Under the Knife: MLB Injury Analysis on Bryce Harper, Yasiel Puig and More

Will Carroll@injuryexpertSports Injuries Lead WriterApril 9, 2014

Under the Knife: MLB Injury Analysis on Bryce Harper, Yasiel Puig and More

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    Matt Harvey spent his Opening Day watching, not pitching, due to injury.
    Matt Harvey spent his Opening Day watching, not pitching, due to injury.Associated Press

    We're barely a week into the season and big names like Ryan Braun, Bryce Harper and Mark Teixeira are spending more time in my column than on the field. Prospects like Jameson Taillon and young studs like Matt Moore have ended up here as well, proving once again that any young pitcher is risky.

    But that's all we can do right now. We can list the injuries and discuss them. From out here, there's not much more that we can do besides manage risk and build depth. Teams, on the other hand, are left holding the wreckage of their seasons in some cases, burning more money on the DL. 

    For the Lords of the Realm that run baseball, you'd think a billion-dollar loss would jolt them to action. Instead, calls I made around baseball indicate that there are a couple of small-scale studies underway right now, perhaps a few on the order of the $50,000 studies that baseball has put together in the past.

    There's no Manhattan Project to reduce injuries. There's no panicked response to a rash of Tommy John surgeries. There's not even really any spin, like the NFL tried when it faced an increased incidence of ACL injuries. 

    Instead, there's business as usual. MLB, and worse, the players, simply move along, either ignoring the problem or being defeatist. "Some pitchers break down," I hear, or "there's always been injuries." Sure, this is true, but reduction isn't defeatist and it's certainly not impossible. There are teams out there taking advantage of it to some extent.

    If you think the investment the Milwaukee Brewers have made in biomechanics isn't paying off, I'd ask you to name the last player they had undergo Tommy John surgery. (Go ahead, first one to do it in comments gets my respect.) How about the Tampa Bay Rays? 

    There's answers and advantages out there. Then again, if baseball just likes reading my columns, I'm happy to oblige. My injury database isn't full, and the Urika isn't tired. Powered by the start of another epic Springsteen tour, on to the injuries.

Matt Moore

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    Orlin Wagner

    The Rays haven't had a Tommy John surgery for years. Yes, Taylor Guerreri, one of their top minor league prospects, underwent the surgery late last year, but no one has good data on minor league injuries. At the major league level, where one-third of pitchers have had the surgery, not having any have it on their watch is significant.

    How significant? Watch what happens when they try to replace Matt Moore, who's headed to see Rays medical director Dr. James Andrews this week. (Yes, same Andrews. Yes, he's been with the team over a decade, and yes, I do think that's significant to their results.) Even with depth, the team will struggle to fill that slot.

    If Moore is headed for Tommy John surgery, as Jaff Passan of Yahoo! Sports reports, there will be a gap between Moore's exit and the expected return of Jeremy Hellickson sometime this summer. It also puts more pressure on Jake Odorizzi, plus makes it tougher for the Rays to limit his innings at the end of the season, as they usually do with young pitchers.

    They can make do with a short-term guy like Erik Bedard or do something out of character and rush top prospect Enny Romero a bit. Romero does have the 100 minor league starts that the team likes to see, so "rush" is just a relative term. 

    The Rays have options, but they're not used to being in this position. Losing Matt Moore is tough, but the data-driven Rays will be working overtime to figure out what went wrong with their pitcher development system in this one notable instance.

Jameson Taillon

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    Gene J. Puskar

    In any other industry, Jameson Taillon heading for Tommy John surgery would be the last straw. Taillon's never been overworked. His mechanics are solid—or at least there's not a string of mechanically minded people pronouncing him doomed. There's even the chance that the Pittsburgh Pirates did a biomechanical evaluation on him sometime in the last two years.

    Still, he showed up in camp and promptly blew out his elbow. It was an insidious tear, not traumatic, meaning that something he was doing was inevitably building toward this, that his elbow could not hold up to what he was doing to it. 

    Changing any pitcher is difficult, even impossible, and even more often inadvisable, but losing a pitcher like Taillon for a year is irreplaceable, especially for a team like the Pirates that could have a very small margin of error in the NL Central. Taillon's injury should throw up a red flag for every young Pirates starter, because the smart, data-driven Pirates are likely handling all their pitchers in much the same way. 

