Collateral Damage: Of the Byrds and the Beaned

Maybe it's the extra day between columns or maybe word got around that we didn't have enough to do this weekend, but the influx of injury news was kicked up another notch in recent days. It wasn't just the sheer number of injuries, but their range, spanning everything from the routine to the downright scary, and affecting everyone from role players to key pieces.

Marlon Byrd, CHN (Multiple facial fractures)
One of the things that isn't really taught but rather learned through experience is being able to glean something about the severity of an injury from a player’s reaction. Some players have been known to be dramatic in hopes of getting a call, but when something truly serious happens, everyone knows it. Beanings of any kind are scary, but Byrd's reaction after his told us all we really needed to know. He was immediately removed from the game and taken to Massachusetts Eye & Ear Infirmary, where he stayed overnight and was eventually diagnosed with multiple facial fractures, among other injuries.

Regular x-rays often don't reveal facial fractures, especially those involving the small, thin bones of the nose and eye orbit. CT scans, on the other hand—which Byrd underwent—can provide the resolution required to evaluate these small bones, and they are also often used to evaluate other, more serious injuries involving skull fractures and intracranial bleeding.

A batted or thrown baseball exerts a tremendous amount of force, so it is surprising that we don't see more facial and skull fractures over the course of a season. While baseball is special to all of us, it still can't defy the laws of nature. When we talked about Dickerson's concussion last Friday following a strong but glancing pitch to his head, we noted that the glancing nature was actually a positive indicator, since the impact wasn't fully absorbed by his cranium.

In Byrd's case, almost all of the force from the ball was absorbed by the structures in the face—with maybe a slight amount deflected by the lip of the helmet—and couldn't be redirected or shunted off elsewhere. The kinetic energy and force had to be transferred someplace, and as a result, several bones fractured. 

Facial fractures aren't the only injury that can result from a beaning, as we all know. Forces strong enough to cause a facial fracture are also strong enough to cause a concussion. While there are medications to help athletes deal with the symptoms of concussions in the long-term, the focus in the short-term for Byrd will be on decreasing the swelling from the fractures. Once the swelling has gone down, the medical staff can start to evaluate further treatment options for both the fractures and the likely concussion.

Josh Johnson, FLA (Right shoulder inflammation)
Elbow injuries used to be death sentences for pitchers, but with the advent of Tommy John surgery and the advancement of sports medicine, the recovery rate from elbow injuries has improved considerably. Johnson hoped his own elbow reconstruction would be the worst surgery he ever had to face; while it still might be, his shoulder is becoming more and more problematic.

While it’s technically true that Johnson’s shoulder never forced him to the disabled list, he did miss almost a month at the end of the 2010 season with shoulder inflammation and a mid-back strain, and in 2009, he had a mild case of shoulder discomfort. Every pitcher experiences discomfort at some point, so we're not going to crucify his shoulder for that, but the last two instances of shoulder problems have caused him to miss at least 15 days each.

With each bout of recurrent inflammation, the odds of an underlying injury—such as a rotator cuff or labral tear—increase. Hopefully this latest bout of inflammation is nothing, but we’re not quite sure we like Johnson’s chances.

Jason Heyward, ATL (Right rotator cuff inflammation)
Heyward himself was placed on the disabled list with recurring inflammation of his right rotator cuff (non-throwing), which dates back all the way to spring training. Heyward felt that his hitting mechanics had changed due to the inflammation, which could explain his disappointing numbers so far in 2011 (.214/.317/.407 in 161 PA). He had been given a cortisone injection into the area in hopes of decreasing the inflammation enough to return, but while he did manage to take the field for three days, it didn't fully clear up the issue.

When inflammation reaches this stage, there is likely at least some fraying of the rotator cuff due to constant friction and pinching, which could be a contributing factor to his continued pain. Several other factors that could be involved would not be categorized as structural damage, including different forms of impingement and also certain labral tears not visible in non-enhanced MRIs. There hasn't been an official timeline for his return yet, but the Braves will likely be conservative out of respect for his talent and previous injury history.

Matt Holliday, STL (Left quad strain)
Holliday had to leave Sunday's game against the Royals because of a recurring minor strain and tightness in his left quad. The quadriceps is such a large muscle group that minor strains can be played through with treatment and supportive sleeves/wraps, unlike many hamstring strains. There does come a point at which wraps and treatment aren't enough and rest is required, and Holliday may be approaching it. The Cardinals are saying that his removal was merely precautionary, but clearly the quadriceps is still bothering him.

Mark DeRosa, SFG (Left wrist strain)
More details have come out about DeRosa's recent injury, and like most problems involving the wrist, it's complicated. DeRosa's previous surgeries involved the sheath surrounding the ECU tendon, but this time there is a tear of the tendon itself. With both of the previous wrist surgeries, the surgeons declared the tendon sound. Now, however, he may end up requiring another surgery to repair it, although his wrist has felt better since he received a cortisone injection.

Our injury database contains comps that range from the surgical in Nomar Garciaparra to the non-surgical in David Ortiz, so all hope is not yet lost. DeRosa will pay another visit to Dr. Tom Graham at some point this week to see whether rehabilitation or another surgery lies ahead.

Brandon McCarthy, OAK (Right shoulder stress fracture)
McCarthy was placed on the disabled list (again) with a stress fracture of his right shoulder (again). It's rare for a stress fracture in the shoulder to develop at the upper professional levels, and it's even rarer for one to recur. After missing three months in 2009 and almost all of 2010 with similar issues, this is now the third straight season in which McCarthy has dealt with a stress fracture in his shoulder, so there is clearly a relationship between his mechanics and his anatomy that is simply not conducive to pitching. It remains to be seen how long he will be out this time, but it will likely be a while before we see McCarthy on the mound again.

Flesh Wounds (Everyone take a deep breath, since we’re in for a lot of these today.)
Travis Hafner will likely miss more than three weeks with his right oblique strain, blunting the offensive attack of the surprising Indians… Glen Perkins also suffered a right oblique strain recently and was placed on the disabled list… Nate McLouth may end up on the disabled list himself with a left oblique strain following a check swing on Sunday…  A bunt attempt claimed another victim, with Gerald Laird breaking his right index finger during Sunday's game. He’ll probably hit the disabled list… Juan Uribe was placed on the disabled list after suffering a lower abdominal strain on his left side… Jesse Litsch was placed on the disabled list retroactive to May 19th with right shoulder impingement… Shane Victorino was also placed on the disabled list retroactive to May 19th, but his complaint was a right hamstring strain… Howie Kendrick injured his hamstring (left) and hopes to avoid the disabled list after an injection, although he still hasn't played since Friday… It wasn’t a hamstring issue but a right quad strain that put Pedro Alvarez on the disabled list… It's going to be two to three months before we see Alex White back with the Indians after he sprained/strained the middle finger on his pitching hand… Andre Ethier crashed into a wall chasing down a Juan Pierre drive and ended up injuring his right elbow, right lower back, and left big toe. More details will follow as we get them… Brad Thomas hopes that the left elbow inflammation that caused him to be placed on the disabled list retroactive to May 11th was the cause of his ineffectiveness… Matt Garza was skipped in the rotation because of right elbow tightness. It may be nothing—he's going to reevaluated early this week—but he does have a history of radial nerve inflammation that required a disabled list move in 2008… Ending on a good note, Chase Utley was finally activated from the disabled list.

And breathe…