Under The Knife: Crawford's return a matter of mind as well as matter
Carl Crawford will have PRP injections and rehab sprained elbow for three months
History shows Michael Pineda's return from labrum surgery anything but certain
Aubrey Huff, Ginats believe anxiety issues will not sideline him for very long
Speed is tempting. When a big injury breaks, it's always my first instinct to get to work, to hit the phones and get something going. That doesn't always work, even in a world where Twitter isn't fast enough for some people. The other side of that coin is to wait until there's enough information to be comprehensive. The right place to be is somewhere in the middle, getting the info you need to you at the right time. I hope I've hit that spot today. Now, on to the injuries:
The change might have only been one letter, but the idea that Crawford is dealing with a sprained elbow rather than a strained elbow is a huge difference. Look, the fact that the words and concepts are close make it tough to keep straight sometimes; I'll guarantee you that at some point this season, I'll accidentally refer to one as the other. It's like naming identical twins something that rhymes. The sprain is worrisome, especially in combination with a visit to Dr. Andrews, but this reminds me of the couple times that A.J. Burnett was sent to see Andrews. Burnett's Tommy John surgery had been done by Andrews and anytime Burnett felt the slightest twinge or soreness in his elbow, he needed the reassurance of Andrews. Once Andrews said he was fine, he was. Crawford's sprained elbow could be serious, but we have very little indication that it's Tommy John serious at this stage. Late news is that Crawford's sprain is not serious enough for Tommy John surgery. Instead, he'll have PRP injections and rehab for three months. Given his home field, throwing is less a concern than in most parks. It's not the worst case that it seems Red Sox fans were expecting, but it's not good either.
The Yankees got the bad news on Wednesday. Pineda has a torn labrum and will need surgery, ending his season and putting his career in jeopardy. Any time there's a labrum injury, an article I wrote back in 2004 comes up. The article, like most things that happened back when I was using my Sidekick, is a bit obsolete. Thankfully, sports medicine has moved forward in the last eight years. Shoulders are still tougher to heal than elbows, because the shoulder is a vastly more complex structure. Even this year, I heard some of the top doctors in the world asking questions of Dr. Steve O'Brien about his research into the labrum after he presented at ASMI.
The question is not so much what the Yankees will do now, but how this happened. The Yankees didn't receive a "damaged player," as both Brian Cashman and GM Jack Zduriencik agreed Thursday. Pineda was risky, a young pitcher who'd run hard into workload issues last year. Pineda had an MRI on his elbow and shoulder as part of the trade physical. (Pineda missed most of the '09 season with an elbow injury.) The assumption has to be that the seasonal fatigue was still in effect by the time Pineda showed up to camp and that the minor microtraumas of normal wear and tear quickly developed into this anterior labrum tear. There's no evidence that this was a single, traumatic injury. O'Brien's research highlights that we're still not even sure how the labrum is damaged in repetitive stress injuries, so there's absolutely no way of pinpointing how or why Pineda was injured. Still, the Yankees believe it happened recently, during a bullpen session last week.
The surgery is pretty straightforward, though there's more variance in how various surgeons operate. (For a unique view on this surgery, check out Curt Schilling's blog post about his surgery.) because of the varying views on what the shoulder's inherent biomechanics should be. Each surgeon looks and tries to put the puzzle back together. The ideal would be to put it back exactly as it was before injury, but Dr. Neal ElAttrache once compared this to trying to solve a puzzle without the box top. Instead, surgeons are forced to try to either guess what it was like based on their view and available imaging or to put it back based on the best research to try to prevent what's happening again. There could be other damage in the shoulder (and likely is) that could be repaired at the same time, which could alter both the surgical technique and the rehab and recovery.
The best case scenario is no longer Rocky Biddle. There are examples of pitchers coming back from this to varying degrees of success. Curt Schilling, Erik Bedard and Chris Carpenter cover the broad range of outcomes. My colleague Dan Wade dug into the injury database and came out with over 50 names, including 33 over the last three full seasons. Here are the names and I've put in bold the ones who have returned to level:
2011: Matt Daley, Cole Kimball, Evan Meek, Clayton Richard, Jon Garland
2010: Damaso Marte, Alberto Arias, Kevin Hart, Dirk Hayhurst, Bobby Seay, J.P. Howell, Kris Benson, Tyler Walker, Cory Wade, Adam Ottavino, LaTroy Hawkins, Jason Berken, Angel Guzman
2009: Boof Bonser, Jeff Francis, Joaquin Benoit, Brandon Webb, Dustin McGowan, Chris Young, Eric Hurley, David Davidson, Scott Olsen, Erik Bedard, Rich Hill, Doug Waechter, Mike Hampton, Jose Ascanio, Mark Difelice
There are not a lot of positives there. You have a slightly worse chance of being a New York Times best selling author as you do coming back to being a major league pitcher. Dan noted that this seems to be an older player's injury, with few matching up well with Pineda's age and stuff. The best comps he could find were Anibal Sanchez and Gil Meche. Pineda's surgery will happen soon, but the story is far from over.
