Under The Knife: MLB should welcome publicity of negative tests

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There's a little known provision in baseball's drug testing protocols that is important for people to know about. It's a simple thing called "for-cause testing" and is exactly what it sounds like. If a team -- any team -- has reasonable cause to suspect that a player is using any banned or illegal substance, they can ask an Independent Administrator to test that player. According to MLB, a mere statistical anomaly would not be enough to proceed with testing, though it appears that it could be one factor in determining a for-cause test. The test would be handled in the same way as all the other random tests, unless there was specific knowledge of a substance being used. The for-cause testing has been in place longer than the modern Joint Drug Agreement, reaching back to the limited for-cause testing instituted for "recreational drugs" in light of the early-80s cocaine scandals. While MLB would not confirm or deny, there is no evidence that a for-cause test has ever taken place. I asked an AL executive about the process and he told me he had no interest in it.

"Even if we had something on someone, I'm not sure we'd do anything. First, the normal program is working and working well. Second, no one wants this to end up a game. If a team found out another team petitioned for extra testing, what's to stop them from doing the same to our guy? Nothing. I can come up with all kinds of rivalry scenarios -- Red Sox and Yankees -- where it would end up being, very literally, a pissing contest."

I got the chance to talk about this with Dr. Gary Wadler, one of the leading voices in the anti-doping community, which will be up on SI Inside Fantasy soon, but it comes down to one question:

If we instituted testing to prove innocence, but guilt is still assumed, what more, if anything, can we do?

There's not a good answer. Even a daily regimen of testing for Jose Bautista, Raul Ibanez, or whoever the next steroids suspect is, is not going to satisfy some people. I'm not ready to say "throw out testing" the way some are, but I will suggest that baseball should publicize negative tests. On the player page at MLB.com, the league could simply add a section and put up the dates where a player was tested with a negative result. Obviously, positive results are going to be newsworthy and deserve their own notice, but right now, negative tests -- the vast majority of drug tests -- are invisible to the general public. I can't see why anyone would oppose this, but I'd love to hear your thoughts, so e-mail or tweet.

Powered by SI Inside Fantasy, on to the injuries:

Sometimes, my inbox and Twitter feed explodes. That's fine, because I love injuries. I don't wish them on anyone and work hard to make sure people understand that many of them can be prevented, but when they happen, I'm here for you. Red Sox fans are a passionate bunch, so even when it's a minor injury, caused by a hard-charging guy tripping over his own feet, there's a reaction. Pedroia essentially kicked himself in the heel, rotating the ankle over as the weight was on the ball of that foot. This was neither an inversion or eversion, which is the rolling of the ankle in either direction when "flat footed." That was a bit of a positive for Pedroia, though with a bit more force, Pedroia would have been looking at a high ankle sprain, which is what would have taken the brunt of the force. It's unknown whether Pedroia had any sort of ankle bracing, but I'm guessing he will next time he's out there. While it appears he escaped a freakish injury, the Sox had Pedroia out of the lineup on Tuesday, but the team had said it was a planned day off anyway. We'll have to see if he's back out there in the next game or if this will take a couple more days. The DL isn't likely.

Titanium screw? The news that Garza did not want to have an MRI due to the presence of a titanium screw in his pitching elbow sent many -- including me -- scrambling for more info.

First, it's a bit of a surprise that he has a screw in his elbow. I dove into Yojimbo, checking my notes from a discussion I had with Garza on the field at Tropicana a couple years back. Garza told me that his ulnar collateral ligament was "stronger than it should be" due to a childhood accident. The UCL had a "layer of scar on it, like a jacket," he said. This is not uncommon, though it is uncommon in pitchers. While the scarred ligament is stronger, it's also less flexible. Since UCL sprains are often undiagnosed in youth, especially when associated with a common traumatic forearm fracture, this wouldn't be that surprising to find. While Garza declined to offer any details on the accident, common things like falling off a bike or skateboard could result in the "right" kind of fracture. As for the MRI, a titanium screw wouldn't be a real issue. Titanium is used in many medical applications because of it's strength, resistance to corrosion, and it's low magnetism. According to one radiologist I spoke with, titanium "seldom heats up or causes any issue in MRIs."

In declining the MRI, Garza also said his problems are weather related. While he did avoid the problem in Tampa, there are plenty of games like this one in Boston last year, in which he had to deal with cooler conditions. The Cubs didn't believe that Garza would be able to return in time for his next start, so they placed him on the DL. They do think that he'll be able to get back at or near the minimum.

Facial fractures are both scary and tough to deal with. Beyond the aesthetic and psychological issues, the bones are small, and while strong, also a bit fragile and interconnected. Byrd avoided the worst case scenario, a blowout fracture, but will need to have the area protected while it heals if he hopes to avoid surgery. Like any fracture, monitoring the progress is easy to do, but it won't be enough to just give Byrd a mask and send him back out there. The shaking that the bones take with simple activities like running would be enough to cause issues, so this will be an extended stay on the DL for Byrd. The ERD of Aug. 1 is a pure guess at this stage, based only on generalities. We'll know more in a few weeks. (Note: the term "fractured eye" is clearly not the correct technical term for the injury, but my database doesn't have a "face" option for body part. I felt "eye" is more correct than "jaw".)

He's not Bautista, but in ways, De La Rosa is a bit like the pitching version of Bautista. He was a guy talented enough to get multiple looks who finally put things together after his stuff clicked with a coach's instructions. The difference for De La Rosa has been that he hasn't been able to stay healthy enough to prove that his solid season wasn't a fluke. De La Rosa left Tuesday's start with what initially looked like a recurrence of his blister issues, but the news was much worse. De La Rosa has a complete tear of his UCL, necessitating an elbow reconstruction (Tommy John surgery.) It's tough to say whether this was a buildup to a breakdown, or if any of the small things built up in a "snowball cascade." The result is the same, the loss of a year of his career and a long rehab. De La Rosa has to be dropped in all formats while we wish him the best.

