Under The Knife: Injuries leave Reds, Royals scrambling for closers

We're deep into fantasy draft season and the injuries already have taken their toll. If you drafted early or sent in your keepers, there's a good chance you've already felt the bite of losing someone for some period of time. There's no surefire way to avoid injuries. By understanding risk profiles, it's easier to limit the effect of injuries. If you draft Chipper Jones, you'd better have a better than average corner infielder behind him with 3B eligibility. If you draft a young pitcher, you'll have to go one deeper than you planned to on starters. Simple, yes, but seldom done with discipline. There's a lot of ways to win in fantasy baseball, but the easiest way to lose is to get overrun with injuries without the proper roster. Powered by Dollar Shave Club, on to the injuries:

Madson will need an elbow reconstruction after it was found that he tore the UCL off the bone. That's a rare traumatic injury normally seen in hard throwers or those with "whip action" and a lack of pronation. It's bad enough that the Reds lose Madson for the season, but they'll also have to reconfigure their bullpen. Sean Marshall is the likely closer, but the Reds are also moving Aroldis Chapman back to the pen. It's unclear how Chapman will be used, since the "Chapman rules" really had Dusty Baker handcuffed as to usage. The normal usage for a setup man doesn't allow for things like only starting an inning and refraining from pitching on back-to-back days. With Madson out and the NL Central a tight race, something like this could be the difference. Madson has an $11 million option for next year, and with the injury, the Reds may have a tough decision on whether to keep him. They have an ace in the hole with Tim Kremchek's record and observation of his rehab.

(You'll note the new designation of "DFS", which stands for "done for season". It sounds like the racing term DNF, which I like, and is easier to understand for the new readers than the 10/3 end of season date.)

Closers are having a tough spring, with Madson out and Soria heading for Tommy John surgery as well. It will be his second, having had the surgery in 2003. The second isn't tougher, nor is it that much different. Still, at least one area where the tendon would be harvested is already gone. One team doctor I spoke with said he has seen some of his patients have an easier time with the rehab. "They've gone through it. They remember the process and usually they've seen good results." There are not enough people that have gone through two Tommy John operations to give any sort of significant results, but there are enough to say that the doctor I spoke with seems correct. Some have had three or even four surgeries! With more and more young pitchers having the operation in high school or college, we're bound to see more second reconstructions. It's not surprising, since few pitchers truly change what caused the first injury and so few have the data to make a smart change. Soria will be back next year, starting the clock on the third UCL he's had.

It feels like déjà vu a bit. Carpenter is out with a disc herniation that's identical in nature to the one I've spent the last nine months of my life discussing. The comp between Carpenter and Peyton Manning isn't perfect -- Manning isn't a pitcher -- but it does show that a good medical staff and diligent player can play through this for a long period of time. Carpenter's nerve irritation recurs with activity, so the week they shut him down shows that rest alone isn't going to get him back out there. The Cards will need to go with a more aggressive set of therapies and modalities, which likely will include massage, traction, anti-inflammatories and a laundry list of other possibilities. The treatment will get more aggressive as they try to avoid surgery, but the Cards are being very conservative with a timeline. They're more focused on getting him back and keeping him back than getting him back soon.

It's hard to be nonchalant about an injury to a key player, especially when a team has dealt with high profile injuries to pitchers the way the Nats have over the past couple seasons. Still, no one in Washington seems terribly concerned with Storen's elbow soreness. He's been more or less shut down for over three weeks and an MRI showed "no structural damage." That phrase can mean many things, but let's assume here that it means the UCL looked intact. The Nats seem to feel that rest will clear this up, but thus far, there's no evidence that it has. We have to assume that a minor inflammation would have been treated normally by this point. That leaves us where the Nats are, wondering if Storen can be ready for Opening Day. He would have to start throwing quickly, this week, to have any shot of showing he's ready for that. The Nats could DL him and let him miss the first few weeks, giving Brad Lidge the early opportunities, but the Nats are playing this season to win. They'll take this decision to the last second, so I'm left leaving a "TBD" on Storen. One other quick note -- Storen is from Indianapolis, and I was reminded by someone who watched him play in high school and travel ball that he's never had an injury that cost him time. While that's certainly a positive, it would also make it tougher for him to deal with. He's never had to describe pain/soreness or rehab anything. That could be a factor here.

The injury to Chamberlain has a wide range of possible outcomes. There's no good comparable here, though the injury is similar in nature to the one suffered by Stephen Drew last season. If there was little or no ligament damage and Chamberlain heals properly and quickly, a late summer return is possible. if the ankle remains unstable, his career is over. That's a lot of wiggle room and the uncertainty makes it impossible to make even an educated guess. The ankle injury won't affect his recovery from Tommy John surgery, aside from making it impossible to continue his normal throwing program. If the ankle heals properly, Chamberlain should be able to finish the final phase of his rehab quickly. It will be weeks before there's any indication on Chamberlain's timeline, but look for him being off crutches as the first sign.

