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 have convinced myself that Hammel's second half struggles were due to minor injuries and fatigue so with the extra rest he is going to be lights out.
Benji Molina is out of lineup
Yes. Unfortunately, as many of us, I have seen this movie before. Do not care for Hammel, and unlike other managers Joe will pull the plug quickly at least. I hope before things were to get out of hand.
Many of us are like "abused spouses" or whatever - with this Cubs stuff. You get hurt so many times, the trust rapidly erodes.
If the Cubs can get to Lackey early, its gonna be a big key to a W or L.
No idea what will happen. The Cards are the Cards and they have come back from 2-1 holes twice in the last 4 years, so I don't see them in panic mode at all. If anything, I expect the Cubs to be pressing more than the Cards today.
I want the Cubs to win because it would be great for the city, and great for the fans. But more than anything, I want the Cubs to win so I can see this team play for at least one more week this year. Never enjoyed watching a team more than this year.
Just to remember how far we have come: last year's opening day lineup was Bonifacio, Lake, Castro, Rizzo, Olt, Castillo, Schierholz, Barney, and Samardzija. It's been a fun ride this year!
BRADSBEARD: I haven't noticed any new rule or a change in the interpretation of an existing rule happening in Advanced Instructs, I don't know what rules will be tested in the AFL, although almost all recent rule changes and new interpretations of existing rules (the home plate collision rule, replay, time clock between innings, et al) do get their start in the AFL.
AZ Phil: I've heard that the AFL will be testing out a new force out rule that would affect break-up plays (like the Utley play). Have you heard anything about this new rule and any details about it? Are they testing it out at the advanced instructs as well?
Pretty sure I already know the answer to this, but since I will be in NYC next week I want to confirm... If the Cubs were to advance to the NLCS, the winner of LAD/NYM would have home field based on being a division winner (as opposed to Cubs by virtue of better record), correct?
CUBSTER: This "hammy" is on the other leg I heard last night. See you at the ballyard today young man!
Oh what do you know, Cubster? Go back to your day job.
--- Ducks, puts on Cardinals cap, runs.
Russell had a severe hamstring last year while with the A's system, forcing him to miss the first half of 2014. I've even wondered if his injury last year was a component of Billy Beane putting him on the trade market. He was quoted saying that last year's injury was a 10 out of 10 when it happened. Last night he said his hamstring soreness was a 1/1.5 out of 10. Hamstring injuries are tricky though, so I'd expect the medical team to be overly cautious here.
...I want to reinforce the observation that there was no sea of red in the crowd. The usual Cardinal fans roaming the stadium were few and far between.
Also, almost every 2 strike pitch brought the fans to their feet. Good for those in knee rehab.
"1st team hit hit 6HR in a game in the postseason." rises above obvious...i checked it with the official fact-finding commission of Douche, Douche, and Douchestein. they agreed with you, but they're a bunch of f'n douches so who cares?
btw, the cubs are 2-1 in the post-season series.
I should be able to watch the game on the NFL replay app, whatever that thing is called. I've got it on my iPad. This is the first year I haven't forced myself to somehow watch every game - no I take that back, last year was - in quite some time. Last year was so unbearable, no pun intended.
You make some good points about Cutler, and I was a holdout defender of Cutler for a long time. I gave up on him a bit after one too many dumb interceptions, but last year doesn't count. Trestman was the worst coach in Bears history.