Collateral Damage: Hasta Luego, Albert

Albert Pujols, STL (Left radius fracture and wrist sprain)
When a wrist is forced into hyperextension as Pujols’ was, it moves into what is called the “closed pack position” of the radiocarpal (radius and wrist bones) joint. The closed pack position is the position of the joint in which the bones have the maximum amount of contact with each other, and therefore the most bony stability.

While this position allows bony protection from dislocation of the joint, it prevents forces from being absorbed by the soft tissues, instead transmitting them directly to the bones themselves. In essence, it's like driving down a pothole-filled Boston road in a car without shock protectors.

When Betemit ran into Pujols, the latter’s bones quickly compressed and caused a fracture of the distal radius, along with the sprain that was initially diagnosed. The radius is a forearm bone, and in most cases fractures to the radius do not have the same deleterious effects as fractures to the smaller wrist bones, which make delicate gliding motions that allow quick and powerful movements while throwing and hitting.

If these motions are disrupted at all in the wrist, power is not transmitted from the lower body and trunk through the arms to the bat, an effect similar to that which we see with shoulder injuries in pitchers, which disrupt the kinetic chain and impair velocity. This is the major reason why power hitters struggle after major wrist injuries, but fortunately, that’s something that Pujols will not have to be concerned about.

If Pujols had had his choice of “major” injuries to the forearm or wrist, this would have been the one to pick. A small non-displaced fracture of the radius in the typical fracture pattern does not have any major detrimental effects on long-term production. Assuming he did not completely rupture ligaments in the wrist, the sprain should heal without any complications, and Pujols should remain the excellent hitter he’s always been. Pujols will be immobilized for about four weeks before stepping up his strengthening and motion exercises, and he should be able to progress to baseball activities quickly.

Brad Hawpe, SDP (Strained right middle finger)
Hawpe battled through left elbow soreness last week, only to end up on the disabled list with a strained right middle finger this week. The pain and swelling in the finger stemmed from a swing on Saturday, although he did experience some soreness in the same finger earlier in the year. This particular strain is more of an issue while hitting than it is while catching, although catching certainly can’t be completely pain-free.

The flexor tendons are of the utmost importance in gripping and controlling the bat. If Hawpe were to try to play through this injury, he’d only risk rupturing the tendon and requiring surgery to correct it. Wisely, he’s going to take the time to rehabilitate his finger properly without aggravating it each time he swings.

Chris Coghlan, FLO (Left knee inflammation)
Coghlan's surgically repaired left knee has flared up again, leading to his being disabled rather than optioned to the minors. It is very common for a player to experience inflammation following any surgery on the knee, but it normally presents itself much closer to the initial return to the field. The soreness Coghlan experienced in spring training was more typical, in that it coincided with increased playing time in the wake of recovery from surgery, when the body part in question wasn’t yet perfectly conditioned.

Despite his best attempts at coping with the uncooperative part, Coghlan’s knee was overwhelmed by the rigors of the season, and he’ll need to balance the strength and flexibility in his entire lower extremity, not just the knee, in order to stay on the field in the future. He’ll have to focus on specific strength and conditioning exercises—which he’s almost certainly already doing—throughout the remainder of the season to make sure the inflammation does not return once he’s activated.

J.R. Towles, HOU (Right leg pain)
Towles still hasn't returned to the field since suffering what is being described as a muscle strain in the back of his right leg last Wednesday. While it’s improving, it still bothers him when coming out of the crouch to field a ball, twist, and throw to first base. We haven't heard the exact structure injured or location of his pain, but based on his description and position, he may have a small meniscal tear.

Small chronic meniscal tears can present with symptoms similar to a mild muscle strain near the knee. Often, these tears are degenerative in nature and become inflamed following one particular episode. The longer his pain remains plateaued, the more likely it is that an underlying meniscal injury is the culprit.

Flesh Wounds: Laynce Nix is day-to-day after leaving Tuesday's game with a sore right Achilles… Brian Roberts still has not been cleared to participate in baseball activities following his concussion and will be reevaluated in two weeks… Jon Garland had to cut an outfield throwing session short after experiencing continued soreness, making surgery more likely…Joe Nathan will probably be activated within the next several days as he recovers from elbow inflammation… Shaun Marcum will make his next start after straining his left hip during his last start against Boston.