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Diamond Cuts: Pessimistic Outlook For Ryan Howard

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.

Bryce Harper

The Nationals are preparing to play their interleague series against the Orioles without the services of their All-Star outfielder. Harper has remained limited after crashing into the outfield wall in Dodger Stadium on May 13. He was cleared for a concussion and needed stitches to close a laceration on his chin but was back in the lineup two days later. However his knee also hit the wall and has continued to give him problems. RotoWire's own Bernie Pleskoff noted Sunday that Harper seemed less than a 100 percent and turns out he was dead on. A new MRI revealed an inflamed bursa sac within the joint and he was not in the lineup Monday.

Bursa are fluid-filled sacs located throughout the body that serve to reduce friction in joints, particularly between bone and muscle. Think of a bursa sac like the ball bearing of the body. These sacs are vulnerable to direct blows, particularly in the elbow and knee. Following a collision the bursa can swell leading to pain and functional limitation. In some extreme cases the sac will rupture, causing the synovial fluid inside to escape. These areas are rarely drained unless the swelling is severe or an infection develops. Instead, treatment consists of anti-inflammatory medication, compression, and other modalities like ice and ultrasound.

Harper will do everything he can to minimize the swelling but the injury is likely to linger. Bursitis is easily irritated as Harper has already learned, aggravating the area multiple times in recent outings. Keep him in your lineup when he plays but until he adjusts to the injury or gets the inflammation under control, expect his lower-than-normal productivity to continue.

Ryan Howard

Howard is playing through a painful knee injury as well but his long-term outlook isn't quite as positive as Harper's. The former MVP is dealing with inflammation in his left knee that is reportedly the result of a damaged meniscus. The menisci are comprised of fibrocartilage and sit between the bones of the leg acting as buffer. They can be damaged in a variety of ways that lead to pieces of the disc fraying or breaking off. Generally these pieces are removed arthroscopically in a process known as a debridement. However Howard has elected to put off surgery and opt for a cortisone injection to help treat the associated inflammation. Cortisone is an anti-inflammatory, not a pain-reliever, but Howard should feel a decrease in pain as the swelling subsides.

Unfortunately treating the symptoms and not the root of the problem does little to help the slugger for the long-term. Howard will continue to deal with pain and could need another injection down the road. Furthermore surgery could become unavoidable if the damaged cartilage shifts. It could then act like a doorjamb, limiting the range of motion in the knee.

Things for Howard are even bleaker if you consider his previous injuries. In 2011, Howard battled ankle problems in his left leg. He utilized cortisone injections to treat the area which may have contributed to his ruptured left Achilles suffered in his final at-bat of the season. His return from Achilles surgery was delayed following an infection in the area. While there is no guarantee his previous ailments resulted in his current injury, it is very likely they contributed in some form or fashion.

If I'm a Howard owner I'm looking to unload him as soon as possible. His injury is one that will linger for the season and could ultimately require surgery. His long-term value remains low as well as multiple injuries continue to pile up on his lower left extremity.

Adam Eaton

Eaton continues to rehab the torn ulnar collateral ligament (UCL) in his left elbow. He was progressing nicely before suffering a minor setback while with Triple-A Reno. Fluid has developed in the area of the injury and Eaton has returned to Phoenix to meet with Arizona' team physician and eventually Dr. James Andrews.

While the Diamondbacks are downplaying the recent setback, it's hard to have confidence in a quick recovery especially when you consider how similar injuries limited other positional players. Multiple individuals, including Carl Crawford and veteran Rafael Furcal, attempted to play through or conservatively treat significant UCL sprains. Their efforts were for naught as both players ultimately required Tommy John surgery to reconstruct the ligament. Eaton could buck the trend and avoid going under the knife but the precedent set is not promising. Regardless of the ultimate outcome, the rookie will miss at least another month so fantasy owners have time to begin thinking about suitable alternatives.

Check Swings

Ryan Braun: Braun has been battling a thumb injury for several weeks now and rested the digit Monday. It doesn't look like he will need to go on the disabled list just yet but expect to see his power numbers take a hit for the immediate future as his grip strength lessens.

Clay Buchholz: The Red Sox should have Buchholz back on the mound over the weekend after he missed time with an irritated acromioclavicular (AC) joint. The right-hander slept on his shoulder awkwardly and had his Monday start skipped for precautionary reasons.

Ross Detwiler:  An oblique strain sent Detwiler to the DL but he has an outside chance of returning by the weekend. The move was retroactive to May 15 allowing for the brief DL-stint. However, oblique strains can be tricky injuries for pitchers so tread carefully here.

Chris Perez: Perez heads to the 15-day DL with right shoulder soreness. He left Sunday's loss to the Red Sox in pain and the team was quick to make the designation. More information should begin to surface soon but it isn't likely to be good as the Cleveland reliever spent a larger portion of the spring resting and rehabbing the same shoulder. Vinnie Pestano will take over as closer for the Tribe.

Jered Weaver: Weaver will not need as rehab assignment and is set to return from his fractured elbow on Wednesday against the Dodgers. Remember the injury occurred to his non-throwing arm allowing him to return a bit ahead of schedule.