    Taillon will be back, throwing in spring training 2015 and in the Pirates rotation at some point that year, but for this one, he's gone. He's just the latest in a too-long line to surgery, to a lost year, but sadly, he's not helped us get one bit closer to a solution. 

Bobby Parnell

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    Jeff Roberson

    Bobby Parnell came back from neck surgery, but things never seemed right for him after he did. He showed poor velocity and command, then showed a sprained UCL, which leads to Tommy John surgery. (Note that the New York Mets often say MCL rather than UCL. It's the same ligament, just a difference in terminology. I'll stick with UCL for consistency.) 

    The Mets announced Tuesday that Parnell had had successful surgery. While it wasn't announced, the surgery was likely done by team physician David Altcheck. Parnell will miss around a year while rehabbing, putting him back throwing in spring training.

    It will be interesting to see if he gains the velocity back after surgery—not new velocity, but a return to his mid-90s stuff. If so, that would indicate that he had this damage all spring, which would be a bit of a surprise. Usually, velocity loss tends to be shoulder-focused, so Parnell will be an interesting test case.

    The Mets will go with Jose Valverde at closer for a while, but when that inevitably goes horribly wrong, they do have some options. Kyle Farnsworth was a solid closer while in Tampa, and the team thinks Scott Rice could handle the slot as well with his plus offering. Rice is worth a flier if you're seeking saves and have a bench slot available. At worst, he's a regularly used lefty for the team.

Ryan Braun

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    Michael Dwyer

    Ryan Braun is having issues with his thumb again. Five months of rest didn't help it, but there's questions about what "rest" means. I'm not being Clintonian here, but rest to an elite athlete often means something different than what it means to you or me.

    Once, while a student athletic trainer, I saw one of the team's star basketball players roll his ankle. It was painful but easily treated. Both the head AT and the team physician checked him and came up with the same plan: rest and ice.

    Ice was easy, but rest? To him, it meant only two hours in the gym, not four. Instead of running sprints, he got on the treadmill (and this is way before anti-gravity treadmills!). He didn't run, but he did go out and shoot.

    When I told the head AT, his head almost exploded. He called the player in and defined rest for him. The next two days weren't easy, and I was assigned to check on him occasionally. The player just sat in his chair, watching TV. Every time I stuck my head into his dorm room, he asked the same thing: "Can I go shoot?"

    Braun was said to be much the same way. Exiled from baseball, he worked out near his California base to stay in shape. There were hours in the cage. Discussions, video sessions, bringing in friends and area players to do sim games. While Braun and the Milwaukee Brewers won't confirm what he did while forced away, you probably wouldn't see it and call it rest.

    What Braun has now is the same digital nerve problem he had last year. Dr. Steven Shin, the director of hand surgery at Kerlan-Jobe, told me that the return of the problem doesn't surprise him.

    "Nerve problems can be tricky and can become inflamed/irritated repeatedly if subjected to the same inciting factors, such as pressure from gripping a bat," he said.

    Dr. Shin agrees that surgery may not offer the best outcome: "Besides the usual non-operative treatments such as rest, medications such as anti-inflammatories or specific meds for inflamed/irritated nerves, therapeutic modalities and cortisone injections, surgery may be a last resort. However, the results of surgery can be very unpredictable for this type of condition."

    The Brewers medical staff is top-notch, so they'll have to find a way to get him comfortable, including the use of padding or even a special substance inside his glove. (And don't read "special substance" and get any ideas, you boo birds.) Getting Braun to full function may take a few weeks, so look for some sign of power. If you're holding him in fantasy, there's no way to bench or deal him right now, so ride it out and look for anything, even long fly balls or gap shots, as a sign that his power is returning.

    (And of course, right after writing this, Braun went for three homers in Tuesday's game. Whatever they did seemed to work, but it bears a continued watch.) 

Manny Machado

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    Al Messerschmidt/Getty Images

    We could use some good news after all these injuries, right? Here's some, especially for Baltimore Orioles fans: Manny Machado is getting closer to a return. The O's have been downright deliberate in his rehab and the later stages have been frustrating for Machado, but there's signs that he's making progress. 

