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Under The Knife: History, trust essential in managing injuries

On Thursday I was on MLB's Fantasy 411 with Mike Siano. He accused me of being the Grim Reaper, which is one of the things I hate about doing radio. When I come on -- aside from one of my great regular gigs -- it means something has gone wrong. I'm the messenger that people want to shoot. It's like Mike Wallace showing up at your office, not the Publishers Clearinghouse guy with all the balloons. It's something I don't know how to fix. Injuries are negative events, but that would make reducing injuries a positive events. We know that injury management is often a leading indicator for success, so I think people are doing this wrong. Fans should be happy when I don't mention their team, right? Let's go with that.

On to the injuries ...

Moments after Werth slid over his glove while making a sliding catch, @jeremytiemini asked me if it was a "Hideki Matsui comp." It turns out that Jeremy's dead on with the comp for how the injury looked and what it was -- a fracture. Werth has a history with this wrist, needing surgery on it in '05. He'd played with a broken wrist for much of that season, finally succumbing to a ligament repair. It never quite got right for a while, causing him to miss much of '06. The history could be significant based on the internal structure, but it depends on what is sprained, strained or fractured. If it's a "simple" fracture, he could miss four-to-six weeks. If there's more going on -- as there was with him last time -- it could be much longer. This ERD is a most-likely scenario.

Trust is a huge thing when it comes to injuries and injury management. A trainer has to trust a player when he asks if he's OK. A pitching coach has to have the trust of his pitcher when he walks to the mound and asks, "How are you?" The same should hold true from the outside as well, shouldn't it? When I first heard the reasons that Robin Ventura gave for shifting Sale to the closer role from a successful month of starting, I thought that it made no sense. Then I realized that trainer Herm Schneider and pitching coach Don Cooper have spent the last decade building up the kind of credibility and trust that made me pause. From the outside, I don't know what the Sox are seeing that makes them think that Sale can last as a closer. Sources tell me that Sale's physical condition has been deteriorating from start to start, that they weren't sure if he was going to be able to continue making starts under normal rest. I think that the Sox are less sure that Sale will stay healthy in the closer role and more sure that he won't in the starting rotation. If they can manage him more closely and get the maximum possible value out of him, it's more positive than just seeing how long he'd last until he blew up, the way Josh Johnson did last year. The Sox likely won't rule out a shift back to the rotation in the future either, given his success. For now, let's trust that the Sox think this is the best course of action and trust that Schneider hasn't lost his golden touch.

Luebke went from "inflammation" to "Tommy John" in a hurry. Elbow inflammation for any young pitcher is always a warning sign. An MRI showed damage in both the flexor tendon and UCL, but a final decision will wait on the swelling to go down. MRIs are good, but tough to read with severe inflammation, so it's worth waiting a week or so. The likely outcome is surgery. Luebke's not "young" -- or at least not below the injury nexus. He's been handled normally. While Luebke was an injury concern entering the season, the issue was workload and he hasn't had enough of that to be an issue. This is just one of those things where what we don't know far outweighs what we know. Luebke's likely done for the season, which puts pressure on Tim Stauffer, who's on a rehab assignment and is Luebke's likely replacement in the rotation.

Lat strains are unusual in pitchers, but not as unusual as they used to be. They might be the unintended consequence of the improvements to the kinetic chain. That is, there's always a weak link in any chain and by fixing the rotator cuff, the elbow and the rest of the focus on the arm, we might have left something out. The long toss proponents talk about how that practice helps the legs and back, which leaves the lat as the strong muscle but possible weak point. Street hits the DL with his, but it's hard to call Street any sort of signifier. He's been injury-prone despite his football mentality, or, in part, because of it. The Padres are going to give Street time to completely heal, so look for him to stay on the DL until early June. Until then, Andrew Cashner will get the first shot at the closer role.

It was a bad week for the Brewers. First Chris Narveson had shoulder surgery, then Mat Gamel tore his ACL. The bad news lingered, with Alex Gonzalez injuring his knee on a slide. It was serious, with the swelling significant enough that the Brewers will wait until Monday to do the MRI. Indications are that this is serious, but no one is speculating on just how serious. If Gonzalez is out long term, there are enough questions about depth to have some wondering if Craig Counsell might be the best option. Gonzalez has a history of knee injuries, so there's a deep concern.

