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Diamond Cuts: Taking a Toll

Jeff Stotts

Jeff Stotts

Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association.

Pitchers

Tommy Hanson

The Braves' playoff push continues without their young ace. Hanson has been placed on the 15-day disabled list with rotator cuff tendinitis. A MRI did not reveal structural issues but the Braves must determine the cause of the problem. Hanson spent time on the DL in June with inflammation in the shoulder and clearly it remains a problem. It sounds like Hanson is dealing with a shoulder impingement, a condition that occurs when soft tissue structures like muscle and tendon are compressed in the shoulder. Pitchers often exhibit impingement related to instabilities that develop due to the repetitive motion that comes with pitching. Constant overhead motion often leads to hypermobility of the shoulder and occasionally can lead to subtle movement of the head of the upper arm bone, the humerus. This shrinks the space that the tendons of the rotator cuff and biceps occupy and makes them vulnerable to being pinched. If the impingement continues, a tear can develop in the cuff.

Hanson has received a cortisone injection, designed to decrease the inflammation in the shoulder. This should help minimize the current impingement but some change must be made to prevent this from occurring once again. Since the MRI did not reveal any bony structures causing the pinching, the easiest course of treatment is rehab focusing on strengthening the shoulder muscles to stabilize the laxity. A change in pitching mechanics could also solve the problem but are difficult to make this late in the season. Furthermore, fantasy owners hoping to have Hanson for the stretch run do not want their guy tinkering with his mechanics. Look for Hanson to return in the next few weeks but expect him to be handled with kid gloves as the Braves shift their focus to the playoffs. Rookie Randall Delgado pitched well in Hansonís place, limiting the Giants' offense to one hit in six innings. However ,Delgado has already returned to Triple-A with Jair Jurrjens expected back Wednesday.

Cole Hamels

Like Hanson, Hamels has inflammation in his throwing shoulder. A precautionary MRI revealed inflammation in the posterior rotator cuff muscles, likely the subscapularis. Again determining the root of the problem remains key but it doesnít sound like this is as severe as Hanson. However, when you couple the MRI results with his recent drop in velocity, the signs are pointing toward Hamels hitting a bit of a wall. He is slated to miss his next start, recovering from the dye injection required for the MRI. Lower your expectations over the next few starts until the two-time All-Star proves he has battled through the fatigue and the inflammation is under control.

Jon Rauch

Rauch will miss the next three-to-four weeks after having his appendix removed. The appendix extends from a portion of the colon known as the cecum. Many believe it no longer has a true use, but others have argued its role in digestion. Regardless of its function, the appendix often goes unnoticed unless it becomes inflamed. Appendicitis causes an individual to experience flu-like symptoms and stomach pain and often requires the appendix to be removed. The injury becomes a medical emergency if the appendix ruptures, spilling its contents into the abdominal cavity. Fortunately, Rauch avoided a rupture and will just need time for the wound to heal. In the meantime those in desperate need of saves can look to add Frank Francisco, who will take over closing responsibilities while Rauch is out.

Hitters

Carlos Beltran and Derrek Lee

The Pirates and Giants both made deadline deals to add a veteran bat to their lineups. Sadly both Beltran and Lee are on the DL after suffering hand and wrist injuries.

In San Francisco, Beltranís surgically repaired knee has held up, but a hand injury has forced him to sit out of eight games before the Giants finally placed him on the 15-day DL. Beltran is battling a strain in the back of his right hand, between his middle and ring fingers. X-rays were negative but Beltran did require two cortisone shots to help with the inflammation. The injury is severely limiting his ability to swing a bat and the situation is reminiscent of the one Rockies outfielder Carlos Gonzalez dealt with earlier in the season. Even if Beltran returns next Tuesday when eligible, his powers numbers are likely to suffer.

Lee is also on the 15-day with a fractured wrist expected to sideline him for two-to-four weeks. He lasted five games for the Pirates before being struck by a pitch from former teammate Carlos Marmol. X-rays were negative but a CT-scan revealed the break. Lee does have a history of wrist problems but those were in his right wrist not the currently injured left. Unfortunately his track record remains less than stellar, as the earlier injury required a lengthy recovery window. With the Pirates stumbling and Leeís shaky past, donít count on the veteran for much production, particularly in the power department, down the stretch.

Rajai Davis

Davis has been placed on the DL with a torn hamstring suffered in a win over the Angels. Davis felt a pop in his left hamstring as he sprinted to first and a subsequent MRI revealed the tear. Less severe hamstring injuries have sidelined Jose Reyes and Adrian Beltre for extended periods of time so itís hard to imagine a speedster like Davis making a quick recovery. He is likely done for the remainder of the season and teams in need of stolen bases will be forced to look elsewhere.

David Ortiz

Big Papi is sporting a walking boot to cushion a tender right heel. A MRI revealed Ortiz is dealing with a case of heel bursitis, a condition that can be very painful. Fluid-filled sacs known as synovial bursa sacs are located in various spots around the body. These sacs often sit in between tendons and bones and help reduce friction between the two structures. Located behind the heel bone (the calcaneus) and under the Achillesí tendon sits the retrocalcaneal bursa. If irritated with repetitive motion or a heavy workload, the bursa becomes inflamed causing pain and limiting range of motion in the ankle. Flat feet or high arches can predispose an individual to the condition and Ortizís girth may have also played a factor. Cortisone injections are not often used to treat this particular injury and the most common treatment is a conservative approach focusing on rest and limiting the amount of weight placed on the area. (Thus the protective boot.) Ortiz is considered day-to-day and hopes to avoid the DL. Expect him to be sidelined for several more games with a DL stint probable if the inflammation remains.

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