    Roch Kubatko of MASN Sports reported Tuesday that Machado is still not running full speed but that he's running on a treadmill in a pool. That's normally an early activity, keeping some of the weight off it. Sources tell me that Machado's wasn't "simple running."

    Instead, Machado was simulating sprints, stops and cuts, with the goal to have him out there doing it for real in the next 10 days. By doing it in the pool, they can detect any soreness or issues without having the full weight and risking a more severe setback. It's smart practice.

    Machado is still a must-hold in all formats, and with him getting closer, the chance to steal him in leagues is closing rapidly. There's no reason to think he won't return to form quickly once he's physically ready and gets his swing tuned up. Jonathan Schoop may see less action once Machado is back, but he's not a solid option at third base, anyway.

Bryce Harper

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    David Goldman

    Bryce Harper is in a funk. He's struggling at the plate and screaming in the tunnel. Slumps will happen, but with this one happening after he was hit in the head on a slide, some are asking whether the two are connected.

    It's a valid question, especially given that Harper reported symptoms a few days after the incident. While headaches happen, it certainly looks suspicious given that Harper was cleared by the Washington Nationals medical staff in spite of the symptoms. 

    That said, they did clear him and have continued to clear him. Harper hasn't reported any symptoms, but then again, he hid his knee injury last season for a while. He's not the type to self-report, and that's what the medical staff is there for regardless.

    Even mild brain trauma can be long lasting. Justin Morneau missed a lot of time and really has never returned to level after a similar-looking play. Harper was back in the lineup after a day off, going 1-for-4, but we'll have to watch and wait to see whether this slump is something more.

    It's impossible to bench Harper at this point—he could explode out of the slump as easily as it could continue—but teams with deep benches may have to consider their options. If a Harper owner is panicking, it's a good time to try to steal him. 

Yasiel Puig

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    Victor Decolongon/Getty Images

    Here's something you should know: X-rays don't tell us anything about ligaments. When you see a suspected sprain, like what Yasiel Puig and Josh Hamilton had recently, an X-ray simply rules out fractures and major avulsions. It's done because it's always been done, and those X-ray rooms are handy at every MLB stadium. 

    It's also a nice spin move. "X-rays were negative," is an easy, quick quote for the beat writers, but don't be fooled. In most cases where soft tissue is involved, an X-ray doesn't show anything. Well, nothing the medical staff really wants to know.

    That's where the MRI comes in handy, visualizing soft tissue like muscles and ligaments. Granted, the medical staff usually knows from manual testing, but the MRI is the current gold standard for diagnosis. 

    Puig's injury was a typical mechanism. He caught his thumb and it was pulled back. The ligaments and tendons that keep the thumb where it's supposed to be can be stretched or even ruptured, but in most cases, the body reacts to the extreme pain and protects the thumb before it gets to that stage.

    Why do I mention tendons? Because there's been some confusion about the actual injury. The Los Angeles Dodgers have said "strain" in some places. My sources confirm it is a ligament that has mild damage, making this a sprain with a "P." 

    Puig's injury was minor, but he could lose a bit of grip strength in the short term. That can lead to a few more strikeouts, and with Puig-induced frustration rampant at places in the Dodger organization, that could lead to more time on the bench for him. Watch this one closely to see if there's more swing-and-misses in the next week or so.

    Puig was held out of Tuesday's game, and with an off-day on Thursday, the Dodgers are likely to chain that with another off-day Wednesday. If there's not improvement by Friday, he'll likely hit the DL, but there's little chance that it would go beyond the minimum there.

Mark Teixeira

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    Tom Szczerbowski/Getty Images

    Mark Teixeira spent spring training struggling with his wrist. Now he's on the DL due to problems with his hamstring. This is not a good pattern.

    Worse, there's indications that Teixeira's problem may be more of an issue. Hamstring injuries and back problems tend to go hand in hand due to similar attachment points and the interrelation of their functions. Sources tell me that Teixeira has needed significant pregame and postgame work by the medical staff to keep his back going, something he hasn't needed in the past.

    Teixeira has a mild hamstring strain, likely a Grade I, but the team didn't hesitate to push him to the DL. That's another solid indication that there's more here, something the team thinks it needs to get ahead of. Given the problems the Yankees have defensively and with depth, it was a bit surprising that they acted so quickly.

