Print and Go Back ESPN.com: Bell [Print without images]

Wednesday, July 1, 2009
Good news, bad news about Beltran, Beltre


They say good things happen in threes. Indeed, there were three very successful returns this week: Asdrubal Cabrera, Scott Kazmir and Roy Halladay all rejoined their teams. They were successful because these athletes proved they were back healthy enough to perform and not suffer day-after setbacks.

Cabrera, returning from a separated shoulder (AC sprain) was able to hit successfully in his first outing … and again in his second. He also managed his duties at shortstop without incident.

Kazmir showed that he was over his strained quadriceps, and past the mechanical issues that have been troubling him, during his start Saturday night, his first outing in more than a month. He struck out five and showed solid command of his pitches. The Rays (and fantasy owners) have to feel good going forward about how he will contribute in the second half.

Halladay pitched well, and the groin was clearly not a factor as the Jays faced the Rays. Despite giving up a two-run homer to Carl Crawford and taking the loss, Halladay was overall solid and still nabbed seven strikeouts. Most importantly, he showed no evidence of being limited by the groin and appears to be beyond the injury.

So much for the good news; now we move on to the injuries of the week. Who's got our attention? Naturally, we start with the Mets …

Carlos Beltran
Carlos Beltran's return is still unknown, but at least there's a decent chance he can return this season.

Carlos Beltran, OF, Mets: It's never a good sign when you're batting leadoff in this column two weeks in a row. Unfortunately, such is the case for Carlos Beltran, who has been on the DL for more than a week now and does not appear to be coming off anytime soon. Last week in this space, we outlined the injury Beltran was dealing with and speculated that his time away would be extended beyond 15 days. Indeed, that appears to be the case.

Beltran made a trek to Vail, Colo., this week to get a second opinion from Dr. Richard Steadman. The choice of Steadman as consultant raised some eyebrows, since his expertise is associated with microfracture surgery, a procedure that he helped pioneer. Although Beltran's agent, Scott Boras, claimed that seeking out Steadman simply represented seeking an independent opinion, you don't take your Ferrari to a Rolls-Royce dealer, even if the latter is accustomed to dealing with high-end automobiles. The Ferrari engine is entrusted to an expert in Ferraris.

Beltran is dealing with a bone bruise, an injury often associated with cartilage damage. Microfracture procedures are performed to address cartilage defects. Evaluating cartilage injuries is a critical component of determining when microfracture surgery is indicated. It does not appear to be a coincidence that an athlete with a worsening bone bruise would seek an opinion from another orthopedist well versed in cartilage injuries, especially within the knee. (It should be noted that Mets team physician Dr. David Altchek is very experienced in managing cartilage injuries as well.)

The good news? Steadman supported Beltran's original diagnosis of a bone bruise and recommended continued rest and rehabilitation. No microfracture surgery for Beltran (at least not now), which would have effectively ended his season.

So why the cause for concern? It's the uncertainty around the resolution of Beltran's condition. How well will Beltran heal, and how long will it take? Just because he's not headed for the operating room doesn't mean we can be certain that he will recover to such a degree that he can play consistently and effectively this year. Although many bone bruises do heal with time and rest, it is not an absolute. The timetable can vary and in a situation like Beltran's, in which the condition has recently worsened, it becomes less predictable.

Consider also that Beltran had arthroscopic surgery on both knees in 2007. Beltran underwent debridement of both patellar tendons, the large tendons that cross the kneecap and anchor the quadriceps muscle to the tibia (shinbone). While the two conditions could be independent, it is also possible that some of the biomechanical features of Beltran's knees that led to patellar tendon problems are at work here.

The plan now is to keep Beltran moving at a gradual pace, with a target of returning at some point after the All-Star break. Fantasy owners need to bear in mind that this is primarily a symptom-based rehab progression, meaning Beltran's activity will largely be determined by how he feels (although subsequent imaging studies can also provide information as to how the bone bruise itself is progressing). The key for the Mets will be whether Beltran's symptoms can decrease enough and whether enough healing can occur to allow him to return successfully this season. If so, the team may still need to re-evaluate Beltran's status at the end of the season to determine what, if any, steps to take next.

Mike Lowell, 3B, Red Sox: Lowell and his sore hip have been relegated to the DL. It's no secret that Lowell's surgical hip (he underwent a labral repair and bony resurfacing of the hip joint) has been giving him trouble recently. Specifically, Lowell has complained of tightness in the hip.

Lowell did take some comfort in the fact that his doctors did not seem surprised by the presence of such symptoms. It is worth remembering that Lowell underwent a procedure to address changes within his hip joint. This tissue injury is often associated with early arthritic changes (wearing of the cartilage surface) within the joint. This can translate into intermittent pain, stiffness and swelling. Indeed, Lowell was experiencing swelling as he had fluid drained from his hip Monday. He also received an injection of a synthetic lubricant designed to alleviate stiffness.