For the second year, the conversion of Feliz to the rotation has hit a bump. Last time, it was need as much as results, but this time it's health that's entered the equation. Feliz missed a start with shoulder soreness, but word from the Rangers was that it was precautionary. He made his next turn, but the Rangers pushed him to the minor league field to do it. By playing him in the minor league games, the Rangers preserve the possibility of putting him on the DL retroactively, which can be done so long as he doesn't appear in a major league game. This would make it possible for him to come back as soon as April 10, but several reports say Feliz wasn't due to start until the 10th anyway, so the move may be moot. The Rangers hope that Feliz's stiffness was normal and that he'll be ready to go without the move. As he shifts from the pen, we'll have to look at signs like these closely. At this stage, things still look positive or short-term.

Howard's out of the boot. Things are progressing for the Phillies' first baseman as expected, with the wound and infection cleared up and Howard out of the boot. The Phillies aren't rushing things and will leave Howard behind in Clearwater. This is the MO of the Phillies time and again, as their rehab staff seems to work better "in the dark." Howard is already doing limited baseball activities, but hasn't truly tested the Achilles. The key, of course, will be hitting. Howard has been watching pitches in the cage, but could be a week to 10 days from actually swinging at any of them. Howard will hit by the end of camp, and then have another two weeks or so to focus on mobility. My May 1 date has always been predicated on him not needing much time in the minors to get up to speed. Seeing how Chase Utley's recovery was handled last year gives me confidence that Howard will be similar: slow, then all at once.

It's never good to be wrong, but sometimes I'm glad. Last week, I was given a piece of information that turned out to be incorrect. Utley was in Phoenix to see a well-known conditioning specialist, rather than a well-known orthopedic surgeon. Utley saw Brett Fischer, telling the press that he was given "new stretches" and that surgery wasn't an option at this point. (To be clear, Utley refuses to consider surgery because he says none of the options is 100 percent, a high bar to set.) These stretches and other maintenance work won't be able to fix the knees, but instead will focus on keeping everything else around the knee in condition to limit the damage. Utley insists that he'll be able to deal with the knee conditions the same way he did last season, with a lot of hard work and maintenance. We'll give him and the medical staff the benefit of the doubt here, since they did an amazing job last season. Utley will open the season on the DL. While it's not known exactly when he'll be back in Philly, looking at this like last season's situation is the smart play. I'm setting the ERD based on last year, but there's really no solid date yet.

Word leaked out that Jones tore his meniscus just minutes before the planned news conference that announced he'd retire after the 2012 season. The injury came during stretches, which tells us that Chipper's knees simply aren't going to hold together over the course of a season. Jones had his knee scoped and should be back in mid-April. Yes, mid-April. I misspoke when I was on MLB Network's Clubhouse Confidential on Monday, saying mid-May. I apologize for the error. Jones is an interesting case. He should be productive once healthy, but there's every reason to believe that he'll break down again. If you believe you can fairly value him based on an accurate assessment of his playing time, there's upside. My friends that put out the STEAMER projections do a great job of assessing playing time and have Jones at 515 plate appearances. Past studies they did indicate a red light should take off about 60 PAs, so putting Jones at around 450 is safe. (Even that sounds a bit high, but not unreasonably so.) Jones should be hitting by next week and could beat that ERD handily.

The Red Sox acknowledged the expected, saying Carl Crawford would stay behind in Ft. Myers when they head north. His wrist is still healing up after wrist surgery ... Miguel Cabrera should begin baseball activities this week. No decision has been made on how his eye will be protected, but glasses are the likely choice ... My observer at Saturday's Angels game told me that Kendrys Morales was moving without a discernible limp. The Angels did pinch run for him later, which gives some indication about where they think he is. I think he's a nice late round pick ... Jonathan Mayo had a nice article on Michael Pineda and his last outing. The "it's not easy" quote has me more worried, not less ... Ted Lilly's stiff neck is minor, but will cause Don Mattingly to shuffle his rotation a bit as he begins setting it up for Opening Day ... Corey Hart will begin playing games on Wednesday. He admits it's tight for making Opening Day, so watch to see if the Brewers DL him early in order for him to only miss a few regular season games. Putting him in minor league games only preserves that possibility ... Logan Morrison is feeling some soreness with activity, even after knee surgery. Sources tell me the Marlins are as confused by Morrison's responses as they are to the knee ... Brian Roberts will start the year on the DL. The question is will he end it there too. The Orioles simply have no idea ... Sergio Escalona will have his elbow rebuilt and will miss the season ... Mike Morse will begin throwing midweek. If it goes well, he'll be ready for the opener. Any setback will start him on the DL ... Reid Brignac is dealing with plantar fasciitis, but it's not the normal kind. Brignac's came on a traumatic injury, sustained on a play at 2B. He's made some improvement but PF is painful and tends to linger ... Hunger Games was solid, but had some very confusing decisions made by the cinematographer. The shaky handheld shots, especially at the start, were distracting to me ... It's called "normal soreness" with the knee, but any injury to Delmon Young, especially one that can further reduce his mobility, has to be watched. ... David Wright looked solid in early action as he returns from his ab strain. He looks like he'll be ready for opening day absent a recurrence ... Zach Britton will miss much of April, even if his shoulder responds well to PRP and rehab ... Don't sleep on Ryan Vogelsong, who's back earlier than expected for the Giants ... Mike Trout won't make the Angels' roster on opening day, but he has been cleared to play the field again. His shoulder injury after his prolonged illness has made this a lost spring for him.