Under The Knife: Wednesday Update

Asdrubal Cabrera (broken forearm, ERD 7/10)
Grady Sizemore (bruised knee, ERD 5/21)
I started to link to the video of the play that snapped Cabrera's arm, but I decided against it. For the squeamish, it's not pretty and it's easy enough to find if you want to see it. The collision with Jhonny Peralta had enough force to snap his ulna at or near the midpoint of the bone, necessitating a plate and/or screws to make sure it heals properly. I say ulna from the video, but it's a bit unclear and there's been no official word from the Indians. It's semantics, since fracturing either of the major bones in the arm in this manner would cause the same sort of lost time. Some are blaming the defensive shift for this injury, but it feels like this one's just bad luck rather than being in an unfamiliar position. Then again, I can't think of a single incident of a third baseman/shortstop collision, let alone one with these kinds of consequences. Cabrera should be out until about the All-Star break, but shouldn't have any long-term consequences. As a lot of young kids can tell you, arm bones heal pretty cleanly. I am curious to watch the timing on this with a lot of the interesting research on bone stimulation coming out of the Cleveland Clinic. The Indians are all about the bones right now, as Sizemore had an MRI to see what his problem is. His knee was thought to be just bruised, but he has had severe pain and some inflammation. He'd had some minor issues with this same knee back in April, so there may be some connection or we could be seeing some underlying pattern that suggests a problem. While the Indians don't sound too concerned, Sizemore's unavailability hurts the Indians' chances of turning things around, even if it's for just a few days.

Josh Beckett (back spasms, ERD 5/26)
When Beckett left Tuesday's game, no one should have been surprised, though the Yankees certainly seemed to be, enough to protest the game over the way he left. Beckett has been dealing with back spasms for several days, pushing his start back. That the back tightened up as things went on and that he didn't look that good prior to his leaving is par for that course. Beckett's back is problematic, nearly as much as his results since signing his big-dollar deal last month. The medical staff will focus on getting ahead of it over the next few days in hopes that he'll be ready for his next turn in the rotation. Between Beckett's back and Daisuke Matsuzaka's struggles, it's becoming more clear why the Red Sox discussed some form of a modified rotation earlier this year; given the injury history and age of their staff, it was almost inevitable. Maybe they could have saved themselves some problems if they'd been able to do it, but right now, they're facing a challenge on the field, in the standings, and in the training room. Don't expect Beckett to be ready for the Phillies on Sunday, but there's no decision on when he'll be back on the mound yet and won't be for a couple days. Watch to see if he's sent for imaging; that would be a bad sign.

Andre Ethier (fractured finger, ERD 6/8)
The Dodgers were forced to push Ethier to the DL after they determined that the fracture in his pinkie wasn't going to take the forces of hitting well. Ethier saw a specialist who suggested that hitting before the finger healed could cause a more unstable situation. He'll rest and receive treatment, but this could be as short as a minimum stay. "Stable" doesn't mean completely healed and with bone stimulation, and pharmaceuticals that can be used—legally, I might add—the time frame for healing has been shortened. This one is a little bit about modern medical science, and a lot about pain tolerance. Ethier will only be able to do as much as he can tolerate, which makes the time line on this one impossible to read. My best guess after speaking with doctors and trainers is that it will be slightly longer than minimum, about three weeks. Again, the short-term consequences of this injury are minimal, though there is some recurrence risk.

Jorge Posada (bruised foot, ERD 5/22)
Nick Johnson (wrist surgery, ERD 7/20)
Phrases like "knot on foot" don't help much. Does Posada have something simple but painful like a stone bruise? Is it something complex and painful, like plantar fasciitis? Is it something much less prosaic, like a simple corn, bunion, or other garden-variety foot problem? While we don't know exactly what it is, we do know what it's not. X-rays showed that it's not fractured and knowing that this problem came up after fouling a ball off his foot likely means it's a simple traumatic bruise. It's no less painful, but like most things a catcher has to deal with, it can be overcome with some treatment and the pain tolerance that Posada has shown again and again throughout his long career. (Quick: Who has a higher career OPS+, Posada or Yogi Berra? Trick question! Both have a 125. Their stats, even via WARP, are amazingly similar.) It should be just a matter of days before he's back in the lineup. As for Johnson, it's going to be longer. He had wrist surgery on Tuesday to clean up issues inside his wrist, which should keep him out until after the All-Star break. Johnson has often been a slow healer, so don't be surprised if it goes longer than that. The bigger concern is whether all these injuries have pushed Johnson from "good but fragile" to "shot."

Adam Dunn (unknown condition, ERD 5/20)
"Minor surgical procedure?" When a player goes from the vague "flu-like symptoms" to a minor procedure, something's up. I won't pretend to know what's going on with Dunn, but the way this has been handled is very curious. I'll allow that if it's something sensitive, then I'd want my employer to be pretty vague. The Nats have said that Dunn could be back with the team and in the lineup as soon as Wednesday, so it sounds like whatever this turns out to be really is minor. Those that have read this column for a while know I hate unknowns, but even my best sources on this one have come up dry. We'll just have to hope for the best and wish Dunn well.

J.P. Howell (torn labrum, ERD 10/4)
There wasn't much discussion about Howell this offseason and even into spring training. It came as something of a surprise that he started the season on the DL even though he'd been shut down at the end of the '09 season. Things never got back on track, and now Howell is headed for season-ending labrum surgery. He'll head up to James Andrews' facility in hopes that he can be put back together enough to get back to "chilling." There's been a lot of speculation about Howell's offseason factoring into this, but sources tell me that the damage was done in 2009 and that he'd begun altering his mechanics to protect a sore shoulder well before his shutdown. Labrum surgery is still a coinflip despite all the advances of the last decade, but we won't have much indication on how this went until next spring in Port Charlotte.

