Over the last week or so we’ve had injury news surface regarding three of fantasy baseball more volatile closers: Jonathan Broxton, Brandon Lyon and David Aardsma. I know what you’re thinking, these guys all suck, who cares if they’re injured, I already dropped them before they got hurt because I’m a fantasy baseball wizard and dominate my 8 team public league! Well I care, as do folks who play competitive fantasy baseball, and as the resident PT for the SoR, it’s my duty to please that injured booty, even if that booty is big and nasty like Jonathan Broxton’s.
Speaking of Broxton, he’s out with what is termed a “bone spur” and “bone bruise” in his pitching elbow, confirmed by MRI. The latest timetable per Rotoworld has him missing 6 weeks, including not throwing at all for the next 2-3 weeks. Broxton’s doctors don’t think surgery is necessary, but they’re dirty liars. Ok they’re not technically lying and chances are the only thing dirty about them is how filthy rich they are, but they’re bending the truth a bit here. There’s a bone spur in his pitching elbow, which is exactly what it sounds like: a jagged boney growth that’s not supposed to be there and IS IN HIS PITCHING ELBOW. That spur WILL require surgery to be removed at some point in time as these things don’t magically disappear with rest and only increase in size with repeated stress.
What will determine exactly when he will have surgery are his symptoms and whether or not the spur is catching or rubbing on any soft tissue, creating inflammation or damage. His MRI has already revealed a “bone bruise” in the elbow, so unless Broxton got drunk and fell directly on his elbow, chances are that bone spur is rubbing against the soft tissue around the elbow, creating the inflammation. The Dodgers will have him rest the elbow for a few weeks to let the swelling calm down and then gradually work into a strengthening, flexibility and throwing program as his symptoms allow. The 6 week timetable is about right if everything goes smoothly, however I’m a pessimist and don’t think he’ll be back that soon, and as I mentioned, with a bone spur there already it’s not a question of if, but when, he’ll require surgery to remove it. If he starts his rehab and it’s still symptomatic, the Dodgers will likely shut him down and he’ll be looking at a scope surgery to clean out the joint, which would probably put him out of commission a minimum of 6-8 additional weeks (and likely longer). It’s not out of the realm of possibility that Broxton doesn’t pitch again this year.
Prediction: Broxton returns to the Dodgers in 8-10 weeks but remains somewhat wild and ineffective as the time off saps both his arm strength and control. He is never fully trusted with the 9th inning again this season, and has off-season elbow surgery to resolve the issue.
Brandon Lyon has a partially torn rotator cuff. I’ve said it before and I’ll say it again: rotator cuff injuries are the worst injuries a pitcher can have. If I’m a pitcher and I had to choose between having Tommy John elbow surgery or rotator cuff repair surgery, I’m taking the TJ all day and twice on Sunday. The severity of the tear has not been reported, but the good news here is that’s it’s not a complete or full thickness tear, because if it was he’d already be having surgery. The fact that the specialist he visited thinks it can be fixed conservatively is a good sign. Will the tear in his cuff heal? That’s a tricky question because it depends on the location. Tears within the “meat” or “belly” of the muscle heal well as there’s rich blood supply and generally less tensile stress on the area. Tears on the tendon (connective tissue-like part of muscle that attaches it to bone) do not heal as well, there’s much less nutrition to this area and any time the muscle contracts it’ll pull on the tear, irritating things or tearing it further. In addition to the cuff tear, he’s got biceps tendonitis. It’s common for these injuries to occur together (remember Brad Lidge’s injury was first thought to be a strained biceps, ended up being a cuff injury also). The biceps injury is much easier to manage; rest and medication can fix that. If this was an isolated biceps tendonitis, I’d be much less concerned.
Timetable wise, we’re probably looking at something similar to Lidge’s recovery: 2-3 months at least I would anticipate. Lyon was given an injection to reduce the swelling, which will expedite his ability to rehab the area, but he’ll still need to proceed slowly or risk re-injury (or tearing it worse). If Lyon doesn’t respond to injections and rehab, the only remaining option is surgery. For a pitcher who doesn’t have great velocity to begin with, rotator cuff repair surgery might spell the end of Lyon’s career. The other factor we need to consider here is that Brandon Lyon is terrible. There is no amount of rest or rehab that will make him good. The timetable for a return to being a good pitcher is never. Even if he returns healthy, the best case scenario is you have Brandon Lyon, so it’s a lose-lose no matter how you slice it.
Prediction: Lyon misses the next 3 months of the season as his rehab takes longer than hoped and there are a few setbacks along the way. He finally returns to the Astros bullpen in late August and never regains his closer role as Wilton Lopez has taken the reigns.
