Under The Knife: Rehab for Pujols could last longer than expected

As we continue to learn more about the Pujols injury, I wanted to know more about how these types of injuries go. Moving beyond comparables and speculation, I asked Dr. Ralph Gambardella, one of the top surgeons in sports, about this type of injury. While Dr. Gambardella hasn't treated Pujols, he does have extensive experience with this type of injury and understands the demands on a player like this. "A non-displaced fracture means a crack in the bone, but the two pieces have not moved, so there is no gap. The healing time is likely a minimum of four to six weeks," he said. That matches up with what we've heard so far, but here's the key: "There will always be some soft tissue swelling, but it could be minimal if it did not bleed much as there was no gap from the fracture. The mechanism is still usually a direct hit to the bone, usually on the dorsal or 'backside,' where there is not any fat or muscle protection and the bone is close to the skin surface."

That's a different mechanism than what we saw, though it is difficult to tell the exact position of the hand in the collision. Dr. Gambardella continued, "The wrist joint may swell some 'in sympathy' for the bone that was injured. Also, if the crack goes into the joint then there is usually more swelling. In addition, if the crack goes into the joint (the wrist) then there could be associated ligament injury to the ligaments of the small bones in the wrist. This will prolong healing time to up to eight weeks."

It's that last part, the possibility of a concurrent sprain, that's the most important thing in Pujols' return prognosis. We'll likely only know this in retrospect, if Pujols' rehab goes long or if we see a significant loss of power on his return.

If you heard GM John Mozeliak speak about Pujols, you heard a bit of depression in his voice. There was a lot more positivity when he spoke about Freese, who's beginning a rehab assignment at Memphis. He'll need about a week to get some swings and work, but the broken hand shouldn't be much of a problem. Watch his minor league stats for bat control stats -- a good K/BB ratio and some power when he does connect. Freese has shown pretty much every skill except staying healthy, something the Cards really need him to do in the second half as they try to stay atop the division despite all the challenges their roster has presented.

The rehab for Chapman on his second time to the DL this season has been a bit slower, a bit more conservative. The recurrence of his shoulder problems showed that something was wrong, but here's the interesting thing: they didn't fix it and, in fact, he might be exacerbating the problem. Unlike many pitchers on rehab, the Reds aren't "starting" Chapman, letting Homer Bailey take the starts and bringing in Chapman. The Reds did, however, target the inning and gave Chapman a lot of time to warm up, I'm told. In the press box before Tuesday's rainout, I was talking with a couple of Reds writers and mentioned the situation with Chapman's lengthy warm ups. "He didn't have them when he was throwing lights out," one said. I dug back through the archives and there wasn't any mention of Chapman's routine or limitations beyond the obvious ones that Dusty Baker and Bryan Price used to protect their flamethrower. The thought is that Chapman will come off the DL and be optioned to Louisville to keep working on things.

Cueto doesn't have much to work on these days. The Reds ace does have a pain in his neck that trainer Paul Lessard and his staff will need to work on. They got an extra day with the rainout, but word from those around the Reds is that this is pretty straightforward. Cueto got a sore neck on a flight home, so maybe Mr. Castellini can chip in for some of those neck pillows from Brookstone next time they head west. Cueto would have made his start on Tuesday, but will no go on Wednesday.

The Yankees are still a hurting bunch, but things are getting a bit better. Early indications on Jeter -- who had been feeling the calf he ended up straining tighten up for a couple days before the injury -- are that he could be ready to come off the DL at the minimum. That's Jeter's hope, for sure, but remember what I said about the bilateral strength? He'll have to give the Yankees the objective numbers as well as the subjective desire, so don't count on that date until we get a bit closer. Jeter has started baseball activities down in Tampa while the team is on the road.

Hughes will move from Staten Island to Trenton after his successful first start. It was actually more than successful, with one Yanks official calling it "blow out, perfect, everything we wanted." The velocity is the key, with many watching to see if he looks good in his side session, proof that he's fine on normal rest and not just with several weeks of rest. Hughes will likely make at least two more starts, one at AA Trenton and another at AAA Scranton, before coming back to the Bronx. The Yankees are focused on his recovery as much as velocity, so don't get too excited about radar readings.

Finally, the Yankees don't think Colon will be back at the minimum, as they'd once hoped. He's just begun throwing again so it's unlikely that he'd be ready at that stage. The team seems ready to let Brian Gordon continue his Jim Morris imitation for a while longer, as long as he stays effective and the offense supports weaker pitching.

If you listen to this week's SI Inside Fantasy -- and if not, what's your deal? -- you heard Eric Mack and I debating the merits of Miller ahead of his first start for the Red Sox. Eric's buying into his potential, believing that as a tall lefty, he's likely to be a late bloomer. For me, Miller is yet another guy who hasn't been able to turn his tools into production. Taller pitchers do have longer levers and the proprioception is a tougher learning curve to deal with, so there's something there. He was solid enough in his first start to get another, but I remain unconvinced. Miller's recovery has always been a major factor, but if the Sox have been able to figure that out as well as getting his mechanics sorted, they're on to something. Tall pitchers might end up being the next market inefficiency the Red Sox could exploit. There's certainly a lot of guys out there lying by the fantasy roadside if they've got something.

Josh Beckett will miss his Tuesday start with an illness. The Sox think he'll slot back in next turn ... Ryan Braun missed Monday's game with a respiratory infection. The team doesn't think he'll miss much time as he's been playing through it for the past few days ... Mike Stanton thinks he'll be back in the lineup on Wednesday. Watch to see if his connect rate is steady before putting him back in your lineup ... Tommy Hanson is saying all the right things about how his shoulder feels, but we'll learn more later this week when he gets back on a mound ... Chipper Jones came back from his groin strain to play a normal (for him) game. We'll see how it holds up and how he uses this against Jason Heyward ... Brandon League got hit in the calf with a comebacker, but shouldn't miss much time if any. He's lucky ... Early reports on Placido Polanco were that he does not have a broken finger. We'll see how much time, if any, he'll miss ... Orlando Hudson came off the DL and had a heck of a day in the Padres loss on Monday. Hudson showed no ill effects or rust coming off the DL ... Rich Harden had a solid rehab start at AAA Sacramento, going three hitless innings. If he can build some stamina and stay healthy, the A's could use him in the rotation and he's not a bad streaming option ... Talk about a heck of a pitching coach! ... I teased a couple things coming up on XM tonight with Casey Stern. We'll have a discussion of the Mets medical staff, a look at pitchers that will be running into innings issues later this season, and hopefully Dan Wade's amazing look at the effects of steroids soon.