    Kelly Johnson certainly isn't a long-term answer at first, so the Yankees have to hope that they can get Teixeira back at the minimum and that they can keep him out there. The medical staff in New York is already going to be stretched with so many players needing work to stay on the field before they even get to their normal routines. That's usually a bad sign and makes any Yankees player a bit more risky.

    One possibility, especially given how he's looked in the field, is shifting Derek Jeter over to first. Jeter's resisted even working at other positions, but if Teixeira isn't back quickly, it's something Joe Girardi should be thinking about. 

The Others

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    Don't touch his head!
    Don't touch his head!Tony Gutierrez

    Adrian Beltre

    Beltre may have a recurrence of the quad strain that hobbled him for part of spring training. He came off the field in Tuesday's game, and Matthew Carroll of The Sports Xchange (h/t Yahoo! Sports) reports that he will head to Dr. Keith Meister's office in Dallas for MRIs and a check. It's early, but sources tell me that Beltre is likely to head to the DL, though they hope Meister is more positive than early indications. 

    Cole Hamels

    Hamels went 65 pitches in his first outing, but the Philadelphia Phillies want him up to 90 before they say he's ready. That could take two more rehab starts, though it's unclear if they'll push him up from Clearwater. The weather is nice there, and with Hamels owned in 92 percent of leagues, it's going to be tough to steal him anyway. If you drafted him, hold. His shoulder looks fine. He's just building stamina now.

    James Paxton

    Strained lats tend to be a big negative for pitchers. First, they can take months to heal, and second, they're an indication of something going very wrong with the kinetic chain. Paxton doesn't seem to have either of those. He felt it tighten up, told the medical staff and got out of the game. That shows how much even the young pitchers trust Rick Griffin and his staff.

    Paxton may still hit the DL as a precaution, but this looks to have been minimized by a solid medical staff and a smart young pitcher.

    Taijuan Walker

    Walker's first rehab stint was a pure success, so he'll shift over to Jackson (Double-A) for his second. He'll likely have one more after this, assuming no setbacks with his shoulder. Like with Hamels, he's looked solid and is just building stamina. The injury to Paxton shouldn't push his schedule up, but if you see his count over 80, it will be an option for the Seattle Mariners. 

    Hisashi Iwakuma

    The M's pitching has been the story so far this season, and Iwakuma's on the upswing, which could help take some pressure off Felix Hernandez and their young arms. He's going to be starting his side sessions and if all goes well, he'll have a rehab outing (likely at High Desert [Advanced-A]) as soon as next week. I don't anticipate any setbacks, so a May 1 return is still the target.

    David Robertson

    Robertson hits the DL with a groin strain. The Yankees closer admitted not telling anyone, including the manager and AT, about the injury for more than a day, so that's a problem we'll have to keep an eye on with this team again. Matt Thornton is likely to get the save opportunities while Robertson is out, but Shawn Kelley could be in the mix as well. It's a very thin and inexperienced pen. I wonder if Joe Girardi still has Mariano Rivera's number.

    Brian Wilson

    Brian Wilson is already back throwing on a rehab assignment, kicking the doomsayers in the teeth. His ulnar nerve issue isn't going to require surgery yet, indicating that the inflammation is under control. We'll see whether it remains under control while he throws, but there's positive signs so far. It's one more reminder to never assume. 

    A.J. Ellis

    Ellis had meniscus surgery, but the Dodgers aren't saying whether he had meniscus removal or repair. The former can take two to four weeks of recovery, while the latter is more like 10 to 12 weeks. With the word being he's expected back in four to six, the guess is that it's removal and that the Dodgers are giving their catcher a bit of a conservative timeframe. The Dodgers lack depth at catcher despite their payroll and will be forced to overexpose Drew Butera until Ellis is back. 

    Aroldis Chapman/Jonathan Broxton

    Aroldis Chapman is back throwing, though the team will take things slow. Chapman has to be returned through the concussion protocol as well as watch the plate and massive incision in his head. The Cincinnati Reds get a bit more time with Jonathan Broxton coming off the DL. He'll immediately become the closer for a team that Bryan Price seems to be struggling with. I don't think it's Price's fault; this team just isn't very good.