BASEBALL INJURY REPORT TODAY
INJURY NEWS
The Baseball Injury Minute February 25-29
Is Gorzelanny Pitching Hurt
The Pirates have had their share of injuries to their young pitchers the last decade so you can understand some of the apprehension that is felt this spring regarding Gorzelanny’s tender pitching shoulder. It was 48 degrees yesterday and pitching in that kind of weather is a risk. So the Bucs get the benefit of the doubt. The bigger question is he having just normal early spring training soreness or does he have a problem with his pitching shoulder? Gorzelanny is on our 2008 Warning Flag list (available to subscribers) of pitchers who could struggle this season due to a big increase in workload. In 2006, Gorzelanny worked a total 161 1/3 innings and posted a career 201 1/3 last season. Last September, his monthly splits were a 5.77 ERA, 1.95 WHIP as he struggled to finish the season. We have already seen the negative results from his increased workload last season and the shoulder soreness may be a continuation of those struggles. Gorzelanny should be watched closely especially reports involving his velocity and if the tenderness continues. (Feb 29)
Scott Kazmir Likely to Miss First Start of 2008
The MRI is back and the diagnosis on his pitching elbow is a grade one strain of the elbow ligament. Most likely, it is the ulnar collateral ligament. The good news is inflammation is the main problem with all ligaments and tendons intact. He will be treated with anti-inflammatory medication and physical therapy. The current estimate indicates he will not face hitters for at least two weeks. Considering his value to the Rays, look for Kazmir to fall a couple of weeks behind the other Tampa Bay starters. Mostly likely, he will hang around in spring training and the Rays will skip his first start of the season to give him a bit more time to get healthy. (Feb 27)
Is Dontrelle Willis Another Steve Avery?
In 1991, Steve Avery, an athletic and lanky six foot four 21-year-old 
southpaw, burst onto the scene for the Braves. He won 18 games, posted a 3.38 ERA, 1.21 WHIP and worked 210 innings. At the time, the Braves and pitching coach Leo Mazzone were not concerned about the high workload because Avery had clean mechanics and he was athletic enough to handle the rigors of 210 innings, even at 21 years of age. Avery would record two more 200 IP seasons with his last coming in 1993 at the age of twenty-three. From 1991-1993, Avery worked 667 1/3 innings with the decline in his career starting in 1994. It has become a general rule in baseball not to work young pitchers below the age of 25 so hard. If we need a poster boy for why, all we have to do is look at Avery.
It is a give that every pitcher at the end of his career will have damage to his pitching shoulder structure. It may come in the form of a frayed labrum or rotator cuff or a general laxity (looseness) of the shoulder. The overhand motion is not a natural movement and it takes a toll on the body. In Avery’s case, his first trip to the DL occurred in 1996, but he was already in the free fall of his pitching career. He would land on the Dl three times in his major league career but never had major surgery. However, from 1994 on, the quality of Avery’s pitches and his velocity would decline. His career ended in 2003. Looking back, he is a classic case of burnout due to the heavy workload in his early 20’s.
At the age of 23, the six foot four lanky and athletic Dontrelle Willis worked 197 innings in 42 games. From 2005-2007 (ages 23-25) he would throw 665 innings. His career year to date occurred in 2005 as he posted a 22 win, 2.63 ERA, 1.13 WHIP season in 236 1/3 innings. His numbers and the quality of his pitches started to decline the next season. In 2005, his K/9 rate was 6.47 and has remained steady the following two seasons. The decline in his pitching has come in the area of command and control, not strikeouts. Last season, he needed 17.1 pitches per inning to record three outs. He walked a career high 87 and his SO/BB ratio has gone from 3.09 in 2005 to 1.68 last season.
It can be argued that Willis’ success early on came from a funky and deceptive delivery. Once hitters got a good look at his pitching, the arms and leg flailing all over the place were less intimidating. We also could argue a complicated pitching motion like Willis’ is difficult to repeat even for someone who is as athletic as he is. There are a lot of similarities between Steve Avery and Dontrelle Willis. Using Avery as a guide, Willis’ career maybe already in decline as the wear and tear of his pitching shoulder takes its toll. The Tigers must have felt he would turn it around in Detroit when they offered him a three-year extension. There was a time when the Braves thought Avery would turn it around too. (Feb 26)
How Bad is Brad Lidge’s Knee Problems?
Back on October 1, Lidge underwent surgery to repair damage to the meniscus cartilage in his right knee. The surgery repaired the damage to the medial meniscus (also known as internal semilunar fibrocartilage), the part of the cartilage on the inside of the knee (see graphic). At the time of this surgery, the meniscus was repaired not removed because the tears were small enough allowing for the repair. He spent six weeks on crutches then 6-8 weeks of rehab work. By early January, he had resumed throwing and did not suffer any setbacks from this surgery.
