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.
Cards already whining
Cardinals look a little road-weary on getaway day http://espn.go.com/blog/st-louis-cardinals//post/_...
-via ESPN http://es.pn/app
dee gordon (MIA) suspended 80 days for PEDs. wow.
"excessive testosterone and Clostebol"
hell of a late-night news flash.
Seems like a bizarre pick -- they moved up 2 spots to pick up a guy who was not dominant in college. According to the talking heads, supposedly a great athlete (but an unpolished football player). So was Alonzo Spellman. And the guy who could jump out of a pool. Bears have missed the playoffs 5 straight years and 8 of the last 9. And they made Marc Trestman an NFL head coach. Maybe they can hire Theo in his free time. Sheesh.
And then the Bears pick an undersized linebacker with very few sacks in his college career and very little ability to shed blocks and the draft becomes less of a joy.
Watching the NFL Draft on ESPN with the mute on is one of the greatest joys in my small life. Being able to not hear Roger Goodell, Chris Berman, Jon Gruden, and Mel Kiper in quick order is just somehow immensely satisfying. I hope by the time the Bears pick they have Steven AAAAAAAAAAAAA Smith and Skip Bayless on so I can not hear them too.
even if the cubs lose feder, he's easily replaceable with a cash/low-end-ptbnl trade...plus, taylor davis is wasting time down in AA and he could pop up to AAA to back up w.conteras.
Tim Federowicz is out of minor league options, so Outright Assignment Waivers would be needed before he can be sent back to Iowa. He also has the right to elect free-agency if outrighted, but he probably wouldn't elect to be a FA if outrighted unless the Cubs shit on him somehow while he's up with the big club (not likely).
But it is possible that another MLB club could claim Federowicz if the Cubs place him on waivers, which would leave Willson Contreras as pretty much the only other option if a catcher goes on the DL again later in the season.
CRAIG: D. J. Wilson is hitting 083/115/167 in six Cactus League EXST games (26 PA), but his K-rate is only 11.5% and he has somehow managed to drive-in five runs along the way (he's tied for second on the team in RBI), so it's not like he's swinging & missing a lot. He does seem to be feeling for the ball a bit, however, which has resulted in too much weak contact and not enough line drives.
Bryant sprained ankle MRI tomorrow
Cubs did a lot of that today: 2-for-17 with RISP.
Man, what an ugly baseball game - Cubs receive 11 walks and Bryant reached twice by HBP, the Brewers pitchers threw almost 200 pitches (199 pitches...in 8 innings!), they even walked Baez (first one of the year), Cubs scored twice when Brewers botched routine DP balls, Cahill walks three guys with a 6-run lead, forcing Maddon to waste Strop, the weather sucked again, etc. Happy with the win, but that was really tough to watch.
"Some of the most racist things I've ever heard have come out of people that are on the air at ESPN," Schilling said Wednesday on "Breitbart News Patriot Forum." He was fired by ESPN last week.
“In the end for me it felt like that rule applied to me and me alone because I was conservative … Bigots are calling me a bigot. A bigot is someone who refuses to accept a different opinion. I will accept anyone’s opinion.”
Rolled scoring on Rizzo double
Re ZOBRIST -
Today's game is what I was referring to re Zobrist and RISP struggles. He did come through with his patented single to drive in a run - but also left the bases loaded, and two men on, no outs (called 3rd).
So, I hope he can pick that part of his game up when they start playing the better teams...
Don't see anything on the replay showing where he rolled it and he played for 2 more innings after so at first glance it so doesn't seem major. Very cold today so any discomfort is probably amplified.
How bad was Bryant's ankle sprain?