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Under The Knife: Giants' pitchers find path to health others covet


While we often focus on failures in injury management, let's talk about a success.

The Giants have two of the best starters in the game in Tim Lincecum and Matt Cain. That's no secret, but both starters are young power pitchers that hit the majors early in their career. Lincecum and his funky delivery get most of the attention and scrutiny, but Cain has been as good, as dominant and as durable. Because Cain didn't come as "fully formed," there's more to learn from him as well.

Cain's inning progression is amazing. After a short season in Arizona as a 17-year old, Cain put up 74 innings in low-A the following year. This is an interesting note, since he made only 14 starts -- was this an innings limit or plan by the Giants? He then made a huge jump, pitching 158 innings across high-A and AA, at age-19. By the time he was 20, he put in a full season at AAA Fresno before being called up, for a total of 191 innings. Every year since then, in his age-21 through 25 seasons, Cain pitched 190 innings or more. Normally, this many innings below the injury nexus would be prelude to disaster, but Cain's done nothing but get better, showing no signs of any wear and tear.

Cain doesn't have a special delivery, a secret workout, or any discernible difference than hundreds of other pitchers, aside from his health and results. I don't know why Cain is both healthy and dominant at such a young age. I do wonder if the Giants know. Given the results across their organization and examples like Madison Bumgarner, Zack Wheeler and Eric Surkamp, there are indications that they do. That makes Giants pitching coach Dave Righetti and minor league pitching coordinator Bert Bradley two very interesting characters in game that is trying to figure out why guys like Stephen Strasburg, Daisuke Matsuzaka and Joba Chamberlain are all out.

Powered by EcoFlame, on to the injuries:

So much for the "Joba Rules." Chamberlain came out of last Monday's game with some sort of elbow injury, it really didn't look that bad. Despite limited panic out of Yankeeland up to the announcement on Thursday afternoon, it seemed to be hidden behind the drama and pageantry of a Yankees-Red Sox series, along with Derek Jeter's continued quest for 3,000 hits.

Chamberlain is said to have a "near complete" tear of his UCL and will need Tommy John surgery. The video and PitchFX logs gave no indication of a problem. Chamberlain was showing all his pitches and good velocity, up to 94. News that came afterwards said he was in some pain, but the thought was that it was a strained flexor muscle. MRIs showed, however, that the UCL was torn. The tearing of a UCL isn't always sudden and isn't normally a significant pain, especially in insidious cases like this appears. (I actually discussed this in more detail yesterday after a discussion got too involved for Twitter's 140 character limit.) Chamberlain likely will miss the next 9-12 months before returning. It's these kind of cases and our inability to prevent them that has me so intrigued by my next book.

"It's like a needle with a camera on it." Pedroia's not a doctor, but he gave a pretty good explanation of what he was scheduled to have done on Thursday afternoon. MRIs are brilliant tools, but they're not the clearest thing in the world. Even highly trained radiologists can differ in their opinions of what they see (or don't see) on the same MRI. That leaves doctors, Pedroia and the Red Sox wondering ... but they don't have to. What Pedroia described was a needle arthroscope, which is exactly what it sounds like. It's a needle with a camera on it, using microelectronics and fiber optics to make it possible to look into Pedroia's knee with a minimum of invasiveness. Surprisingly, it's not a commonly used tool in sports medicine. One orthopaedist I spoke with said he doesn't like the response to it, which usually is significant swelling as the body deals with the trauma of being jabbed and poked, and that the response isn't worth the small gain in certainty. "I use it if I'm 99 percent sure that we'll need to scope a knee or shoulder and the patient or employer needs 100 percent certainty," he told me.

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Pedroia has had good speed this year, but bad power, which tells us what he's having issues with. He can run in straight lines, but anything rotational is having some issues. That points directly to some kind of meniscus issue, which can be cleared up with a scope and a month or so of healing. Whether Pedroia has surgery or not depends on your definition of the term. The insertion of a needle arthroscope could be, by most definitions, considered surgery, but the worry is that this will show that Pedroia needs more extensive, but still minor, surgery.

Alas, late word is that Pedroia has a bone bruise on his kneecap, so that's a very positive sign. It's very unclear what was done to find this, but there's no sign there was a needle scoping performed. Pedroia should be back in the Sox lineup by the weekend.

We're still waiting on the official word about Anderson. The A's were busy firing their manager, after all, and it's not like it's a quick flight between Oakland and Birmingham. The A's will go with another young pitcher, Graham Godfrey, in the interim, but this could end up being a longer sting for Godfrey. He'll need to make at least a pair of starts; beyond that, the team will need to hope that Tyson Ross heals. If Anderson comes back at the minimum, things would get better, but that's a small possibility. If there's any positive, it's that there's not a strong indication that Anderson has a significant elbow issue. It's more that he's had a series of them, which could be the insidious onset or it could be something that could be arrested. New head trainer Nick Paparesta has a solid working relationship with the Andrews organization, as do the Athletics.

