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Ethier close to return; don't panic on Rollins

Welcome back! Here's to being back from an extended stay away from the team, settling into the regular routine and finishing out the season on an upswing. No, the salutation is not self-directed, although I did manage to tear myself away from the beaches of Cabo San Lucas in Mexico to get back to the business of discussing injuries. This welcome is directed to Los Angeles Dodgers shortstop Rafael Furcal, who rejoined the lineup Tuesday in Chicago after missing time with a hamstring strain.

After originally looking as if he'd be back when eligible May 14, there was enough concern about some lingering symptoms to postpone the return date until now. It wasn't exactly Furcal's most notable performance (0-for-4 and a couple of errors), but he got through the game just fine. As reported by Tony Jackson of ESPNLosAngeles.com, Furcal said after the game, "I am very disappointed with the way I played. The best thing is that I'm healthy and I didn't feel anything." Very true. Rust can be overcome quicker than reinjury. The biggest test, however, will come during the next couple of weeks as we see just how Furcal and his hamstring tolerate the grind of daily play.

Also returning from injury were Boston Red Sox outfielder Mike Cameron, returning from an abdominal strain, and Minnesota Twins shortstop J.J. Hardy, coming off a bone bruise in his left wrist. Cameron is going to be eased back into play, according to The Boston Globe. He will not be used daily, at least not initially, plus he will spend some time playing left field. The 37-year-old Cameron, whose superb fitness may be a reason he's even been able to return from this injury, may yet require surgery down the line. Hardy's return Tuesday was abbreviated because the Yankees-Twins game was suspended in the fifth inning by rain. That said, Hardy's first at-bat was a double to deep right, so it looks as if his wrist is not a limiting factor.

Earlier it appeared that we would be welcoming back another star in this week's blog, Philadelphia Phillies shortstop Jimmy Rollins, but he was back on the DL before we ever got the chance. On that unfortunate note, we turn to some of the key injuries in the world of baseball this week ...

Jimmy Rollins, SS, Philadelphia Phillies (15-day DL, May 22): Rollins' situation exemplifies the challenge for a medical staff when dealing with an athlete returning to play following a significant muscle strain. No matter how many sprints, drills or running workouts an athlete goes through to test the injured part, there is no guarantee that he is out of the woods when he returns to play. It is impossible to simulate every game situation and perhaps even more challenging to simulate the environment -- such as the intensity, the adrenaline of playing in a major league game -- and those things can factor into how the body responds. The Phillies brought Rollins along at a conservative pace, even holding him back at times as a measure of precaution. Sometimes even the best-laid plans don't unfold as anticipated.

In Rollins' case, his right calf gave him a signal that it was not going to fully cooperate with his agenda. Rollins returned to the lineup on May 17 after missing 30 games with the original injury. Just four days later, the calf bothered him while he ran to first on a single. He was forced to leave the game early and returned to the DL the next day. No fooling around here.

As Phillies general manager Ruben Amaro told The Philadelphia Inquirer, "It might not take [the entire 15-day DL stint], but we can't afford to put ourselves in a position where it gets reinjured and turns into something serious." Hmmm. It looks as though the first part (reinjury) already happened, but the hope is that this does not represent a serious setback. The fortunate aspect is that this strain is reportedly not as severe as the initial injury. The team is referring to it as a Grade I, or mild, strain (the original injury was a Grade II, or moderate, strain) and the team hopes he will not require much, if any, additional time off.

Fantasy owners are understandably frustrated (just think how Rollins feels!), but this is not time to panic.

Andre Ethier, Los Angeles Dodgers (15-day DL, retroactive to May 15):
What a difference a day -- or a splint -- makes! Ethier, who landed on the DL after suffering a fracture in his right pinkie finger while taking batting practice, could have missed up to six weeks with the injury. As it turns out, thanks to the aid of a particular splint, Ethier may be able to return when eligible on Sunday.

The emphasis is on the word "may," however, as Ethier will have to show that he can perform without limitation and that the fracture is indeed healing before he can definitively play. But so far, things are looking good. If he performs well in a simulated game Saturday, he could be activated Sunday.

The fracture that Ethier suffered was bit odd, or at least the mechanism of injury was unique. Ethier sustained an avulsion fracture -- when a small chip of bone is avulsed or pulled away where the tendon attaches to the bone -- at the tip of his fifth finger. Typically this type of injury, also called mallet finger, results from hyperflexion (exaggerated bending) of the digit, most often when the finger gets jammed by a ball or by contact with another athlete. In Ethier's case, it occurred while batting, when a slight slip of his pinkie finger caused it to get jammed between the bat and his hand.

