Beware The Five Inch Screw
Matt Garza heads to the DL for a "bone contusion" just above the elbow and his 25 man roster replacement, Lou Montanez finally winds up in the Cub starting lineup with a memorable night. As you recall, Montanez was the Cubs 2000 first round amateur draft pick (3rd pick overall) as a high school SS and after a stay in Cubville East (the Orioles System), he now resurfaces with the Cubs in RF. Getting back to Garza, let me think out loud with you readers about what seems to be the problem.
Let me stipulate that I AM NOT A DOCTOR (but I play one on tv)...so my opinions are just based on long miserable experience with the Cubs.
Garza's injury is being reported as a "bone contusion." Correct me if wrong but in my experience that's the same as saying he has a bone fracture except the fracture has no deliniation. Also, it's in his elbow so that implies that it involves cartilage as well as bone. This doesn't sound like something that heals in a week. Contusions often take longer than outright fractures to get better.
If the Cubs bring him back after missing one more start...look out.
In Garza's situation, using the term "bone contusion" is clearly an MRI diagnosis. I do have some issues with using this term here and (hopefully) I can provide some clarifications of muddy concepts being bandied about.
I love my headline (nope, I'm not going there, so shame on you) but you need to read on for some Serious Splainin' Lucy.
The diagnosis of "bone contusion" means that Matt Garza's X-Rays are negative for a fracture and the elbow MRI does show an abnormal signal in the area that his elbow is tender. The MRI is magnetic imaging which reflects changes in water content of tissues, so anything that changes the normal pattern on the imaging gets a descriptive term (an abnormal signal). If there is no linear signal seen in the bone, they won't use the term fracture. Not to be funny here, there are shades of gray to these signals. I assume the abnormal signal is in the bone (in this case the distal humerus) and probably does not extend to the soft tissues adjacent to the bone or joint, otherwise they would be worried more about the ligaments or tendons too.
Here's the local anatomy in a nutshell (some nice diagrams at the link). The medial or inside part of the elbow bone is called the medial epicondyle of the distal humerus and includes the flexor/pronator tendon origins (often referred to as "golfers elbow" when inflammed) and the nearby ulnar collateral/UCL or "Tommy John" ligament. The outside portion of the elbow bone is the lateral epicondyle and the tendon attachments, if inflammed, would be what is commonly referred to as "tennis elbow, or in medical lingo, "lateral epicondylitis" involving the extensor tendon origins that functionally extend the wrist.
For the diagnosis to be a contusion there usually is a history of direct trauma to the area. So I ask, when did that happen? Garza does not seem to indicate there was a direct trauma as his quotes below indicate. The Cubs doctors may be thinking it's a repetitive stress injury but are not willing to call it a stress fracture based on the abnormal uptake pattern on the MRI being more diffuse (rather than focal or linear) but the radiologist didn't come up with a better term for the signal abnormality. If this is the case the term "bone contusion" is misleading and what they really mean is the signal abnormality on the MRI is an early precursor to a stress fracture. The difference here can be subtle and it has to do with the normal bone remodeling process. If the repetitive stress/ trauma overwhelms the pace of bone remodeling, a structural break can occur, initially on microscopic level and just like a small car windshield crack that propagates beyond the ability to seal the defect, when a microscopic fracture propagates, the body shifts to a larger scale process of fracture healing and a clinically significant stress fracture occurs. This invokes more inflammatory changes as cells are mobilized that can lead to fracture healing. If my speculation is correct, the DL decision is an attempt to interceding before the problem becomes a stress fracture. This would be analogous to a leg injury from distance running often called "shin splints" which can progress to a formal stress fracture of the leg if the repetition continues and eventually overwhelms the bone remodeling process.
It's unlikely that there is any cartilage involvement in a bone contusion unless the direct trauma also affected the joint (that would make the diagnosis of an articular or intra-articular fracture) and one would see fluid (blood) in the joint on the MRI to make one consider that being the case.
From a Tribune article on Garza's elbow condition, Garza is quoted:
"There's a lot of reasons things like that can happen," he said. "It's just one of those things that happen, more wear and tear. Like, if you're a runner and your knees are sore, that's usually what it is -- a bruise."
The above quote bothers me as a "contusion" means some direct trauma and "wear and tear" is more of a repetitive stress problem. The "if you're a runner and your knees are sore" equals a bruise quote clearly comes from a lack of understanding orthopedic anatomy and diagnoses. I hope that's not what his doctor really told him.