The Brewers are in a difficult situation with Braun as well. He's fighting a strained Achilles, which he can be effective through -- as evidenced by a home run over the weekend -- but it's bothering him and could get worse -- as evidenced by his Kirk Gibsonian trot after said homer. The worst case here is that the Achilles snaps, but that's not likely. The question is how to keep him effective. The Brewers' medical staff has its hands full with these tasks and more, while trying to keep the rest of the team healthy as well. It's situations like this that make me wonder how two athletic trainers are enough to keep up with all the issues a team presents.

It's hard for some to remember that prior to his MLB debut, Morneau's biggest claim to fame was a run of injuries and illnesses that would have derailed most players. Instead, Morneau finally got healthy at just the right time and was able to show the ability he'd always had. Unfortunately, the health left as quickly as it came. While most were watching Morneau struggle with concussion symptoms, most didn't pay much attention to the minor wrist surgery he had. This has lingered and Morneau is having more problems than most. His Saturday hitting session didn't go well, pushing the Twins to put him on the DL. They are waiting, so there's a chance they change their minds Monday. To make it more confusing, it will be a retro move, so he's not expected to be on the DL long. The worry is that Morneau's wrist will remain inflamed and he'll lose some power even after his return. He's had decent power numbers thus far, but an increased miss rate, so there are mixed signs. That makes him risky even on return.

Utley rejoined the Phillies last week and reportedly looked "significantly better." Utley isn't heading down to Clearwater just yet -- or perhaps at all. There's a question as to whether Utley might go directly to a rehab assignment, perhaps at nearby Lehigh Valley (AAA) which would allow him to be monitored by the Phillies medical staff. The key here is that Utley says he's not just better, but "pain free." More interesting, Utley seems to think that the fielding, and not the hitting, is what's holding him back. It's unclear if it means he wants to be sure with his fielding before worrying about finding his swing, or if he thinks he'll have a quick return. At this stage, it's difficult to get a solid timeline, but his quick return last year has to be the guide. The ERD here is conservative, at the dead center of a broad range.

Mariano Rivera confirmed that he'll be back for the '13 season. In doing so, he pretty much closed the door on '12, absent a big change once his knee is opened up ... Scott Downs left Sunday's game with an apparent leg injury. Keep an eye on this and I'll have more on Wednesday if necessary ... It got worse for the Angels. LaTroy Hawkins broke the pinkie of his throwing hand in the same inning. The Angels will evaluate him before Monday's game, but the DL is a probability ... Buster Posey took a nasty foul tip to the mask on Sunday. The slo-mo of the hit was scary, showing the waves of energy. The mask took some of it, but we have to watch to see if Posey has any concussion symptoms over the next few days ... Desmond Jennings left Sunday's game with left knee soreness. I'll be following this one ... Daniel Hudson will get back on a mound this week. He's made some progress but any setback is going to push the D'backs to look at Trevor Bauer, who isn't being challenged at Mobile(AA) ... Lance Berkman tried to sprint on Friday, but his calf still felt tight. He'll try again before Monday's game ... Adrian Beltre is still having issues with his hamstring, though his use as a pinch hitter shows he's not going to miss much more time ... Kevin Youkilis had an MRI on his back. He's making some progress with his issue, but he's not likely to be back at the minimum, which would be 5/14 ... Aaron Cook was forced up because of his opt-out clause. Now a nasty spike to the knee will put him on the DL, which keeps him around as an insurance policy for a bit longer ... Daisuke Matsuzaka had a minor setback in his rehab. It's unclear if the Sox will use this to reset his rehab clock ... A lot have asked for updates on Andrew Bailey. There's simply no new news. He should begin throwing around the end of the month ... Carlos Gomez's hamstring strain is pretty minor, but the team was already short on the bench. They used this move to get some reinforcements up now. He'll be back at the minimum ... Chris Young (Arizona version) is at least a week away from a rehab assignment. He's swinging a bat and making some progress... The Astros are looking smart for shifting Brett Myers to the closer role. It's not making them better, but the inevitable trade will make the team better in the long run ... Andy Pettitte was as bad on the mound this weekend as he was on the witness stand last week. The Yankees may need to see one more outing from him.

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