Collateral Damage: Backing Down

Carlos Zambrano, CHN (Back stiffness)
Zambrano was pulled from Thursday's game with low back stiffness in the second inning, an ignoble end to a very wild outing. While we’re still waiting to hear an update on his condition, we do know that Zambrano was sent to a local hospital for MRI evaluation. Considering Zambrano's history of a bulging disc in 2009, concern is always present for interval worsening of the injury.

If the disc herniation becomes large enough, Zambrano could be at risk for Cauda Equina Syndrome (CES), a condition that compresses the nerve roots below the spinal cord. CES can also be caused by narrowing of the spinal canal, infections, inflammatory conditions, traumatic injuries, and tumors. CES patients can experience pain patterns similar to those of sciatica, but the condition can also involve other symptoms such as bowel or bladder incontinence. If CES is present, timely surgical intervention is required to effect a full recovery.

Zambrano is unlikely to have CES, and it’s probable that the availability of an MRI at the hospital is what caused the swift response. Zambrano’s bulging disc may have progressed and could be herniated, but jumping to conclusions about surgery at this point would be premature.

Erik Bedard, SEA (Left knee sprain)
We can sum this one up quite easily: Bedard simply cannot stay healthy and was placed on the 15-day disabled list on Wednesday with a left knee sprain. Bedard has managed to stay off the disabled list in exactly two of the last nine years. With so many injuries on his record, it shouldn't be a surprise that in 2005 he sprained the MCL in his left knee and ended up missing almost two months. Every single one of the ligaments is vital in providing a strong foundation for pitching mechanics, so it's crucial that any sprained ligament, even if it is not the dreaded ACL, heals completely. While some feel that Bedard should be back in the minimum, we can't guarantee anything given his injury history.

Jayson Werth, WAS (Left hip pain)
During Tuesday's game against the Angels, Werth felt a sensation of his hip locking up on him and returned on Wednesday only in a pinch-hitting role. True locking of hips can occur for a few reasons, including tears of the labrum or loose bodies. Hip flexor tendinitis and tightness can also cause clicking, popping, or feelings of locking for a brief second deep in the front of the hip. That's not to say there couldn't be an injury inside the hip joint, which is a real possibility here.

Often the hip flexor tendon can become inflamed from injuries inside the joint, which can easily be confused with a labral tear. One way to tease out the difference is through an MR arthrogram of the hip, in which dye is injected to offer improved visualization. If the results of that test are inconclusive, a numbing agent can be injected into the joint itself, which can be very helpful in determining the root cause of pain or discomfort.

Jerry Hairston Jr., WAS (Right wrist fracture)
Over the course of a season we typically see several fractures as the result of being hit by a pitch. On Wednesday, Hairston was hit by a Dan Haren pitch and almost immediately tried to absolve both parties of any blame, claiming that late-afternoon starts cause difficulty in picking up pitches and prevent players from making the necessary adjustments. Josh Hamilton recently blamed his blue eyes for his daytime struggles at the plate, and throughout the years there have been daytime beanings that were partly attributed to an inability to pick up the ball out of the pitcher’s hand.

Still, Hairston may be searching a little too hard for a scapegoat, especially since finding one wouldn’t quicken his recovery. Expected to miss at least a few weeks, Hairston has responded that he wants to try to play through the pain and discomfort. He will be reevaluated, at which point a decision will be made regarding a potential move to the disabled list.

Chipper Jones, ATL (Right knee meniscus tear)
Chipper has a lot of wear and tear on his legs, and his right knee has been the problematic one this year. The pain and inflammation returned in the last few days, keeping him out of action. Jones had surgery on his left ACL last year, but when his right knee bothered him earlier this year, further testing revealed a small meniscus tear, likely degenerative in nature. Rather than immediately having surgery back in May, Chipper had a couple of cortisone injections in the hope that they would allow him to manage his pain for the rest of the year.

Now that the pain has returned, his options are more limited. Too many cortisone injections in a short amount of time can actually weaken tissues, making them more prone to injury. Physical therapy, rest, and viscosupplementation injections could decrease the inflammation, but since the knee is a weight-bearing joint, more time would be required for recovery than Chipper is willing to allow. Surgery is also an option, but that would necessitate at least two or three weeks of recovery time, and most likely more. However, if the pain continues, he may have little choice but to go under the knife to repair the meniscal tear.

Cole Hamels, PHI (Right wrist contusion)
Hamels was lucky to suffer only a contusion on his right wrist after a drive by Adrian Gonzalez connected just below his glove. As Gonzalez drove one up the middle, Hamels was able to twist his body and almost get his glove up in time, but he wasn't quite fast enough. Since the bruise is on his glove hand, it shouldn't be much of an issue for his next start, especially since it is unlikely to change his mechanics.

Flesh Wounds: Travis Snider has passed all of his concussion-related tests and been cleared through the new concussion protocol… Roy Oswalt will meet with Dr. Andrew Boscott today for a second opinion regarding his back… Kevin Youkilis missed yesterday's game after bruising his left foot and ankle by fouling a ball into the area in Wednesday's game… Kerry Wood broke his own news and let everyone know he is coming off the disabled list today following his recovery from a blister on his right index finger… Elvis Andrus was able to return from his sprained left wrist on Thursday night… Take it for what it's worth, but Marlins president Larry Beinfest thinks Scott Cousins is dealing with a bulging disc, not just a low back strain. Many players have bulging discs, not all of which cause problems… Brandon Lyon underwent season-ending surgery to repair a detached tendon and torn labrum yesterday… Chris Gimenez was placed on the disabled list with a strained oblique, while his Mariners teammate Miguel Olivo underwent an MRI on his hamstring after cramps took him out of the game prior to Gimenez’s injury… Jason Bourgeois' strained right quad will end up costing him time on the disabled list…Manny Acosta was taken out of yesterday's game with a hyperextended wrist. No updated prognosis has been given yet.