Garza also is quoted in a video interview at CSN Chicago and reported at SB Nation saying that the injury is the result of throwing in cold weather and coming from the Rays, Garza isn't used to the cold (tongue meet cheek).
Again, this points to repetitive stress injury, not contusion.
In contrast, I recall Mark Prior's "bone contusion" to his right elbow when he was hit by a line drive by Brad Hawpe in 2005. They ultimately called the injury a "compression fracture." It was certainly more extensive than a "bone bruise" (OK, a severe bone bruise) yet his X-Rays were negative for a fracture so it took MRI imaging for the final diagnosis.
Finally, I remember former Brewer-WSox-Cardinal pitcher Cal Eldred, who had a diagnosis of "stress fracture" of his pitching elbow. He started the 2000 season with a 10-2 record with the White Sox but due to the stress fx, in August of 2000, had a 5 inch screw placed across the stress fx to try and heal it. He was mostly out until 2003 when he tried a brief comeback with StL before ending his career in 2005.
So, in summary and reading between the lines, I'm not sure what kind of estimate to recovery Garza has. If it's a "pre-stress fracture" or shin-splints equivalent at the elbow, it might be just the 2 weeks on the DL in the best case scenerio and that's enough rest for the bone to remodel. If he's not better or if this happens again...well, lets hope it doesn't become a recurring problem because a stress fracture at the elbow can be a bear to resolve.
I went to a Nats game in DC two years ago while looking at colleges with my son -- it's a fun park, worth a visit if you are in the area.
I also saw the "slowness" thing -- particularly Werth, who would mosey out of RF about 5 seconds before the inning started.
It's Dusty's fault. It'll be the end of them.
Speaking of how teams "look", my take on the Nats- It's really weird, but the pace of the entire team seems slow. Slow walking to the plate, slow on the mound, even on some routine groundouts, it looked as if there wasn't a ton of hustle. Don't get me wrong, when the ball is hit to their outfielders, they get after the ball, I'm really referring to non-critical action- they mosey around. It's kind of odd. Maybe that "calm power" is part of the Nats ethos, idk.
My favorite moment of Hendricks' performance last night was the last strikeout he rung up- the cajones it took to throw a high, 86MPH fastball to Zimmerman on a 0-2 count. And he swung the bat like it was a 96MPH heater. I literally laughed out loud.
In listening to Maddon's post-game, he is interested in how these other teams "look" to him. He is assessing for today...and tomorrow. I love this guy.
One observation from last night: Joe Ross is incredibly slow. 20-30 seconds between pitches at times. Hendrix had a nice, peppy rhythm which is great to see.
I know there are plenty of purists here which I applaud, but the game just will not sustain itself unless change of pace rules come into play. Pitch clock, improve the shit-ass reviews, mound visits (there is a clock for this), batter time outs, etc.
Thanks, Phil. Albertos at 17, and having gotten a good signing bonus ($1.5, even though as Mexican prospect I think his team gets half of that?), throwing in the 90's and showing some command of a curveball sounds pretty interesting, even if that control is only for a dozen-pitch sample.
What kind of a frame does he have? Is he on the stocky and short-ish side (I'm recalling Fernando Valenzuela!), or somewhat taller? A lot of 17-year olds have projection, "when he fills out" projection. Would that apply at all for Albertos?
I definitely hang around here looking to reply to your comments as noticed by my nearly year long absence.
there's a fine line between posting something relevant, useful or at least humorous versus posting something irrelevant, useless or unfunny...actually it's rather quite a thick line and easy to see for most people not named crunch.
I certainly am digging the RISP machine Zobrist version.
Cubs are taking advantage of bad D by their opponents -- did it a few times in PIT and the Nats botched 2-out rundown leads to 3 Cub runs in the 8th. Which were nice to have.
I hope Kyle had fun at the dance party -- he was terrific.
i hope he's getting more consideration for the 2-slot vs lefties, too.
I hope we can dispense with the Zobrist RISP concerns.
Is this heaven?
They call me Schwarberino because I'm basically Ruth,
and as long as we're rapping I'm gonna tell you the truth:
This team would be even better if I wasn't laid up;
we'd win the World Series, the Superbowl, and the Stanley Cup.
As long as we're at it, I'm putting the Premier League on notice.
Hell, if I were healthy, Epstein could run for POTUS.
My busted knee's even sadder than this presidential kerfuffle,
but my first rehab assignment will be the World Series Shuffle.
I am avoiding grading papers.