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Under The Knife: Pitching injuries piling up early in the season

Whether you believe in pitch counts or not doesn't matter. Whether you believe in biomechanics doesn't matter either. Long toss? Pilates? Genetics? Irrelevant. Your beliefs don't matter because while facts might be dead, they're clear in the case of pitching. What the sport is doing is not working. It's time to tear this thing down and build it back up based on something that's proveable, repeatable and sustainable. I honestly don't care how it's done or who does it. I've looked under every pitching rock, listened to scientists and charlatans, spilled ink and pixels and blood and tears, sent kids to surgeons, and the problem isn't one bit closer to being solved. Nine years ago at his ASMI course, Jim Andrews said that he hoped he would put himself out of business. Instead, business is booming for him and the other surgeons that are playing the part of all the king's men in baseball these days. I'm standing here and asking -- begging -- that next year, every team doctor, every team medical staff and some top names get together in a room somewhere. Then Bud Selig should lock the door and say that we're not coming out until we have a plan. I'll bring the coffee and some ideas. Who's in?

On to the injuries:

People out there seem to think I like being right or that I enjoy injuries. It's the opposite. When I see storm clouds on the horizon for someone like Pineda, I want to be wrong. I remind everyone (and myself) that it's probabilities I talk about, that we remember the improbable ones that make statistics and predictions bow down to their talents. Word came from the Yankees over the weekend that Pineda's throwing program had failed and that he was headed back to New York for further tests. Those tests will include a contrast MRI in hopes that doctors can find whether something deeper, such as a labrum, is causing the weakness. A source tells me that Pineda's arm is weaker now than it was when he was initially shut him down despite the rest and rehab. What happens next is all speculation until we get a solid diagnosis, so I'm taking off the expected return date for now. At best, Pineda will be out until June and likely longer.

I don't have any problem with Lee pitching 102 pitches over 10 innings. You know what, I'll go further. I don't care about pitch counts at all because without context, they're meaningless. What I don't know is whether Lee was fatigued when he went back out there in the 10th. I don't have any idea how to measure the fatigue in an oblique, so I'm not faulting anyone -- Charlie Manuel, the Phillies medical staff, even Lee himself -- that this happened. The strain in his oblique is enough to push Lee to the DL and cost him as much as a month of the season. Lee has a history of serious abdominal issues, so while this is considered a relatively minor strain, the Phillies are likely to be conservative with him

Rotator cuff injuries are very bad for any pitcher, but are thankfully rare. Frank Jobe once again gets the credit, having created a cuff strengthening exercise series called the "thrower's ten" that helped reduce the number of incidents. (The thrower's ten has since been modified, but the basic concept holds.) Narveson had been a bit inefficient in his last outing, but there was no sign that there was a significant problem before the announcement. Narveson will consult with Lewis Yocum before making a final decision, but assistant GM Gord Ash believes this will be a surgical case. Narveson is done for 2012 and recovery from significant rotator cuff tears is difficult for any pitcher.

A pitcher needs his legs, so a strained quad will put Dempster on the shelf for a couple of starts. His DL stint will be backdated, meaning he'll only miss two starts on the schedule, with the Cubs bringing up Randy Wells to take those. Getting him back in to the rotation won't take much juggling, though I usually add a couple days to the ERD just to be safe. Dempster originally injured his leg during a side session and felt it during his last start. The Cubs did some tests and were worried enough that they decided to rest him. This shouldn't be a problem going forward, assuming the rest and rehab heals things up.

Impingement is a pitcher's equivalent of clogged pipes. When inflammation causes the structures inside to get pinched during the throwing motion, the catch-all term is impingement. This inflammation usually is focused on the subacromial space, where there are a lot of structures, including parts of the rotator cuff. For any thrower, that's bad, but it's also controllable. Hudson is a young pitcher who throws hard, so it's actually a bit of a positive that the D'backs medical staff caught this early, before the impinged structures rubbed or tore. Hudson will be rested, given anti-inflammatories and should be checked to see whether his movements are part of the problem. The D'backs are using some advanced movement techniques in both rehab and pre-hab that I hope to be able to give you more information on soon. Hudson should be shut down a couple weeks and then brought back slowly, so saying he could miss about a month seems reasonable, though he could beat that estimate.

Zimmerman is pretty beat up for April. He's coming off a sore foot and has a strained shoulder. The Nats don't seem terribly concerned by the shoulder injury, electing not to do an MRI. However, there's some confusion, since the Nats also announced there's no structural damage. (One theory is that Bryce Harper is actually Superman and was brought in to use his X-ray vision.) Zimmerman got some rest and is expected to be back in the lineup Tuesday. Zimmerman told reporters that he could have played if needed, but the Nats used the schedule to get him some rest. Watch to see if the Padres test him with some early bunts.

Making the switch from any position to pitcher is tough. Without getting into the finer points of physiology and tougher concepts like humeral retroversion, just accept that pitcher conversions see a higher rate of injuries, especially to the elbow. Santos hasn't been pitching long, but he's been doing it well. The downside is that he has some issues with recovery. After a recent outing, he experienced inflammation, pain and tightness. The Jays shut him down and decided after a couple days that he should see Dr. Yocum. While the Jays say this is precautionary, it's also worrisome. The Jays' struggles with keeping pitchers healthy are well chronicled, so it's nice to see them trying to catch things early.

The Rangers are waiting to see how an MRI on Adrian Beltre's hamstring looks before deciding on a roster move. He'll have that in Arlington on Monday. A DL stint looks likely. They have depth at 3B with Alberto Gonzalez and Michael Young ... Kevin Youkilis got plunked on Saturday, but would have been in Sunday's game if it had been played. His leg is sore, but shouldn't be an issue ... Carl Crawford could be cleared to play the field sometime this week. A return to the Red Sox could come shortly after that ... Daisuke Matsuzaka starts his rehab assignment Monday at Salem (A). With the clock starter, we'll see him in Boston in May, putting him back at the 11-month mark. His first outing will come with a 75-pitch limit ... Both Uptons were back in the lineup over the weekend and looked good ... Keep an eye on Paul Konerko's ankle. He was removed in the 8th inning Sunday and had the ankle wrapped before the game ... Kevin Correia was pushed back due to pain in his side. With Monday's game facing a possible snow-out, his status is also questionable ... AJ Burnett went seven scoreless in his Pirates debut after getting torched in his rehab starts. My guess? He didn't care about his results in the minors ... Yahoo's Tim Brown said that Ryan Howard won't be back until the All-Star break in a piece about Charlie Manuel and the Phillies slow start. Tim is a top notch writer, but I don't know where he got that. All signs lately on Howard have been positive, though he's not going to make the initial ERD I had for him (May 1) ... Jon Jay had a setback while taking batting practice. He's headed back to St Louis for tests on his shoulder ... Kyle Blanks will have surgery to repair a torn labrum. He's done for the season ... The pitch count being shown on-screen isn't helping things, but it's added because it's understandable. Any of you math whizzes out there have a replacement that doesn't require any (not easy, but any) explanation? Tell me on Twitter (@injuryexpert).

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