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Diamond Cuts: Teres Major Heartache

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.

Clayton Kershaw

The Dodgers season began in Australia nearly two weeks ago but the good vibes from Kershaw's first start have quickly diminished after the 2013 Cy Young winner was placed on the disabled list with inflammation in his back and shoulder. The DL stint is the first of his career but the injury has understandably caused fantasy owners to panic. However there is reason to believe the injury is not as serious as it could have been and the long-term effects currently appear minimal.

The exact location of Kershaw's injury is the teres major, a muscle that extends from the inferior border of the shoulder blade (scapula) to the upper arm bone known as the humerus. Its main responsibility occurs during internal rotation of the arm but it also pulls the arm toward the midline of the body in a motion known as adduction.

Furthermore its insertion inside the primary joint of the shoulder allows it to help with shoulder stabilization. Keep in mind the teres major should not be confused with the teres minor, one of the four rotator cuff muscles.

If the information sounds familiar, it is because I detailed this exact type of injury in last week's column with Rangers shortstop Jurickson Profar. Profar is expected to miss 10-to-12 weeks with a partial tear of his teres major. However there are differences between the two, including the nature of the injury. To begin, Profar is dealing with a true tear. His injury is considered a significant or Grade II strain. In Grade II injuries actual muscle fibers are damaged, eliciting pain and limiting function. By contrast, Kershaw's injury isn't even listed as a strain, though inflammation in the area would indicate a Grade I strain in which microtearing has occurred. Other explanations for the inflammation exist but the treatment remains fundamentally the same.

The Dodgers will take a slightly different approach in rehab than the Rangers will with Profar. In pitchers the teres major plays a key role during the late stages of the cocking phase as well as the acceleration phase and follow through. Kershaw will have to insure the teres major is functioning properly to insure the rest of his mechanics are not altered, a problem Profar won't necessarily have to manage. The Rangers will still emphasize proper shoulder motion but it won't be broken down to the extent of Kershaw's recovery.

The successful return to play rate for pitchers recovering from teres major injuries remains high and Kershaw's value for the season should remain high. However considering Los Angeles recently made him the highest-paid pitcher in MLB history, don't be surprised to see them handle the situation extremely conservatively. (ED Note: In fact, the Dodgers announced Tuesday that Kershaw would go on a non-max effort throwing program for 2-to-3 weeks after which he would be re-evaluated, suggesting a return sometime in May.)

Manny Machado

The future of the Orioles was placed on the 15-day DL to start the season as he recovers from reconstructive surgery on his injured left knee. The injury occurred in September of last season when Machado took an awkward step rounding first. A MRI revealed the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) were intact but the lesser-known medial patellofemoral ligament (MPFL) was torn. The MPFL connects the kneecap to the femur and plays an obvious role in patella stabilization. Following a tear, the ligament can be surgically reconstructed using a graft taken from the injured individual. Surgery has a high success rate and provides suitable protection against recurrent kneecap dislocations.

Machado's recovery has not gone quite as smoothly as hoped with the 21-year old experiencing some lingering soreness due to scar tissue. However this is a fairly common issue and shouldn't affect his long-term health. Look for him to spend the next few weeks rehabbing in Florida with a late April return in mind. He will likely require an adjustment period in first few games back so scale back your initial expectations.

Check Swings

Wilson Ramos: The Nationals catcher suffered a hand injury in Monday's opener but conflicting reports have raised questions about the severity of the damage. Initial reports called the injury a broken hand but the team then stated that no fractures were detected on preliminary x-rays. He is slated for a visit with a hand specialist Tuesday that should provide better insight to the nature of the injury. Fantasy owners will need to find a replacement for the immediate future and have a long-term backup in place should the injury be significant.

Jose Reyes: Last week I detailed Reyes' hamstring woes and warned that the risk associated with the former All-Star was too high to heavily invest in him this season. Hopefully my words were taken into consideration as Reyes limped off the field on Opening Day after aggravating the previously injured muscle. The Jays have quickly placed him on the 15-day DL and plan on having Reyes undergo further evaluation to determine the extent of the new injury. Maicer Izturis is expected to take over duties at shortstop.

Shane Victorino: The Flyin' Hawaiian endured an injury-plagued 2013 season but emerged as valuable fantasy option when healthy. Unfortunately his 2014 campaign is starting in a similar fashion as he was placed on the DL with a Grade I hamstring strain. While a Grade I classification is the lowest grade and considered minor, the same principles discussed with Reyes are applicable here. Hamstring strains are debilitating injuries for players dependent on their speed. These types of injuries are easily reinjured even when the muscle appears able to withstand the demands of returning. Victorino has proven he's worth a stash at this point of the season but exhaust your options before you handcuff yourself to him.

Jered Weaver: Weaver took the mound for the Angels Monday but couldn't make it through the sixth inning. The right-hander apparently has been fighting a bug that caused him to vomit shortly after being removed. It doesn't sound overly concerning but don't be surprised if his stamina dips in his next few starts.