As the medical staff discussed what route to take for treatment, the Dodgers' director of medical services, Stan Conte (himself a physical therapist and athletic trainer), made a call to colleague Gary Vitti, longtime athletic trainer for the Los Angeles Lakers. Anyone who has followed the Lakers lately knows they have had their share of finger issues, as is common in basketball. Conte said that Vitti recommended use of the "Pro-Ferred" splint, a splint that uniquely maintains the joint of the tip of the finger in extension (keeps it straight) to allow it to heal while allowing the joint just below some ability to flex or bend. This ability to flex the proximal or near part of the finger is what allows Ethier to be able to handle a bat.

Conte said that the use of the splint, along with some modifications of padding at the knob of the bat to make for easier grip, have enabled Ethier to already begin taking batting practice. While Conte stresses that the Dodgers are not yet sure whether Ethier will be ready to return when eligible, he does acknowledge that they are very pleased with the progress he has been able to make. Ethier would continue to wear the splint even if he does return because the tissue will still be healing.

From a medical standpoint, the more normal motion that can be encouraged while still protecting the injured area, the better the outcome typically is. We often see hitters who struggle when returning from wrist and hand injuries, particularly as they work to regain their motion and strength even if the injury has technically healed. In this scenario, it's quite possible that many of those challenges could be avoided as a result of Ethier's being able to continue to swing the bat relatively uninterrupted.

A little interleague cooperation could prove to go a long way to make fantasy owners really, really happy here. Stay tuned.

Grady Sizemore, OF, Cleveland Indians (15-day DL, May 19): An awkward landing while diving back to first base sent Sizemore to the DL, aggravating a knee injury first sustained near the end of spring training. Sizemore's next step will not be known until he gathers several opinions on his injured knee. The team has termed Sizemore's injury a bone bruise, but based on the locales of the specialists he's reported to be visiting -- Vail, Colo., and New York -- it raises the specter of cartilage damage. Vail is home to Dr. Richard Steadman, a pioneer of microfracture surgery (he performed January surgery on the New York Mets' Carlos Beltran), and there are surgeons in New York with similar expertise in cartilage defects.

The question that every fantasy owner wants answered is whether Sizemore will require surgery. Although the bone bruise likely will have him sidelined for multiple weeks, surgery could keep him out even longer, perhaps even threatening his return this season. Until the team releases more information, a timetable remains speculative, but at the very least, fantasy owners should make alternate plans for the next month.

Josh Beckett, SP, Boston Red Sox (15-day DL, May 19): Beckett and back problems are nothing new. In fact, he has dealt with lower back and upper back issues at different points in recent years. It seems that this year will be no different.

Beckett began having back spasms in early May after taking batting practice, and he missed a scheduled start. Days later, while pitching in rainy conditions, Beckett left his start early with tightness in his back. A DL move was natural and precautionary in trying to prevent this from being a lingering and lengthy situation. Although Beckett is eligible to return on June 3, there is certainly no guarantee that he will. So far he has thrown a few side sessions, and next up comes the bullpen. The Red Sox will want to see how he tolerates the progression to the mound before deciding on a return date.

Jorge Posada, C, New York Yankees (15-day DL, May 20): Posada has been placed on the DL with a hairline fracture in his right foot, the result of absorbing a foul tip off that foot in mid-May. Posada was hoping for just a bone bruise, but imaging tests showed the crack.

Initial projections from the team after the fracture was revealed had Posada out for three to four weeks, but he has taken a bit of a defiant position against that notion. According to the Newark Star-Ledger, Posada believes he will return earlier. "They can say whatever they're going to say. I'll be here before that," Posada said. It's worth noting that he followed up by saying he had never had a problem with his feet before, pointing out that "You've got to be able to put your weight on and all that stuff. You've got to be able to transfer your weight from one side or the other." Right. And he was immobilized in a walking boot when he made the remarks.

Given his position as a catcher where he is in a crouch, placing significant load through his feet while intermittently, explosively moving to full stance, the demands on the foot are high. Not only is he not likely to be back before three weeks, he'd be lucky to be back by then.

