Diamondbacks' Young, Upton hurting

Arizona Diamondbacks center fielder Chris Young took a flying leap while making a big play Tuesday, and his right shoulder crashed into the outfield wall. He made the catch but the wall made a mark, at least a 15-day mark, as Young was placed on the DL Wednesday. Clearly in discomfort as he lay on the ground for several moments following the impact, Young was able to eventually get up on his own. As he walked off the field, he raised his left hand up toward his right collarbone and shoulder, as if he were cautiously checking to make sure all was still intact. According to the Arizona Republic, Young later indicated that he was specifically concerned about his collarbone after the crash, but X-rays showed no fractures. Even in the absence of a break, the possibility of a variety of soft tissue injuries exist after such a collision and, as is sometimes the case, more detailed imaging can reveal more subtle bone injury. Young, who did not return to the game following the injury, is scheduled for an MRI on Wednesday to further evaluate the area. "I can't lift it right now," Young said, adding, "We'll see. ... All we can do tonight is ice it, do a little [electric-stimulation] machine on it and hope it feels better in the morning." Inability to lift the arm overhead is not uncommon acutely in the presence of pain and swelling, even when the injury itself is relatively minor. For now the team is calling Young's injury a shoulder contusion, or deep bruise, which the Diamondbacks hope is the extent of it. Stay tuned for details.

Young isn't the only outfielder ailing right now. Teammate Justin Upton has a left thumb injury suffered in the first week of the season (those darned headfirst slides!) that has continued to nag at him ever since. Upton consulted Tuesday with Dr. Don Sheridan, a hand specialist (incidentally, Sheridan is the surgeon who operated on Boston Red Sox outfielder Carl Crawford's wrist), who confirmed the initial diagnosis of a bone bruise and drained the thumb of fluid, according to the Republic. While the team is still hoping Upton can avoid a trip to the DL, it does remain a possibility. Upton has essentially played through the injury but will likely rest a couple of days after having it drained (he did not play Tuesday and is not in the starting lineup Wednesday). The thumb is critical for bat grip and control and although Upton has managed to stay in the lineup thus far, we have seen how lingering thumb injuries can sap a hitter's power (the Atlanta Braves' Jason Heyward in 2010 comes to mind, also injured his thumb on a headfirst slide, played through for a while, then went on DL). The Diamondbacks will likely see how Upton responds over the next several days before making a decision.

No "immediate" surgery for Ellsbury

According to ESPNBoston.com, Boston Red Sox manager Bobby Valentine indicated that Jacoby Ellsbury will not require immediate surgery on his injured right shoulder, a decision arrived at following consultation with Dr. Lewis Yocum. Yocum reviewed Ellsbury's MRI results after which "there was a consensus of opinion on both the damage and how to proceed," Valentine said. Now the focus is on rehabilitation for Ellsbury, working towards gradually restoring range of motion and strength before ultimately returning to baseball activities. As noted here on Monday, there will be challenges for Ellsbury to overcome both offensively and defensively in his recovery from this injury.

The key word here may be "immediate." While avoiding surgery, especially in the shoulder, is always preferable if not absolutely necessary, there are sometimes situations where surgery becomes an option down the road. Since we do not have any details as to what soft tissue damage was specifically present, it is impossible to know what exactly Ellsbury is dealing with other than pain, swelling and weakness which would accompany any subluxation. What can be assumed is that no one saw anything on imaging so severe that it would require immediate surgical attention. We have seen players successfully play through various soft tissue injuries, then undergo surgery once the season ends. (Successful in this context means showing up to play on a regular basis. It may or may not mean performing at the level typical of that athlete.) We have also seen players rehabilitate fully from similar injuries and return to play at a high level with no follow-up procedure required. The translation then is that there is hope for a positive outcome in Ellsbury's case but until we see him back and performing as he was pre-injury, nothing is certain. The Red Sox have not issued a timetable but given the injury, expect Ellsbury to be out for at least a month.

Baker ends up with Tommy John surgery

Many were surprised to learn that Minnesota Twins pitcher Scott Baker, who went into surgery anticipating a repair of his flexor tendon, emerged with a new ulnar collateral ligament (UCL). In other words, Baker underwent Tommy John surgery. The hardest part undoubtedly for Baker was learning when he woke up how long his rehab just became. On the other hand, he has to feel somewhat validated for the struggles he has been having with his elbow for some time. It's also worth noting that this scenario is not unheard of in the world of sports medicine. The UCL is a complex structure with multiple bands, and even a partial defect can render an athlete incapable of throwing. The athlete's elbow can still appear stable on clinical exam and imaging may be imperfect. To further complicate the issue, pitchers often have tissue changes visible on MRI which are the normal consequence of repeated throwing, hence the need to put the patient's history, clinical exam and imaging together to come up with the most likely diagnosis. And even then, as is evidenced by Baker's situation, there is no better way than actually visualizing the anatomy during surgery to be certain. Unfortunately, surgery is an extreme way to diagnose and comes with its own set of risks and potential complications, which is why it is generally viewed as a last resort. While the rehab Baker now faces is going to be lengthier than what he envisioned before he went under the knife, at least he can rest assured that structurally, there are no more questions.