The Twins have had Mauer working at catcher in XST, but several people seem to think that Mauer could be ready to come back as soon as Tuesday. Mauer is on the 60-day DL, and Tuesday would be the first day he's eligible. Ron Gardenhire publicly said what the Twins have been saying quietly for the past couple days, that Mauer would need more innings at catcher. That pushes him out further, closer to the 20-day limit on rehab stints. Mauer will be asked to catch at least four days a week when he returns, and until Gardenhire -- and yes, he appears to be the decision-maker on this -- feels comfortable that Mauer can do that without needing to carry an extra catcher, Gardenhire's willing to roll with what he's got. One AL scout I spoke with thought that Gardenhire is "a bit too comfortable" in his situation, that he feels no pressure to make any sort of quick move despite the poor record. "He's Bobby Cox now," the scout said. "He can blame all this on injuries and bad luck and know his job is safe." It's not just Mauer that the Twins are dragging their feet on. Tsuyoshi Nishioka has looked good in Fort Myers and Joe Nathan's been solid in his work down there as well.

The Pirates are pushing for 500 and for the first time in a long time, but things aren't all positive for them, as some injuries have them reeling. Alvarez remains out with a quad strain. He had a setback in his rehab and isn't ready to start XST games. Given his below-expectations play, the Pirates had hoped that he could straighten out his swing while rehabbing, getting a double boost for the second half. That will have to wait, and Alvarez might not be back until July.

Snyder is out as well, hitting the DL and heading for surgery on a herniated disc in his lower back. This is about as bad as it comes for the short term, especially for a stocky catcher with an injury history. We'll have to wait and see how extensive the surgery is, but seeing him lost for the season wouldn't be a surprise. The Pirates have some catcher depth, but it's not top-line talent. The Pirates seem a bit down on former first rounder Tony Sanchez, who had some off-field issues last month while in AA Altoona. He's going to have to come into the conversation quickly if Snyder's out for the season.

The Cardinals have forced Tony La Russa to mix and match all season. Craig is one of the position-flexible players that has allowed him to do that, but he's also been one of the injury-affected players that has required the flexibility. Craig made a run for a catch and ended up cutting his knee on some part of the wall. He needed stitches to close the gash, so he'll need some time to make sure that heals up. It's unlikely that he'll need the DL, but given the Cards roster situation, a lot of things are possible that wouldn't normally be considered.

Rauch has always been a bit injury prone, but he's also got a gift for being in the right place at the right time. The combination of the two define his career as a journeyman Plan B. He's locked in as the closer right now for the Jays, surrounded by a bunch of guys who can't quite take the job. A strained lat was thought to be a worry, but the Jays staff doesn't think it will be. I'm going to straddle the line and think that John Farrell will try to roll with Rauch until he proves that the injury is a problem. If he stays relatively effective, he'll keep the job. This is a bit of an opportunity for Frank Francisco, but fantasy players shouldn't get too excited here.

Baseball hasn't gotten too unlucky, but I'm sure Verlander's heart skipped a beat as the ball came flying back at him. It ended up hitting him on the inner thigh, which couldn't be comfortable. No word on whether Verlander is an Adrian Beltre-style freedom advocate, but I hope not. Verlander was able to stay in the game after the play, but as the bruise developed, he tightened up. It's one of those things that progresses, but the Tigers medical staff has been working on it since Saturday and he was able to take the ball as scheduled on Thursday.

This is amazing stuff. It might take a while to absorb all this ... Brian Roberts is still experiencing post-concussive symptoms. There's no chance he's back before July ... Alfonso Soriano will start a rehab assignment this weekend and should be back in the middle of next week ... Jarrod Saltalamacchia was hospitalized to check for appendicitis. Looks like it was just a nasty flu or virus ... No matter how you pronounce it, it's a bad day for Lowries. Jed Lowrie is out with a shoulder injury that is thought to be minor, while Brett will miss a month with a broken hand, delaying his major league debut ... Barry Zito will make another start this weekend at A-ball, but it looks like he'll be back in late June for the Giants. He could be put in the bullpen, so watch out if you're looking to fill in a starter slot ... Aroldis Chapman didn't last an inning in his first rehab outing, giving up three runs. Dusty Baker said he would need four rehab appearances, which indicates he could be back at the start of next week ... Rich Hill and Daisuke Matsuzaka will both have Tommy John surgery this week. Hill will have his done by Dr. James Andrews while Matsuzaka will go with Dr. Lewis Yocum ... If you're in New York City next Friday and you'd like to hang out with me, Joe Sheehan, MLB's Fantasy 411 crew, and more, come to Foley's. We did it a couple years back on my birthday and what I remember was a great time. Follow me on Twitter for more details.