There's some controversy about Matsuzaka and the possibility that he will need Tommy John surgery. The Red Sox do not believe he will need it, but let's remember that any sprain is a tearing of a ligament. With the UCL, the ligament replaced in Tommy John surgery, there's a level at which an incomplete tear still compromises the ligament enough to necessitate a replacement. For most doctors, that level is between 25 and 50 percent. Matsuzaka went back to Japan on "personal business", which some are whispering includes a visit to a Japanese doctor. Matsuzaka is supposed to see Dr. Lewis Yocum on his way back across the Pacific. The likely path here is that Matsuzaka continues the rehab in hopes of avoiding surgery, but for many, this has a some deja vu to it. No matter the result, Matsuzaka is out through the All Star break and possibly longer.

Nishioka is making nice, normal and trackable progress as he returns from his fractured fibula. He's slightly behind the expected return date, but that's more a result of a deliberate schedule than any sort of setback or reflection on his healing. Recoveries come in ranges, so being in the back half of a range isn't bad, it's just not as good. Nishioka will start in XST and should move up quickly. One interesting thing is that he'll play SS, at least as first. A source told me that his comfort level is significantly higher at SS and that the team is toying with the idea of shifting him there permanently, keeping Michael Cuddyer at 2B. It's a defensible (if not defensive) move, one that has me scratching my head a bit. It's not that I don't like this move. I do. I just wonder why the Twins are willing to be so flexible and "out of the box" in this situation, but are seemingly inflexible with Joe Mauer. Is it possible that the Twins are taking the heat for Mauer here? Mauer has long said he wants to catch and sees his value there. We'll have to see once the Twins get their expected team back sometime in June.

The Reds sent Volquez back to the minors to ... well, it's not real clear what's going on. Volquez has a problem with the first inning, which isn't uncommon for many pitchers, something that likely goes back as long as there have been pitchers. Volquez has such good movement that one pitching coach I know speculated that it took him an inning to get a feel for what he has, helping him locate the corners. A quick look at Pitch FX shows how much Volquez seems to leave pitches over the plate in the first inning, but that same data set also shows that the movement tends to be consistent. If he's just "getting a feel", why does it take an inning, many will ask. No matter how much they try, grounds crews can't get mounds identical, nor will all the conditions be the same. Someday, we'll have physiological data like heart rate, and I guarantee we'll see huge swings from pen to mound and from inning to inning. For now, Volquez is left to try and correct something that might not be correctable. Let's be clear -- this has nothing to do with his return from Tommy John surgery. Volquez was like this prior to his surgery as well. Suggestions that this is some "mini-Blass" episode just don't fly either.

I don't often get accused of East Coast bias, since I live in Indianapolis, but hey, it happens. News comes in later from the West Coast, and while I don't sleep much, the news that Sandoval took batting practice on Monday didn't get to me in time to make Monday's column. Sandoval's rehab from his wrist surgery is precisely on track, with no issues up to this point. Sandoval is still at least 10 days away from a return, but progress is always good. With Mark De Rosa out, the Giants will be pressed to push Sandoval back quickly, but it seems they're taking a longer term view. That's smart and one of the reasons they've ranked so highly in training staff ratings over the last decade.

One of the things that has been reported regarding the need for Morales to have a second surgery is a cryptic phrase -- "needed for later life." We don't often see that, but it is a consideration for every player. If you or I tore our UCL, we wouldn't need Tommy John surgery. Ankles are very different, and with Morales' situation, sources tell me the second procedure was necessary. Morales reportedly needed surgery to clean out the ankle due to necrosis, which is dead tissue. While it was not clear how advanced this situation was, getting it taken care of is needed not just for later life, but if he's going to come back to baseball. I don't mean to compare the two, but it was a vascular necrosis of the hip that all but ended Bo Jackson's athletic career. Losing two years of a short baseball career to a freak accident is bad enough. Let's hope that Morales' surgery makes it so he doesn't have to be reminded of it on every step for the rest of his life.

John Lackey's bullpen session went well enough that the Sox scheduled a rehab assignment for May 31. If that goes well, he'll likely be right back in the rotation ... Andrew Bailey is looking great in rehab and with the controversy around Brian Fuentes, he could be right back in the closer role by the weekend ... The Sox think Bobby Jenks will be back in their bullpen starting next week. No word on whether he'll head on a short rehab before then or not ... Bronson Arroyo is headed back to Cincinnati ahead of the team. An MRI on his back came back clean and he's expected to make his next start ... Kevin Slowey is getting a second opinion regarding his abdominal issue. While he's getting a second opinion, the Twins are making their second and third calls to teams trying to trade Slowey away ... Adam LaRoche has a significant labrum tear as well as some rotator cuff damage. If he was a pitcher, he'd be shut down and headed for surgery. He's not, so the Nats will wait a couple weeks before making a decision on season-ending surgery ... Scott Kazmir was lousy in his rehab start at Salt Lake, giving up six runs in 1 T! innings. Worse, his control was lousy and his velocity was off. "There's no positives to take away," said one person in attendance ... Jason Bay left Tuesday's game with a calf strain. No word on what percentage of a player Fred Wilpon thought he was after the injury ... I don't have full details yet, but if you're in New York City, I'm going to be there in mid-June. I don't know if I can take a get-together at Foley's, but it's very possible. If we do it, you're invited.