David Aardsma has yet to appear in a game this year due to his recovery from hip surgery during the off-season. From the reports I’ve read, his hip is going great. Unfortunately, Aardsma does not throw a baseball with his leg, although if he did that may explain his control issues during his rehab outings. News has surfaced that Aardsma has a “grade 2 UCL sprain” in his throwing elbow. He’s going to see Dr. Yocum, the elbow surgeon to the stars (Dr. Yocum, if you read fantasy baseball blogs and see this article, please hire me to work for your rehab department). Gulp. First, I’d like to thank the Mariners for providing the grade of the sprain, most of the time we never hear such specifics. Anybody can Google a grade 2 sprain and see what it is, I’ll spare the long explanation. The important part to understand is that grade 2 sprains are in fact legitimate tears, and tears of ligaments don’t tend to heal very well. Through rest and rehab, you hope that improved muscular support and scar tissue will develop around the tear and provide the stability necessary for a fully functional elbow. I hate to name drop again, but guess which big name pitcher came into this year with a partially torn UCL that team doctors thought would be fine because there was plenty of scar tissue holding things together? Adam Wainwright. Generally speaking, if you have a tear in the UCL and you’re a throw a baseball for a living (R.A. Dickey excluded), it’s probably more of a question of when, not if, you need Tommy John surgery.
Aardsma and the Mariners have 2 choices here, rest and rehab or jump right to exploratory surgery (and repair the UCL if necessary). As of this writing the plan is TBD until Dr. Yocum examines Aardsma, so time will tell. If rest and rehab is the approach, we can expect around an 8 week timetable. He’ll need to rest and let the swelling and pain subside, rehab the muscles and regain any lost flexibility or strength, and then begin a gradual throwing program. Let’s also keep in mind that this elbow injury came in the middle of his rehab stints for his hip, he’ll still need to deal with that issue as well. Even in the best case scenario I can’t see Aardsma returning before the All-Star break, and I’d expect later. Even when he does return, I would expect him to require a considerable amount of time to find his form, and with Brandon League pitching well so far, the Mariners have little reason to rush Aardsma back as the closer. To make matters worse for Seattle, this injury pretty much wipes out his trade value, as he was probably one of the better trade chips the M’s had. Not a good situation, unless of course you have League on your fantasy team, in which case the news could not be much better.
Prediction: Aardsma rests and rehabs for the next 8 weeks, then goes back on a rehab assignment. Upon pitching back to back days, Aardsma re-aggravates the elbow, and the decision is made to proceed with TJ surgery. Aardsma misses the remainder of 2011 and most if not all of 2012, and the Brandon League era becomes official.
A little known fact about the biceps is that it has 2 attachment points in the shoulder region, referred to as the short head and the long head. When you hear biceps tendonitis, 99% of the time it's the long head, as it's attachment point is on the top part of the "socket" portion of the ball and socket shoulder joint. The tendon of the long head also travels through the shoulder joint space and is positioned within a groove in the upper arm, and repeated rotational forces such as those seen in throwing motions cause the tendon to undergo a lot of friction as it slides back and forth in this groove. Excess movement will generate inflammation, aka biceps tendonitis. This is why rotator cuff tendonitis and biceps tendonitis tend to be seen together as both are positioned in similar locations and can be injured when put under similar stresses.
It's anyone's guess as far as Morneau, concussions are not an orthopedic issue and thus outside my scope of practice, and really there's no concrete timetables to this sort of thing. I'm not sure what medication he's taking that would limit his weightlifting routine, but it wouldn't surprise me if they're very careful about the way he exercises. Dizziness, blurred vision, headaches, these are the typical side effects of concussions, and rigorous exercise can also have similar side effects. The last thing Morneau or the Twins want is for him to overdo it powerlifting and re-aggravate his symptoms. Could he bounce back this year? I guess so, the Twins lineup has been awful and is ravaged by injuries, perhaps when Mauer, Young and Nishioka return they can provide a little more protection for him, and perhaps he just needs time to find his stroke, but I'm not optimistic here. It pains me as a Twins fan to say it, but I don't think we'll see the MVP caliber player we're used to seeing this season. Perhaps if he's symptom free for the rest of the year, finds his timing at the plate and is able to participate fully in his usual offseason workouts, he might be a nice buy-low guy for next year's drafts.
Excellent work as always. Any reason bicep tendonitis usually occurs along with cuff tears? Is it the bicep trying to overcompensate?
Also, whats your read on Morneau's health situation. Last I read he was taking some kind of medication and being limited in his weightlifting routine. That, paired with the flu, led him to lose 15 pounds he hasn’t been able to put back on. Is there light at the end of the tunnel for Morneau owners?