Under the knife -- wrap

Publish date:

Normally, my daily Under The Knife and UTK Wrap columns cover the 10 biggest injuries in the game. For today's Wrap, though, there are just too many to cover. I'm going 17 deep today, to make sure we get all the important injuries that could affect who's in and who's out for the playoffs in here. Since it's already running long, I'm not going to ramble. Powered by Ron Santo for the Hall of Fame, on to the injuries:

So the Mariners knew what this was all along. Bedard has been pitching with a torn labrum and cyst inside his shoulder since July, yet the Mariners kept trying to trot him out there. That's to say nothing of the times he pitched with pain prior to that. You'll pardon me for cringing a bit at the word "prior" in the previous sentence, because that's exactly what this situation reminds me of. Mark Prior pitched through a damaged shoulder that has necessitated two major repairs and will likely never pitch again, the result of overwork and deteriorating mechanics after a magical 2003 season. Bedard now finds himself in a similar position. Dr. Lewis Yocum won't be doing so much of an exploratory surgery as he will be checking to make sure there's nothing else going on in there. The "best case" scenario is that Bedard will miss six months, but a power pitcher post-labrum isn't often on the best case path. The more interesting thing here is that the tear might have been a cascade from his hip injury, suggesting a traumatic onset rather than the insidious wearing down that can happen with overuse. As we often don't know the true cause of any injury in the shoulder, it's impossible to tell how this will affect things. We just know that Bedard's not going to be tradeable this winter.

About halfway into the e-mail flood that happened last night, reader Bobby Mueller fired this one off to me: "I'm guessing you're getting flooded with questions about Ben Sheets. I don't have a question, I just thought I'd mention that anyone who has Sheets on a fantasy team and is freaking out about this should be reminded that we (I have him on two teams myself) got 196 innings with a 2.98 ERA and 13 wins from Sheets this year -- which is much more than we could have hoped for." It's small comfort for the Brewers. Sheets left after two innings with forearm tightness, a worrisome diagnosis. This could be anything from cramps to a flexor tendon and everything in between, but a post-game revelation that he's been playing with pain for nearly a month isn't a good sign. Neither is a "cutting sensation" that Sheets described. It's unclear if this is related in any way to his groin strain, or if that was cover for the elbow injury, but Sheets isn't ruling out a quick return, saying it's been "up and down" throughout the period he's been playing with it. The timing couldn't be worse for the Brewers, who need Sheets to make his next three scheduled starts, or for Sheets, who's on the cusp of free agency. This could force the team to move up the return of Yovani Gallardo, though he will be working out of the bullpen. After a sim game on Tuesday, Gallardo could join the team rather than throwing another sim game that had been scheduled for Friday. Gallardo will be more of a replacement for David Riske, who is schedule for elbow surgery to remove bone chips, and will take those high leverage late innings.

Word came from sources in Tampa that Crawford won't make it back for the final series as planned. At least, he won't be hitting at that point. There's some question about whether Crawford would be valuable enough as a pinch-runner and defensive replacement to be on the playoff roster, for which that last series would serve as an audition. I don't think anyone has any real question about Crawford's ability, least of all Joe Maddon and the Rays' front office, so an "audition" probably isn't necessary. Crawford could be sent to Instructional League for some at-bats if he were cleared, but there are a lot of questions about those last couple spots on the Rays roster. With B.J. Upton still out, and Crawford in question, multi-position players such as Ben Zobrist, Willy Aybar and Eric Hinske become even more valuable.

The Rays will also be without Riggans for the rest of the season, including playoffs. Riggans had surgery to remove an infected bursa sac in his knee. It's the same procedure undergone by Peyton Manning and Riggans has a similar four-to-six week recovery period that just won't have him ready for even late October.

Things aren't getting clearer in the bullpen either. One doctor I spoke to joked that Percival "has had enough epidurals so that he could give birth comfortably now." Percival's back problems aren't a laughing matter to him or the Rays as they try to hold on to the AL East and set up their bullpen for the playoffs. Another epidural this week is really about the last one he could safely have this season, according to an unofficial count. The Rays bullpen has options, but if they're going to shorten the pen for the playoffs, it will be interesting to see how they construct it out of a couple starters pushed back, some specialists, and guys like David Price who could be better than the other options.

You'd think with all these injuries that the team would be struggling, but no, they're not. Even with a number of name players out and the division long since clinched, the Angels just keep winning. They're 7-3 through the last 10, though two of those losses came against the White Sox, the one winning team they've faced in September. Good teams beat who you put in front of them, and despite the injuries the Angels' depth -- largely homegrown -- is doing enough to win. Of course, when the calendar flips, the team needs to not only have its best players healthy, they need to know who their best players are. Right now, it would seem that as many as four spots on the playoff roster are in doubt. With Vladimir Guerrero's chronically sore knees, Torii Hunter's ongoing problems with his quads and hamstrings, Howie Kendrick's current hamstring issues and Erick Aybar's hamstring strain ... oh yeah, you noticed the pattern, too? None of these should hold any of the players out into the playoffs, but with Guerrero and Kendrick, their fragility has to be considered when filling out the roster. The biggest question mark in the bunch is Kendrick, who had a setback during his rehab and is now not expected back before the final week, if then.

Just nine days since having an ORIF (open reduction, internal fixation) procedure -- one you and I would call having a screw inserted in the wrist -- Quentin has his cast off. That's a pretty good sign, but it's still quite a ways from swinging a bat in anger. The White Sox will be watching closely as Herm Schneider works his rehab magic. While this is a good step, it's still unlikely that Quentin will be ready for the Division Series and even the LCS will be a challenge. Ozzie Guillen is using the last couple weeks of the season as something of a tryout for Quentin's roster spot, costing Nick Swisher some playing time.

