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How long are Ellsbury, Wilson out?

Friday the 13th indeed

And people wonder why baseball players are superstitious.

On Friday, April 13, nearly two years to the day since he suffered what would become essentially a season-ending rib injury, Boston Red Sox outfielder Jacoby Ellsbury made an ill-fated slide into second base, trying to take out Tampa Bay Rays shortstop Reid Brignac. Turns out Brignac's backside, which landed on Ellsbury's outstretched arm, did the taking out. Ellsbury, who seemed in considerable pain immediately after the collision, left the game with his arm held against his side, a common instinctive protective position when the shoulder is injured. The Red Sox issued a statement which read, in part, "An MRI was performed and showed findings consistent with a subluxed shoulder. We are in the process of gathering further information and determining the treatment plan."

Although it is widely expected that Ellsbury will be out at least six to eight weeks, the team's official website noted Sunday that more tests will be forthcoming as the swelling in Ellsbury's shoulder subsides. Swelling often makes initial visualization of the soft tissue structures difficult, so subsequent testing is often indicated. At this point, it is fair to say that the full extent of Ellsbury's injury is not yet known.

What is known is that Ellsbury suffered a subluxation of his right shoulder (where the arm bone [humerus] slips beyond its normal range within the joint but does not completely dislocate). While subluxations are often thought of as less traumatic since they do not require medical assistance to "reduce" the dislocation (put the arm back in place as it were), that may not necessarily be the case. When any joint moves out of its normal alignment, there is a risk of damage to the surrounding soft tissues. In the case of the shoulder, the most vulnerable structures are the labrum (the cartilage ring around the joint which enhances its stability), the capsule (fibrous tissue around the joint) and the ligaments which also help stabilize the joint. Additionally, depending on the mechanism and direction of dislocation, the cartilage surface on the humerus can be damaged. In a 2007 study published in the American Journal of Sports Medicine looking at shoulder instability events in military cadets, the authors found many injuries associated with subluxation to be just as serious as those with dislocation. In fact, labral injury and cartilage damage, typically associated with dislocation, were often present in subluxation events.

The news thus far can be viewed as either glass half-full or half-empty, depending on one's outlook. Since the injury was to Ellsbury's right shoulder, his non-throwing side, returning to make throws from the outfield will not be a huge obstacle for him to overcome. But, the injury is to his glove side, which makes fielding potentially problematic. Outfielders have to be able to make diving catches with the glove arm outstretched, a particularly vulnerable position for a shoulder with any hint of instability (this is, after all, the position Ellsbury's shoulder was in when he was injured). At the plate, Ellsbury's injured shoulder is his lead shoulder. If there is any residual instability, particularly in the form of labral injury, it could very easily affect his swing. The painful catching sensation that accompanies lead shoulder instability on the follow-through of a hitter often forces him to shorten his swing or alter his angle, whether consciously or unconsciously, to avoid veering full speed into the discomfort at the end of that motion.

Rays outfielder B.J. Upton and Marlins third baseman Hanley Ramirez both underwent surgery to repair labral tears on their lead shoulder, as did Ellsbury's teammate and fellow lefty, first baseman Adrian Gonzalez. They all came back to a high level of performance but there is no doubt that it takes time. Again, there is no word as of yet as to whether Ellsbury sustained any significant soft tissue damage, but it is worth noting that labral tears do not heal on their own. And so, we wait.

As fantasy owners await further updates on Ellsbury, for replacement options be sure to check out Eric Karabell's blog entry dedicated to just that topic.

Another closer's season ends very early

Disappointed as everyone may be, few are completely shocked by the news that Brian Wilson has an elbow injury which is expected to sideline him for the remainder of the season. After all, Wilson struggled with the elbow late last year, even paying Dr. James Andrews (who performed Wilson's first Tommy John surgery while he was at LSU) a visit. At the time, Wilson was given clearance to proceed with a conservative approach. After a DL stint in August, Wilson made a brief reappearance before being shut down for good in late September.

This spring, the San Francisco Giants proceeded cautiously with Wilson, ramping his activity up slowly and limiting his Cactus League appearances. But it didn't take much once the season began to effectively put an end to Wilson's season. Wilson indicated that he sustained the latest setback with his elbow during Thursday's outing against the Colorado Rockies and an MRI confirmed structural damage. The specifics of the MRI were not detailed, but Wilson told reporters that he expects to undergo reconstructive surgery, although he is seeking additional opinions, including one from Dr. Andrews, this week.

Although the list of two-timers for Tommy John surgery is not long, if Wilson does indeed head under the knife for a second procedure, he will not be the first closer to do so this season. Joakim Soria of the Kansas City Royals holds that distinction. Soria, who had his ulnar collateral ligament first reconstructed in 2003, underwent his second surgery on April 3 with Dr. Lewis Yocum in Los Angeles. While the data is not nearly as positive for pitchers undergoing a second such procedure -- and the total sample size is notably smaller -- the odds do seem to favor relief pitchers.

It would be easy to complain or to lament one's circumstances given the grim news, but Wilson has gone a step further. Wilson seems to have put his latest injury in perspective, telling reporters he sees it as an "opportunity for me to get a better arm. How's that disappointing?" Talk about finding a silver lining.