Under The Knife: Giants' staff tested in World Series hangover

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One of the worries for any team coming off a World Series is the extra workload and the reduced rest. That usually affects pitchers in what's known as the "playoff hangover" among medheads, but the Giants' top-rated medical staff seems to have handled that, or at least allowed their workhorse staff to power through it. (Tim Lincecum and Matt Cain appear to be exceptions.) The Giants have plenty of short-term issues that they have to deal with right now.

Beltran was thought to be a risk switching teams because of his chronic knee problems, but instead it's a hand/wrist injury that's lingering and keeping him from swinging a bat. Sources tell me that this is similar, but not identical to what Carlos Gonzalez went through. Since the pain and symptoms are a moving target, it's harder for the medical staff to get a fix on what's working and what's not. They'll push him to the DL to try to get a handle on this, including some more aggressive tactics. It's a retro move, so he could be back as soon as the Aug. 24, but I'm going to put the ERD at the end of the month since there doesn't seem to have been much progress over the last week.

Sandoval escaped with just a bruise on his foot after fouling a ball off his foot. X-rays were negative and he returned to the lineup on Tuesday. They'll keep a close watch.

Things aren't as easy on the pitching side. Sources tell me that Romo has bone chips in his pitching elbow. If he has to have surgery, he's out for six weeks, which puts it deep into the playoffs before he'd be back. The Giants' bullpen might be seeing something of that hangover, but Romo's going to try to pitch through it, which is possible, but painful. The Giants medical staff will spend the next few days doing everything they can to avoid losing him for the stretch run.

Things got worse on Tuesday as Sanchez sprained his ankle. He was seen on crutches after the game. Late word is that he'll need more images done, but the team is very concerned about having both him and Barry Zito out, putting more pressure on the new top three of Lincecum, Cain, and Madison Bumgarner, without much else.

The Phillies did the smart thing with Hamels. Not only did they skip his next start -- easy with their upcoming schedule -- but they also sent him for an MRI. The results showed "no structural damage" but there was some inflammation near his rotator cuff. In other words, it looks like an early warning that he was about to have a serious issue. They'll need to get it calmed down and address anything that might be an issue mechanically or physically that they can, but for now, things look as good as they can. It's this kind of work that puts the Phillies medical staff at the top of so many lists. How important is Hamels? The Phillies are locked in to the playoffs, but once they get there, Hamels is very valuable. Matt Swartz, one of the smart guys over at Fangraphs, estimated that Hamels could shift the odds of the Phillies winning the World Series about six percent, from 27 percent down to 20 percent. Swartz is a Phillies fan and admits that the Vegas odds seem a bit high, but if you move the Phillies down to a 20 percent line, Hamels being out would shift it more to 14 percent. That's big, even as "just" the SP3.

It surprised me to find out Pierzynski had never been on the DL. First, he's a catcher. Second, I figured someone would have put a spike in him along the way. Pierzynski is well liked among his teammates, but he's a mouthy one who doesn't inspire much goodwill, especially in the AL Central. It was a pitch that hit him on the wrist -- unintentionally, mind you -- that broke one of the small bones of the wrist. There's a chance that Pierzynski could return this year, but the standings will tell whether or not it will happen, plus it gives the Sox a chance to get an extended look at Tyler Flowers, a player who has been their "future" for a couple years now. Pierzynski isn't the type to shut things down, so I'd expect him back, maybe around mid-month if the Sox still have a chance. Pierzynski has one more year, but the Sox would like that to be as a backup.

In some situations, teams can take on risk and manage it, as the Rangers have done the last couple seasons. While it won't put any trophies on amie Reed's shelf, he'd rather have the ring they came close to winning last season. He's managed ... oh wait, you know Reed is the Rangers' Head Athletic Trainer, right? ... all of the injuries and physical issues that the Rangers have dealt with, from sore arms to broken arms and kept the team in position. It's not all Reed, but he deserves as much credit as most.

Now the Rangers are dealing with the latest muscle strain for the injury-prone Cruz, an extended hamstring strain for Beltre, and managing the shoulder of Feliz. Cruz's latest issue is minor and will cost him time, but not much. The team is used to this and manages him with depth in the OF/DH slot. Beltre's a little more worrisome. His re-strain of his hamstring not only took him back to square one, but did more damage. Beltre is now on track for an early September return, but the standings will be watched closely and Beltre will get extra rest before and after his return, which will affect his fantasy value. Feliz is coming through a period where he lost effectiveness. Sources tell me that fatigue is at least a part of it. Feliz has been monitored closely not only for his usage, but for the times he warms up. Bullpen guys call a situation where they warm up but don't get into the game a "dry hump" -- I'll let you work out the etymology -- but it is a major factor in fatigue. With Koji Uehara and Mike Adams in front, Feliz is still a key part of what the Rangers hope will be another World Series team. His workload will be closely monitored.

Quietly, Johan Santana is restarting his rehab. We'll know pretty soon, maybe by this time next week, whether he'll be able to pitch at all this season for the Mets ... Chipper Jones is having more trouble with his repaired knee. He'll be given rest when possible through the playoffs ... Steven Strasburg hit 99 on the gun while dominating Single-A hitters again. Yep, he's clearly being rushed back ... David Ortiz's heel issue will have him in a walking boot, but the Sox don't think he'll end up on the DL ... Edwin Jackson is expected to make his next start. He left his last one with a hamstring issue, but the Cards are saying it was cramping rather than a strain ... Bronson Arroyo made it through a bullpen session, but his Achilles issue still worries me (and the Reds) ... Jon Rauch's appendectomy will take him out for at least three weeks, with the Jays bullpen filling in with its normal mix of options ... The Jays also lost Rajai Davis for the season with his significant hamstring tear ... Chris Davis is heading to see Dr. Yocum to determine whether a tear in his shoulder will need surgery. Either way, the O's don't think Davis will be back this season ... Conor Jackson is out indefinitely after a cortisone injection for his neck problem. It does give the A's a look at Brandon Allen as well ... I saw Devin Mesoraco for the first time this season. He doesn't look like much of a player, but Scott McCauley says he's gassed ... Danny Duffy also looks gassed, as the Yankees beat him up on Tuesday. He's near his overall innings peak, so he's a Verducci Effect guy unless the Royals rein him in.