On the first pitch of his first bullpen session for the Phillies, he caught a spike on the mound and tweaked his surgically repaired knee. Initially it did not look that serious. Upon further examination from a MRI it revealed he tore more of the cartilage necessitating the need for a partial medial menisectomy. This is where the surgeon removes all or part of the damaged meniscus. Lidge underwent successful surgery on Monday to remove (15-18%) part of the medial portion of the meniscus. The lateral portion was intact and without damage. 
The Phillies say he will not be able to do anything baseball related for a week then he should get the green light to start long tossing. The current estimates have Lidge missing three-to-six weeks. Realistically, how the knee responds to treatment and workouts determines how long he will be out rather than the three-week range of time. If the surgeon discovers more damage than expect then his status for the early part of 2008 is in jeopardy.
The fact he is expected to resume throwing in a week hints that it will not be a complete removal of the meniscus which should bode well for the short term.
Because he has undergone two knee surgeries and rehab programs in four months probably means his return will be a bit longer than most expect. The Phillies will protect their investment and leave him behind in extended spring training for up to a couple of weeks just to make sure the knee is sound. A third surgery could end his 2008 season before it gets started. (updated Feb 25)
Is Curt Schilling’s Career Over?
Schilling has started the long rehab road back to the major after the Red Sox instructed him to rehab his shoulder rather than have surgery. Will this mean the end of his major league career? 
Let’s take a look at his medical history first. Back in 1995, he was diagnosed with a Slap Lesion (Superior Labrum Anterior to Posterior.). This occurs where the biceps tendon connects to the labrum and there is a tear. This surgery performed by Dr. Craig Morgan, not to be confused with Dr. Bill Morgan, the former Boston team physician who performed the infamous ‘ankle surgery’ during the 2004 postseason. In 1999, Schilling needed surgery to shorten and tighten the shoulder capsule. Again, the surgery performed by Dr. Craig Morgan. Last season, he was diagnosed with bicipitial dysfunction (the biceps tendon was starting to degrade in function and strength) leading to muscle weakness in his pitching shoulder. When he returned from the DL down the stretch, he had not regained the normal velocity on his pitches but was able to use guile to get the job done. Just before the start of the playoffs, he needed a cortisone injection to get him through the post season.
In December 2007, Schilling felt discomfort in the front of his shoulder and was shut down until January. When he attempted to resume workouts early last month, the pain was much more intense and he went to see Dr. Morgan. A contrast MRI was done on the shoulder that revealed significant damage to the biceps tendon. It was torn into several pieces longitudinally (length wise). Dr. Morgan consulted with the White Sox team physician who has done the procedure and planned to do a subpectoral biceps tenodesis surgical procedure. This is where a surgical screw is used to hold the biceps tendon in place to allow it to heal. Both Morgan and the consulting physician believed the injury would not heal without surgery. It is important to note there has never been a major league pitcher who has undergone this surgery. The Red Sox balked, insisting on an extended rehab program.
On February 9, Schilling was given a cortisone injection and told to avoid baseball related work for up to eight weeks. In the meantime, he is doing shoulder strengthening exercises. The Boston medical staff believes if he can avoid a setback, he could return in July or August. This is totally contrary to Dr., Morgan’s viewpoint.
Back in early January, Morgan told Schilling if he had the surgery in the next few days, he would have a 5-6 month recovery period. That would put his return during the middle part of the season. Because of the nature of the surgery, the odds were still against Schilling, but at least he had hope and faith in his personal physician. The window of opportunity for surgery to get Schilling back on the mound has now come and gone as the Red Sox fought the idea. According to Morgan, Schilling has no chance of returning by going the rehab route. In both 1995 and 1999 Morgan performed experimental and successful surgeries to keep him in the game. So it is easy to see why he has faith in Morgan. When you factor in his age, it is easy to see why this is the last year for Schilling and the odds are huge that he will not pitch in 2008 or ever again. At least his last outing was a win in the post season. (Feb 23)
Was Santana Pitching Hurt Late Last Season?
Toward the end of last season, there were rumors flying around the Twin cities that Santana was hurt. The speculation was based on reports he was avoiding throwing his trademark changeup and breaking ball at times. Was he hiding the pain because he was about to enter his free agent winter?
Part of the speculation was based on his numbers late in the 2007 campaign. We need to look at his numbers to see why there was speculation in 2007. Santana burst onto the scene in 2004 with an outstanding second half of the season. His ERA was 1.21, WHIP 0.88 and he carried both the Twins and fantasy teams alike. He duplicated the feat in 2005 with another terrific second half. In 2006, he became more consistent but just as dominating though his second half was of the more normal variety.
Late last season turned out to be very un-Santana like. His second half ERA was 4.04, the highest of his major league career. In September when the rumors were their strongest, he posted a 4.94 ERA but his WHIP was still a solid 1.23. His K/9 rate was 10.2 so he continued to garner strikeouts at a normal rate for him. Up until this point, we cannot conclude Santana was pitching hurt based on these numbers.
We still haven’t made the case that Santana was hurt last season. But you can bet we will be watching closely looking for more early game struggles any signs that he has an arm injury. (Feb 21)
| photo headshots of players courtesy of mlb.com |
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