A hairline fracture can show evidence of healing more quickly than a complete fracture, but beyond the bone repairing itself, the foot needs to be able to tolerate loading, pivoting and twisting, without causing any symptoms before an athlete is able to return to baseball activities. Then, of course, he has to get back up to the level of playing in games. Until Posada is cleared for impact activities, it's probably too soon to even think of a return date. Fantasy owners should be planning on being without his services for the better part of a month.

Brad Penny, SP, St. Louis Cardinals: (15-day DL, May 22): Penny escaped with a relatively mild injury but was still relegated to a DL stint just to be safe. Penny, who was diagnosed with a strained lat (short for latissimus dorsi, one of the broad muscles of the back), left his Friday start early because of discomfort. Despite delivering a grand slam, Penny was not feeling good and came out of the game as a result.

According to the St. Louis Post-Dispatch, the decision to move Penny to the DL was easy for the Cardinals when considering the big picture. General manager John Mozeliak said, "It just makes sense to DL him, rather than put him out there for the next start and he makes a pitch and goes backward. It's a precaution." The team does not expect him to miss time beyond the minimum DL requirement.

Justin Duchscherer, SP, Oakland Athletics (15-day DL, May 16): After working so hard to get back this season, Duchscherer has to be disappointed in the cards he's been dealt so far this year. He knew that keeping his lead hip healthy was the key to keeping his lower back pain-free and avoiding overload on his throwing arm, which was surgically repaired in 2008. In fact, he told me that very thing in spring training after making his first start of the year coming off pain-alleviating sacroiliac joint (where the low back joins the pelvis) injections. That's why he dedicated extra time to stretching his hips and keeping them loose.

But his anatomy is just not cooperating. Duchscherer, who already endured surgery on his right hip, is now being plagued by similar symptoms on the left side. His prior experience with the right hip is no doubt what led him to tell the San Francisco Chronicle that he anticipates needing surgery on the left hip. That statement came just after Duchscherer returned to the DL in mid-May because of continued hip discomfort one mere day after coming off it.

For the time being, Duchscherer is trying the conservative route to see whether he can delay surgery until the season ends. The Chronicle reports that he has undergone a Synvisc injection, a joint lubricant that may alleviate some of his current symptoms.

Fantasy owners who were holding out hope should probably look elsewhere, however. Synvisc was not ultimately able to stave off surgery when Duchscherer's right hip was bothering him; it's hard to be overly optimistic that this will turn out differently.

Other names to watch

Huston Street, RP, Colorado Rockies (15-day DL retroactive to March 26): Street began experiencing shoulder stiffness in mid-March. After steady progress, Street was throwing in a rehab assignment mid-May and was feeling good. So good, in fact, that he told the Rockies' official website, "I'm close -- dangerously close. I'm close enough to start getting my hopes up, and that's something I'm trying to keep together." Then, as if foreshadowing what was to come, Street added, "I got real excited last time [in spring training], and we had the setback. That set us back six more weeks."

Uh-oh. It happened again. Street suffered a setback just when it appeared he was on the verge of returning. It's important to distinguish, however, that this setback was not to his shoulder; instead, Street suffered a groin injury. Fortunately, it appears that the injury was not as serious as first thought, and Street's return may not be extensively delayed. In fact, Street threw a bullpen session Tuesday, which suggests he could be back in a rehab assignment in the not-too-distant future. Fantasy owners should keep an eye on early June if all continues well.

Brett Anderson, SP, Oakland Athletics (15-day DL, April 27): Anderson has been out since late April with a flexor tendon strain in his throwing (left) forearm. ESPN's Buster Olney originally reported that Anderson was expected to miss a month, and it appears that time frame could be right on the money.

Anderson has been progressing well since his injury and threw three innings in a rehab start in Sacramento on Monday. Although it seems like a relatively short rehab stint, the A's must be pleased with what they have seen so far, because Anderson is expected to rejoin the team Wednesday according to Contra Costa Times reporter Joe Stiglich. The plan is for Anderson to throw off the mound and, if there are no setbacks, pitch Saturday. Despite the short rehab assignment, Anderson has been throwing his repertoire of pitches without incident during flat ground sessions since mid-May, according to the San Francisco Chronicle. Although this is certainly a strong sign, the demands of throwing off the mound are always greater. It will be interesting to see how deep he goes into his first game out after the layoff.

And yes, there are always more injuries than there is room to discuss here. We might even hit on some of them in tomorrow's Fantasy Focus podcast. Next week, we will take a look at some of those "forgotten" players nearing the end of their terms on the 60-day DL. Will they be ready? Check back and see what we're hearing.