of the woodwork, but aren't instructive. Wang did have a similar tear in his shoulder capsule, but it was the result of an injury cascade that was exacerbated by the humeral motion inherent in a sinker.

Try this at home: Put one hand on your shoulder. With the other hand, point your thumb up, then turn it down. Feel how the head of your humerus moves in the shoulder? That's what a sinkerballer like Wang or Brandon Webb does on every sinker, except much, much harder.

Santana doesn't throw a sinker or even the type of change that requires hard pronation. Until we know more about what, if any, physical problem Santana has, it's impossible to do more than guess. The Mets will have to decide just how much they're willing to risk Santana, even if it turns out this is just a minor setback. His season is again in jeopardy, which adds to the uncertainty the Mets have heading into 2012 and the final two expensive years of Santana's contract.

Peter Abraham gets it. His article on Dustin Pedroia asks the right questions, and while some will say that the before and after stats are the equivalent of the random endpoint stats that Joe Sheehan rails against, I think it's telling that that particular point is the fulcrum. The needle arthroscopy and knee lubrication* appear to have worked, though the obvious follow-up question would be: when does it wear out? Pedroia is still just 27, is signed for at least three more seasons at a below-market rate given his production. Even with a minor risk for injury and the style of play that makes Pedroia more likely to wear himself down, the Sox have to be very happy to have him at 2B. They're a worse team without him.

(* Please, anyone, give me a better term for the injection of lubricant into a joint. I hate having any player, let alone a polarizing one like Pedroia in the same section as "lubricant.")

The Marlins announced that they would not be shutting Johnson down, electing instead to have him start a throwing program they say could have him back in September. Allow me to point out the smoke over here and the mirrors over there. This statement from the Marlins isn't a lie, but parsing it out to reality shows that it's not the good news that some made it out to be. Johnson's shoulder is still a problem, but one that the Marlins feel better about when he's being watched by their medical and pitching staffs. There's a chance -- a small one, maybe 10 percent -- that Johnson comes back in September. Aside from being able to show him off to potential season ticketholders and to give everyone a bit more confidence heading into the new ballpark, there's no gain to pushing him back. If you don't expect anything from Johnson, you'll be better off. Even if he gets one or two starts in late September, the best you'll get is a better idea of whether he's a keeper or not.

I hate when any pitcher has to have surgery, or even just faces the possibility. I realize that what Dr. Frank Jobe invented allows pitchers to come back from a sprained UCL, but there's been so little done to help prevent the injury that when I hear that a guy like De La Rosa might be the next to have that triangular scar on his elbow, it pains me. De La Rosa saw Dodgers doc Neil ElAttrache after his last start, but De La Rosa said he felt something in the third inning. De La Rosa pitched only four innings, but made 100 pitches in those four innings. One hundred pitches! Look at the quotes from Don Mattingly in Tony Jackson's article and tell me why Mattingly didn't act more quickly. The "quick hook" seems to be something that's out of the modern manager's arsenal, though I have no idea why. De La Rosa will be shut down and was placed on the DL, and while the team initially said they would take a couple weeks to see how the elbow does before making a decision on surgery, late reports were that he would undergo surgery soon. If so, he'll miss the bulk of 2012 as well.

The Yankees didn't get any help at the trade deadline, but they should get Rodriguez back soon. He'll start baseball activities on Thursday at the Yankees complex in Tampa. He's three weeks post-surgery, so if he stays on pace, he'll return right at the expectation, in between four and five weeks. GM Brian Cashman identified the second week of August as the target date early in the process and it looks like that's going to hold. Rodriguez shouldn't have any issues once he's back, though the Yankees will watch closely to make sure that their 3B doesn't have the kind of rush-back issues that Chipper Jones has seen since his return. The Yankees also had Hughes with his back against the wall on Tuesday. With Ivan Nova coming and Hughes' velocity dropping, a bad outing might have had Hughes out of the rotation. Hughes was solid enough through six before a rain delay forced him out. Hughes was living at 92 and showing 95, which is better than his previous outings and makes me wonder if Hughes, knowing how much was at stake, was reaching back for a little more. The Yanks will take it, but it could cost him on the recovery toward the next start. As usual, it bears watching.

Pujols was hit on the hand by a Takashi Saito pitch. There were two men on and Pujols stayed in the game. In the next inning, Jason Motte missed with one pitch, then hit Ryan Braun high in the back with a mid-90s fastball, to put the go-ahead run on. I don't understand baseball sometimes, but I hope Motte is fined and that Tony La Russa is suspended. I had an extended discussion about it over Twitter and while many, including some Cards writers I trust, say that La Russa likely did not specifically call for the pitch, but that he wouldn't need to. That makes sense to me, but it doesn't solve the problem. In this case, one star player was potentially injured by an accidental pitch that came up and in. There was no indication that Pujols had any injury more than a bruise, having stayed in the game throughout. Across the field, another star made it out of the game with just a bruise on his back. Neither is expected to miss any time, but neither was necessary. Pujols could wear a padded glove and no one needs to be injured by an intentional beaning.

Hanley Ramirez fell in the field, spraining his shoulder on Tuesday. There were few details at deadline, so watch this one closely ... Carlos Gonzalez could return this weekend. His wrist injury has progressed well, according to the Rockies ... Roy Oswalt went 90 pitches in his Monday rehab start. He was in the low 90s, but seeing him in the Phillies dugout on Tuesday tells you where he's making his next start ... Jake Arrieta will miss at least one start due to a bone spur in his pitching elbow. He may need surgery, though the Orioles hope he can wait until the offseason. He'll see Dr. Lewis Yocum next week ... Jed Lowrie was expected to be in Pawtucket (AAA) for the rest of the week, but Marco Scutaro's dizziness might force Lowrie back early ... Barry Zito went back on the DL for his foot injury. Conveniently, Jonathan Sanchez will come off the DL this weekend ... The Cubs would like to get Andrew Cashner back in September for much the same reason the Marlins want to see Josh Johnson: confidence. He'll relieve if he is able to return ... Rich Harden, who the Red Sox didn't think would stay healthy enough to help them, started for the A's Tuesday. He was ok, going 105 pitches with a decent line. With Erik Bedard scheduled to go Thursday, it will be interesting to see how they match up for the next couple months ... There hasn't been a web service since Gmail that I love as much as Spotify ... Charlie Blackmon had surgery on Monday to put a pin in his fractured foot. He's done for the season ... Freddy Sanchez had shoulder surgery Tuesday in Arizona, ending his '11 season ... Chone Figgins heads to the DL with a strained hip flexor (and a bad contract) ... This is an utterly fascinating piece on the on-deck routine. The "dinosaur sport" is something I'll vouch for.