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Diamond Cuts: An Aversion To Avulsions

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.

Paul Goldschmidt

The Diamondbacks season has been a major disappointment and now their most consistent offensive weapon is done for the season. Goldschmidt was hit in the left hand by a pitch late in Friday's loss to the Pirates. X-rays later revealed a fractured fourth metacarpal, the bone of the hand located directly below the ring finger. The injury is often referred to as a Boxer's fracture as it commonly occurs following a punch. However in a true Boxer's fracture the bone snaps because it's overloaded with an axial force. In Goldschmidt's case, the mechanism of injury was a direct blow. This actually helped the Arizona slugger avoid surgery as the bone did not displace and remained broken but aligned. While this has to be considered a win, it doesn't mean much for his availability this year. The Diamondbacks have set his recovery and rehab at a reasonable eight weeks, effectively ending his season. He's worth stashing if you have the room but can be dropped in non-keeper situations should you need to place another player on the disabled list.

Cliff Lee

It also seems reasonable to believe Lee will be lost for the remainder of the season after he aggravated his left elbow injury. Lee recently returned from a two-month hiatus following a flexor pronator strain in his throwing elbow but reinjured the muscle in most recent outing. The former Cy Young winner visited with team physicians that confirmed the diagnosis, though a trip to consult with renowned orthopedist Dr. James Andrew remains likely. Lee will likely spend the last few weeks of the season and the entire offseason resting and rehabbing his elbow. The extended break should allow Lee to be ready for next season as well as provide additional time to determine if a biomechanical issue is causing the problem in his elbow. Keep a close eye on Lee's offseason to get a better idea of his value entering the 2015 season.

Andrew McCutchen

The reigning NL MVP could be placed on the DL for the first time in his career following a midsection injury. Initially it was believed he had suffered an oblique strain but further testing revealed he suffered an avulsion injury in his rib cage.

The rib cage is made up of 24 ribs (12 on each side), the sternum (more commonly known as the breastbone), the thoracic vertebrae, and a type of connective tissue known as costal cartilage. The costal cartilages of ribs 1 through 7 attach directly to the sternum and the manubrium and body of the sternum. However the bottom two ribs, ribs 11 and 12, and their costal cartilage do not attach to the sternum. However the still serve as anchor for ligaments and muscles, creating the environment for McCutchen’s injury. A muscle in the area of the 11th rib did not tear but instead pulled away a piece of the chostochondral cartilage. A costochondral injury is a very significant injury and can take longer to heal than a fracture. Sharp pain is normal with the affected individual often experiencing a stabbing pain for several days after the injury occurred. The injury can elicit pain with breathing, sneezing, and trunk movement.

The Pirates are currently waiting to put McCutchen on the DL, hoping an alternative treatment can allow him to return to play. The move will be maddening to fantasy owners who will have to simply bench an inactive player. A trip to the DL still is likely but Pittsburgh is going to wait as along as they can before making that decision.

Masahiro Tanaka

The Yankees right-hander is hoping to return this season despite a partially torn ulnar collateral (UCL) in his throwing elbow. Tanaka put off Tommy John surgery in hopes that an alternative method of treatment will help enough to allow him to pitch again this season. Three weeks ago Tanaka underwent a platelet-rich plasma injection in the injury site. The procedure is designed to accelerate the body's natural healing process using the injured athlete's own blood. A small sample of the athlete's blood is placed into a machine known as a centrifuge. The centrifuge spins the blood at a high speed forcing the various parts within the blood to separate. A protein-rich mixture is then taken from the sample and injected into the area of concern. The PRP mixture is filled with platelets, the primary component of blood responsible for clotting. The idea is that by introducing high concentrations of platelets at the point of injury, the healing process becomes faster and more efficient.

Tanaka took a small step forward Monday, throwing 25 pitches without pain. While the reports are good and throwing is a significant step forward, the Japanese ace still is ways away from returning to the mound. The Yankees have a detailed plan for his potential return, including at least one rehab start in the minors. The plan would put Tanaka back by September barring any setbacks. As a result, moving on from Tanaka appears to be the best scenario for fantasy owners fighting for a playoff berth.

Check Swings

Matt Cain: While Cain's UCL is intact, the bone chips in his throwing elbow remain. The bone chips are the root of the problem, causing Cain pain and his functional limitations. Cain was holding out hope that he would pitch again this season but instead has opted for surgery to excise the bony fragments. The surgery is slated for Monday and his season is over.

Edwin Encarnacion: The Jays slugger is hoping to begin a rehab assignment this week. E5 suffered a minor setback in his return from a quadriceps strain pushing back his return to the lineup. Quadriceps strains, like most lower extremity strains, are often easily aggravated so tread lightly with Encarnacion until he shows he's moved past the injury.

Matt Garza: The Brewers' right-hander was finally rounding into form, reeling off three straight outings in which he surrendered one run or less. However he was forced out of his pitching gem Sunday after straining his left oblique muscle. The obliques on both sides are utilized during throwing so the fact that injury occurred opposite his throwing arm is largely irrelevant. Garza has a history here having missed the first five weeks of the 2013 season with a similar injury. Garza stated the injury does not feel as severe as his previous injury but he’s already been sent to the DL. No firm timetable has been set but I suspect he will miss at least three to four weeks.

Carlos Gonzalez: The Rockies outfielder can't seem to put an extended period of good health together this year. After battling finger problems in both hands and tendinitis his knee throughout the season, CarGo rolled his right ankle during a recent warm-up. Pain associated with the injury kept him out for a game before he returned to the lineup. The return lasted two games before he aggravated the injury. Now the Rockies will wait and see if the soreness and swelling dissipates or if another DL stint will be necessary.

George Springer: Springer is in line to return from a left quadriceps strain at some point this week and potentially as soon a Tuesday. He was slated to begin a rehab assignment in Iowa paving the way for his return to the active lineup. However the same issues previously discussed with Encarnacion are in play for Springer and additional time should be allotted to allow the up-and-coming star to prove he's healthy.