People don't whisper about Larry Bowa; they love him or hate him. I won't say which I heard from tonight, but there are some who blame Bowa for Nomar Garciaparra's injury. I haven't seen the play, so I can't vouch for this, but evidently Bowa put a very late stop sign up for Garciaparra, who tried to stop quickly and ended up having his left knee collapse. It's the same knee he injured back in late July, so if he's re-injured the MCL that he'd previously sprained, he could be out for the rest of the regular season. Garciaparra is going to try to play through this, but it's clear that he's 'on the edge' of function. He can play with it braced, but it will certainly make things tougher for him in the field. With Rafael Furcal on the way back, Garciaparra could find himself left off the playoff roster altogether.

Carpenter is done for the season, one that barely got started, but there hasn't been a whole lot on the why. Carpenter is reportedly out with "nerve issues", though the team is clear that it is not a recurrence of the ulnar neuritis that caused quite a scare last spring. There's some rumors, which I could not confirm that the problem is in his shoulder, but given the symptoms we know - weakness and an inability to recover -- it would suggest that it may be a problem in the brachial plexus, a bunch of nerves in the shoulder. Called "plexitis," this is a very uncommon condition and is often mistaken for a cervical problem due to similar symptomology. The most worrisome symptom of plexitis is that it can cause weakness in the deltoid that can lead to subluxations of the humerus. A humeral subluxation can lead to labral tears, something you don't want in your ace. While I admit that I'm speculating here, it's based on a conversation with two physical therapists with whom I regularly consult. One suggested the condition given the symptoms while the other concurred when asked. Add in that the Cardinals treatment plan appears to match up with plexitis and there's definitely some consideration that has to be given here, especially if you're making keeper decisions. The upside here is that it's usually treatable without extraordinary measures.

While newspapers seem to be curling up and yellowing like last week's news itself, creative (but poorly designed) outlets like WEEI.com are doing more and getting results. (I can't wait to see what justification the BBWAA uses on this one.) Rob Bradford got the scoop on Lowell, who's been battling a torn acetabular labrum. The hip injury is bothersome and irritating, but doesn't reach the point of pain much. It is something that will necessitate an eventual surgical fix, but he's playing through it pretty well, and even popped a home run in a big win against the Rays. It's another management situation for the Red Sox medical staff, one they've been dealing with all season long. Somehow, they've managed to hold things together enough to keep the team in the race. The zero DXL here doesn't so much indicate that he won't miss time -- he was out of the lineup on Thursday -- but that he'll be hit and miss with Terry Francona buying him rest with the flexible roster through the last two weeks of the season.

By the sheer volume of e-mails, I think everyone not in the path of Hurricane Ike was watching Lincecum's pitch count. There was an interesting internal discussion about the value of a shutout, Lincecum's long-term health and his general Freakness. Let's look at the facts: Lincecum threw 138 pitches, an average of just over 15 per inning. His high for the game was 22, in the first inning. He was coming off a 127-pitch game and had a 132-pitch game three starts ago. He followed that high-count outing with a 92-pitch game where his effectiveness was down, but came right back with the aforementioned effective 127 -itch game. He lived at 92/93 on his fastball all game and didn't appear to be "reaching back" in later innings. In fact, it seems that he was "pitching to contact" and trying to go for quick outs rather than strikeouts in later innings. While I'm not big on the value of a shutout, I'm not sure that Lincecum was taxed by this. Just after the game, I wondered if the Giants might be thinking of shutting him down and that's still not the worst idea, especially given that Brandon Webb's 21st win likely takes Lincecum out of the Cy Young running. All that said, I completely agree with Gary Huckabay. There was no reason to do this. There's a giant difference between "could" and "should"; apparently Bruce Bochy doesn't understand this. Worse, he followed up this high count game with a 118-pitch complete game on Thursday.

I told you Zambrano would be helped by the extra day's rest. I had no idea that a no-hitter would be coming. He dominated the Astros in Milwaukee -- now there's an odd sentence, completing the game in 110 pitches. He was clearly refreshed by the time off and perhaps by the cortisone in his shoulder, throwing 95 in the first inning and getting as high as 97, via Gameday. Of course, the key was that his elbow was higher. On most pitches, it was right at the level of his shoulder and didn't dip as low as previous. He was very consistent to the naked eye, so I'll be interested to see if PFX agrees. The worry is that, as before, he'll come off the DL rested and relatively pain-free, then slowly the inflammation will work its way back in. If the Cubs medical staff can get him through the playoffs before that happens, they'll deal with the consequences. The 110 pitches, in context, is tough to figure. He was cruising and 110 isn't that high for Zambrano in normal circumstances. These aren't normal circumstances however, so I'd have liked to have seen more caution. His next start will be the tell. I'm also relatively sure that he threw the first no-hitter ever thrown in the first game off the DL. Even Baseball Reference doesn't have that!

Edinson Volquez has lost much of his control as he's fatigued. You fill in the blank ... Eric Patterson is done for the year with a strained hamstring ... Rod Barajas is done for the year after suffering a severely strained hamstring ... Shawn Marcum is headed to see Dr. James Andrews after an MRI showed elbow issues ... Justin Duchscherer could be back for a start this week ... Anthony Reyes has been shut down by the Indians ... This column may be written by me, but there's a lot of people that help behind the scenes, so with just a week left, I want to thank Bil Burke, Rodrigo Pereira, Chase Gherrity, Jeff Erickson and the Rotowire crew, and Trace Longo. This column might happen without them, but it wouldn't be as good.