Chris Young (unstable shoulder, ERD 9/1)
After surgery to clean up a frayed labrum, the Padres thought that Young would be back and leading their rotation by now. Instead, he's shut down with more damage to the labrum, cuff, and shoulder capsule. This is as bad as it sounds, and the shutdown they've put Young on could extend for the rest of the season or even beyond. The team has him working on stabilization, which is pretty much what it sounds like and about as basic as it can be. Without a stable shoulder, the rest is moot. The worry here is that this is a bad pattern. How bad? Well, the first guy that comes to mind with comparable injuries is Mark Prior. The Padres didn't have much to work with when Prior came to them, but they weren't able to get him back. For all his talent, Young just has never been able to stay healthy under a starter's workload; now he may never get the chance. It would surprise me if he's able to come back with any effectiveness in 2010.

Quick Cuts: I got the chance to see Carlos Santana on Monday night. He's good. Two big homers were all the offense the Clippers needed. Hanging out with Craig Calcaterra and talking baseball was pretty solid,too. I'm hoping we can convince Craig to come by a Ballpark Event in his native Ohio. … For all the blowup about his misplay, there's no question that Hanley Ramirez really smoked his foot with a foul on Monday. … There's no late word out of Boston on J.D. Drew. He came out of Tuesday's game with what was reported as a leg injury. I hope to have more soon. … Chase Utley has missed a couple games with flu-like symptoms. We're assuming that it's really just that. … Word out of Philly is that the cortisone and anti-inflammatories are working well with Brad Lidge. He didn't have a joint lubricant put in, leaving the option open for the future. … The Red Sox want to see Mike Cameron recover better after games on his rehab assignment before activating him. The abdominal muscle still tightens up, making his back-to-back availability a bit of a question. With the Red Sox struggling and a bit undermanned, that's a tough question to be asking. Things are a bit clearer for Jacoby Ellsbury, who'll be activated if he had no problems in Tuesday's Double-A rehab game. … Jorge De La Rosa is long-tossing, but he's a ways off from a return. The Rockies still don't have a timetable, though the finger is said to be doing well. … It's early, but it sounds like the cortisone shot Alfredo Aceves got in his back is giving him some relief. … Jim Edmonds hits the DL with an oblique strain. You know how these go in older players. … Rangers rehabber Michael Schlact—or as most know him @michael_schlact—made a big step with his first game work this week. He's scheduled for more. Follow him on Twitter or his MLBlog on MLB.com for a taste of what a pitcher goes through after an injury.

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Carlos Zambrano

With the news that Zambrano is heading back to the rotation, we have to ask ourselves why. It's not like the long argument I listened to while driving to Columbus on Monday between Sirius/XM's Casey Stern and Jim Bowden. My 'why' is why we're so stuck on the five-man rotation. The Cubs aren't a progressive team, so I don't expect them to be out ahead of people, but with Zambrano's situation, it would be the perfect place to move to a more standard four-man rotation. Instead of deciding what role to put Zambrano in or who to remove, why not shift to a four-man rotation with a swingman? I asked a couple of BP's interns to put together a rule-based four-man rotation. Going on three days' rest a couple times through the rotation wouldn't be too much to ask, so if we limited it to two times through the rotation on three days'rest before dropping in the swingman to buy an extra day, how would that look? Given the Cubs'schedule, it looks pretty darn easy, as you can see below. The Cubs would need to use the swingman just once through the All Star break. This isn't a creative or progressive solution. This is simple resource management. We could go beyond this and say that Zambrano or Randy Wells could be pushed into games if there's a big lead or to keep the pitch counts down, but let's not complicate things.

Cubs starters with schedule (rest days in parenthesis, "x2" means second time through rotation on three days' rest):

May
19 Tom Gorzelanny (4)
20 Ryan Dempster (4)
21 Ted Lilly (4)
22 Carlos Silva (4)
23 Gorzelanny (3)
24 OFF
25 Dempster (4)
26 Lilly (4)
27 Silva (4)
28 Gorzelanny (4)
29 Dempster (3)
30 Lilly (3)
31 Silva (3)

June
1 Gorzelanny (3) 
2 Dempster (3×2)
3 OFF
4 Lilly (4)
5 Silva (4)
6 Gorzelanny (4)
7 OFF
8 Dempster (5)
9 Lilly (4)
10 Silva (4)
11 Gorzelanny (4)
12 Dempster (3)
13 Lilly (3)
14 OFF
15 Silva (4)
16 Gorzelanny (4)
17 Dempster (4)
18 Lilly (4)
19 Silva (3)
20 Gorzelanny (3)
21 OFF
22 Dempster (4)
23 Lilly (4)
24 Silva (4)
25 Gorzelanny (4)
26 Dempster (3)
27 Lilly (3)
28 Silva (3)
29 Gorzelanny (3)
30 Dempster (3×2)

July
1 Lilly (3×2)
2 Silva (3×2)
3 Gorzelanny (3×2)
4 SWINGMAN
5 Dempster (4)
6 Lilly (4)
7 Silva (4)
8 Gorzelanny (4)
9 Dempster (3)
10 Lilly (3)
11 Silva (3)