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.
That's a hell of a first impression by Montgomery. Brian Cashman having a good laugh on that debut.
...and it's a 3 run homer.
hey, vogelbomb had a HR on his 1st game with SEA AAA, too!
montgomery comes on with men on 1st/2nd, 2 out, in the 8th.
"Tommy Stokke of FanRag Sports reports Chris Sale was sent home from U.S. Cellular Field on Saturday after cutting up throwback jerseys that he did not want to wear.
I thought the same. It'd be great luck to face these non-contenders after the trade deadline.
...why isn't j.lucroy playing for TEX yet?
2r HR on a 12-pitch AB.
nathan to join the cubs tomorrow.
Wow in deed.
FOX Sports @MLBONFOX
Chris Sale was scratched from tonight's scheduled start due to a clubhouse incident before the game
he was sent home by the team, too. the wsox released a press statement and everything. they stated it was non-physical in nature.
He was scratched from his start today. No reason given.
At the start of the season the book was that he was trying to pitch to more contact so he could stay in the game longer and it seems to be working so far. Contact against is 77.5% this year and it was 70.2% the year before. He averaged 6.7 IP/game last year and so far it's 7 IP/game. His actual pitches per game are only down to 106.1/game from 107.2/game last year but if he's able to go a bit farther into games without throwing more pitches and without giving up more runs that is a good thing.
sale's skills and insane value makes it almost too hard to have a market for the guy...he's got 3/38m owed to him over 3 seasons (2 team options). he could easily pull in 30m/yr if he was on the market as a FA.
he's throwing a bit differently this season, especially with more sliders and less changeups like earlier in his career, but all his stuff still looks great even if the HRs are a little elevated and the Ks are down.
Torres, Happ, McKinney, Jimenez, and Candelario for Sale. Deal or no deal?
"The White Sox are reportedly asking for “five top prospects” for Chris Sale, FanRag Sports’ Jon Heyman reports."
Unless he develops 30+ HR power and keeps his walk rate close to his K rate at the MLB level, he's not going to turn into Prince Fielder. And even if he does turn into Prince Fielder, he's gonna have a short prime. His very limited athleticism is likely to also detract some value from his ability to reach base--I don't buy making an out as being preferable to base clogging, but you'd certainly prefer just about any base runner other than Vogelbach, David Ortiz, etc.
seeing as arod has played a total of 27.1 innings of D at 1st/3rd and somehow managed a -0.5 dWAR with his 1 error at 1st and an overall positive total zone rating...he might end up even more in the shitter via the characteristics/flaws/whatever of how some sites determine various WAR values. dWAR doesn't directly lead to a WAR value, but the 2 main entities pushing the most popular variations of WAR sometimes lead to some interesting discrepancies in value.
I have a lot of faith in Baez that he's going to turn into a more consistent, solid player. It looks like it took him about a half season or so of futility at the plate to figure out he was not talented enough to get away with the crazy approach he had. I think his running game will eventually have a more measured aggression.