With Pineda out, Pettitte moves from luxury to necessity, leaving many wondering if the Yankees knew that could well be the case back in March. (My guess -- they thought this was a possibility and were smart to give themselves the option.) Pettitte only made it through 81 pitches in his first outing at Trenton, but this was more about work than anything else. Pettitte himself was down on the outing, saying he was disappointed with his command. There's no sign that there's degradation of his raw stuff, so command and control should come with more work. Pettitte is on a minor league deal, so there's no timetable as if this were a minor league rehab. The expectation is that Pettitte will have two more outings at Trenton (AA), assuming that the command comes back and he gets near 100 pitches of stamina. Trenton will be the base, due to its proximity to the Bronx, where Pettitte can be checked by the medical staff if need be, and because the Yankees' AAA team is barnstorming this season.
Duffy is one of the young players the Royals were counting on to move up in the AL Central this year. Instead, after a long outing in which he lacked control, Duffy will miss his next start, but the Royals are already saying that they believe Duffy will make the following start. The 23-year old is being watched by last year's best medical staff, but this has to be concerning for Royals fans and fantasy owners. Control is often the first indication of an elbow injury, as the body tends to compensate by a last second shift, moving the hand position and causing release point problems. That's exactly what seems to be going on with Duffy. With Felipe Paulino getting closer to a return, there's going to be the possibility of being very conservative with Duffy. I trust the Royals medical staff, but this will be a high profile test.
This column wouldn't exist if it weren't for panic attacks. I suffered severe, debilitating panic attacks for over a year and it was during the time I was nearly housebound that I started writing Under The Knife. Between this column and an amazing therapy called EMDR, I was able to get back in the world. So I know what Huff is going through, but I can't understand it exactly. Mental illness doesn't need to carry a stigma, and I'm glad that Huff is not only getting help for his issue, but isn't afraid to have the information released. There have been players in the past who have come up with "hamstring strains" to mask an episode and that's OK. I've played along in this column because while I always want to get you the best information, I do understand a fundamental right to privacy. There's no telling how this will go, but indications are that the Giants and Huff believe this will be short term.
Ryan Zimmerman had a cortisone shot in his shoulder. If he needs a second one, the Nats are indicating they'd put him on the DL with a retro move. This is a concerning issue with his shoulder, more for the long term than the short ... Shin-Soo Choo won't be back over the weekend, but the Indians seem happy with the progress his hamstring has made ... Javy Guerra got hit in the jaw by a comebacker. He's very lucky and should consider boxing if this pitching thing doesn't work. He'll be held out a day, maybe two, as much for rest as for the bruise ... Jim Johnson is out with flu, giving Pedro Strop a couple save chances. Johnson should be back soon, but Strop could see a couple more chances while Johnson gets back to full strength ... Chris Parmelee took a nasty pitch to the head. The team says there was no sign of concussion, but that they would be cautious with a return. All the team needs to do is glance over at Justin Morneau to remind them why taking their time is the smart play ... A scout for an AL team recently saw Scott Rolen play. He told me "his swing is back," which tells me the shoulder surgery he had this offseason is working ... Worst part of this is that it was clearly called. Best part was Buster Posey's response ... Doug Fister is throwing off a mound, a very good sign. He's still a couple weeks away from a return ... Grady Sizemore has started some baseball activities, but he's not eligible to return before early June. He could begin a rehab assignment before that ... Jeremy Bonderman sat out last season. He had Tommy John surgery recently and will use the rehab to ramp him up toward an attempted comeback ... If Yankees fans are looking for a bit of hope, maybe they should look at Boston. Rich Hill is coming back from a torn labrum and from Tommy John surgery. He's pitching well and could be in the Sox bullpen soon ... I'll be in Dallas this weekend, getting a look at two of the top teams in baseball. The Rays and Rangers are going to factor into a lot of fantasy decisions this season. Due to the trip, I'll be off Monday, but you can always follow me on Twitter for the latest updates.
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