Berkman hurts knee; Strasburg leaves early

It seemed as if St. Louis Cardinals first baseman Lance Berkman was about to be added to the growing list of baseball players whose seasons have been cut short by ACL tears. Not so fast ... maybe. Cardinals general manager John Mozeliak announced Monday that the results of Berkman's MRI revealed a torn meniscus, not an ACL tear as originally feared. In an interesting follow-up, Jenifer Langosch, who covers the Cardinals for MLB.com, tweeted the following: "While no evidence of ACL tear came on MRI, it hasn't been ruled out. 'I'm not as optimistic' as team, Berkman said." In other words, it sounds as if the picture is not totally clear. He is expected to get a second opinion this week. At the very least, a meniscal injury would require surgery and subsequent rehabilitation that could sideline Berkman for the better part of two months.

Berkman is no stranger to knee troubles, including ACL tears. This latest injury is to Berkman's right knee, the same knee in which he suffered an ACL tear back in 2004. Berkman has a history of issues with the cartilage in both knees, and the increased wear and tear that comes with being a veteran ballplayer doesn't help matters. Consider that even after last year's contribution to a World Series championship team, Berkman is on a one-year deal with the Cardinals this year, perhaps reflecting the inherent injury risk he represents. After more than three weeks on the DL earlier this season with a calf strain, Berkman had played in only six games since returning before suffering this setback with his knee.

The complexity of the injury could make a big difference in terms of Berkman's future. According to the St. Louis Post-Dispatch, even Berkman seemed to question what the future would hold if the injury turned out to be serious. "If I've re-torn my ACL or something like that, I'd certainly get it fixed but you don't know how psychologically you're going to come back from something like that," Berkman said. "I'm not talking from the standpoint of being scared of hurting it again. I'm talking about doing everything it takes to come back and play again at an elite level." We have seen an aging baseball star return from a second ACL procedure (Atlanta Braves third baseman Chipper Jones did so in 2011) but it is not an easy task, particularly if there is no guaranteed job at the finish line. Until the evaluation process is complete, the next steps for Berkman are on hold.

Strasburg update

Last week we talked about the incredible run of bad luck the Washington Nationals have been confronted with recently in terms of injuries. Just when it seemed as if they could not possibly be presented with any more bad news, ace pitcher Stephen Strasburg was forced to leave Sunday's game against the Baltimore Orioles in the fifth inning ... because of his biceps? At least that's how manager Davey Johnson described the situation.

As for Strasburg, he seemed to downplay the incident when speaking with reporters after the game, relating it to arm fatigue and suggesting it is just a byproduct of returning from his 2010 elbow procedure. "It's all part of coming back from Tommy John [surgery]," Strasburg said. "It's something I have to be smart about."

So is this something to really be concerned about, or is it much ado about nothing? The reality is it might be a little of both. On one hand, Strasburg is correct. It is not uncommon following Tommy John surgery and the associated recovery that pitchers have little dips and dives in their performance, comfort level or both. We often hear of pitchers who develop symptoms such as forearm tightness or stiffness or who suffer from intermittent command struggles and are forced to back off their throwing a bit until they settle. Strasburg also referenced going out of his routine after his previous start, increasing his work in the weight room and the bullpen, something he called "a little immature," according to the Washington Times. It's possible that veering from a structured routine, even minimally, can lead to problems, especially if that structure contributed to a smooth return from surgery with no real setback along the way. Perhaps this is just a minor speed bump as a result of that altered routine.

On the other hand, it's worth remembering that Strasburg had shoulder inflammation that sent him to the DL just weeks before he tore his ulnar collateral ligament. The data of pitchers returning from Tommy John surgery suggests there might be a relationship between the elbow procedure and subsequent shoulder issues leading to DL placements (read: Josh Johnson). Is it possible Strasburg could be headed that direction?

It's certainly feasible that any major league pitcher could be beset by shoulder problems at some point in his career; in fact, it is almost expected that given their profession, most pitchers will sustain some form of elbow or shoulder injury. But in Strasburg's case, there has already been a DL placement related to the shoulder, which makes any shoulder-like symptoms now a bit more worrisome. If, in fact, Strasburg has any existing damage to a structure that does not heal independently, such as the labrum, there is an increased likelihood that it will present a recurring problem at some point in time. Davey Johnson said Strasburg's issue was with his biceps, but the specific location within the biceps becomes relevant. If it is the portion of the biceps tendon that attaches to the labrum, it becomes more significant than if it is general soreness or tightness in the muscle belly itself.

There are a number of questions raised by the incident, most of which are not likely to be answered directly. Before we can become either dismissive or obsessive about Strasburg's latest incident, however, it is worth watching to see how he responds. The Nationals have indicated they do not expect him to miss his next start. Amanda Comak of the Washington Times reported via Twitter on Monday that Strasburg was participating in the pitchers' flying disc match (hmmm). In the meantime, expect him to return to his structured routine. If questions remain as to whether the Nationals will adhere to the innings limit originally set for Strasburg at the start of the season, they seem to be diminishing with every yellow flag.

Other injuries

Texas Rangers pitcher Neftali Feliz has been placed on the DL with right elbow inflammation. There was some concern about his health this spring when he was experiencing shoulder stiffness. After backing off his work for a few days he resumed throwing and was able to start the season on time. His performance, however, has been up and down this year as he has transitioned from a closer role to the rotation. It's unclear when the elbow began to bother him but he is being forced to rest it now. An MRI revealed only inflammation, according to ESPNDallas.com, but the pitcher will be shut down from throwing for a month to protect the elbow. Feliz will then resume a progressive throwing program. A more precise timetable is impossible to project until Feliz picks up a ball again and then, naturally, it will be dependent on no further recurrence of symptoms.

Dan Hayes of the North County Times is reporting San Diego Padres pitcher Cory Luebke will undergo Tommy John surgery Wednesday. Luebke had been evaluating his options, including an attempted rehabilitation period, but appeared recently to be leaning toward surgery. It can't be overemphasized that a pitcher needs to be afforded the time and the latitude to carefully evaluate his options before embarking on such an intensive procedure and lengthy recovery process. Once he is fully committed to the idea that surgery is indeed the best option, the road becomes more about going forward than looking back at the what-ifs, a necessary step in a successful return. Luebke should be expected to return at some point in 2013.

Los Angeles Angels outfielder Vernon Wells was expected to be placed on the DL after suffering a thumb injury Sunday while stealing second base. After an MRI Monday, it became clear he would miss more than 15 days. Wells announced via Twitter that he would be undergoing surgery Tuesday to repair a torn ligament in his thumb. Expect him to be out a minimum of two months.

Boston Red Sox outfielder Cody Ross has been diagnosed with a fracture of the navicular bone in his left foot. The team has not indicated yet what the plans are for treatment or how long Ross is expected to be sidelined, but plan for at least a couple of months (six weeks for the bone to hopefully heal followed by rehab games).