Since joint changes cannot be reversed, it becomes essential to focus on protecting the joint from degenerating further. Procedures such as this, along with a maintenance program that includes regular rest, can help a player like Lowell continue to perform.

Grady Sizemore, OF, Indians: Sizemore was able to return to play with the Indians after a stint on the DL with elbow synovitis. We cautioned last week that Sizemore might still be faced with intermittent pain across the season and that consequently the Indians might choose to rest him from time to time.

Those thoughts were essentially confirmed this week by Indians athletic trainer Lonnie Soloff, who told the Cleveland Plain-Dealer that Sizemore will "have symptoms the balance of the season," adding that the Indians hope to "keep him away from symptoms that will affect his performance." In fact, Soloff acknowledges that Sizemore likely will face offseason elbow surgery to fully address the condition. Fantasy owners need to monitor Sizemore's status on a regular basis.

Adrian Beltre, 3B, Mariners: Beltre underwent surgery this week to remove a bone spur from his left (non-throwing) shoulder and is expected to be out of action for six to eight weeks. It's possible he could be on the low end of that scale, based on the overall health of Beltre's shoulder. One good thing about shoulder surgery in a situation like this is that it gives the surgeon a chance to examine the overall health of all the tissue in the joint. Beltre's surgeon, Dr. Lewis Yocum, reportedly saw some bursitis, but structurally everything was intact.

This isn't Beltre's first encounter with a spur. Beltre underwent similar surgery last year, but pain gradually returned and got to the point that Beltre couldn't swing the bat effectively. A concern with spurs, which tend to form in response to abnormal stress, is that the spur can be a sign of structural compromise, or the spur itself can damage surrounding tissue. This report is about as good as it gets for Beltre, so fantasy owners can take heart. Once Beltre is cleared to resume baseball activities, watch closely for signs that he is nearing return.

On the Mend

Cubs third baseman Aramis Ramirez takes yet another step toward rejoining his team. Ramirez, returning from a shoulder dislocation in May, is scheduled to begin a rehab assignment Friday and, if all goes well, could return to the team next week. So far, batting practice has gone well, although he is still reportedly (and understandably) guarded on some swings. Fantasy owners should keep an eye on how he performs in his rehab assignment for clues as to how he will do when he returns. His power may be a bit slow to return as he gets more comfortable with letting the shoulder go when swinging the bat. Consider Ramirez a work in progress.

Last week we noted that Phillies outfielder Raul Ibanez was making improvements and was hoping to return on or near his eligible date of July 3. We also noted, however, that the big test would come when he had to run full speed or make quick lateral movements. As it turns out, Ibanez really hasn't been able to push himself that hard. According to the Phillies' official Web site, general manager Ruben Amaro Jr. said of Ibanez, "One day he can be doing great, and another day not as great." The encouraging news reported by the Philadelphia Daily News is that Ibanez could potentially begin a rehab assignment Wednesday night if he wakes up feeling good that day. While the Phillies are still leaving the door open for him to rejoin the team this weekend, it appears unlikely, given his iffy day-to-day status. Nonetheless, if he feels good while on assignment, he might be able to return within the week. Fantasy owners should check daily lineups.

Reds pitcher Edinson Volquez has been cleared to begin a throwing program, according to the Cincinnati Enquirer. Volquez, who has been out with elbow inflammation that resulted in irritation of his ulnar nerve, will be moving very slowly, starting with tossing from 60 feet. It's not time to get too excited yet, as the inflammation could recur at any stage. But at least there's some forward progress.

Keep a close eye on Erik Bedard. The Seattle Times is reporting that if a Wednesday bullpen session goes well, Bedard could pitch for the team as soon as Saturday, albeit in a short outing. This is an interesting idea. I would have concern about bringing him back so soon without building up his endurance, particularly in a pitcher who's shown to be susceptible to soft tissue injuries (his most recent setback was in the shoulder that was operated on just this past year). If he does start Saturday, it's probably a good idea to wait and see how he handles it before inserting him back in your lineup.

And finally … the long-awaited return of Pirates catcher Ryan Doumit may be approaching. Doumit, who has been out since April following surgery to pin a fractured scaphoid bone (at the base of his thumb near the wrist) is headed for a rehab assignment this week and could rejoin the team mid-month, according to the Pittsburgh Post-Gazette. The slow progression has been due more to a cautious approach (which is wise) on the part of the Pirates, not setbacks by Doumit. As with many thumb and hand injuries, the key will be whether he initially struggles with his grip and power at the plate.