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.
a 60" TV with slow-motion replay and multiple looks on that replay helps...a lot...
it's one thing to shy away like he did the 2nd time, it's another to bail out of the box on a called strike. that happened in the 1st one he pulled away from. he misjudged that one by a foot or so...
Good Hendricks sure is fun to watch. He was hitting all his corners today and the Phillies couldn't do anything with his changeup.
Bryant and I believe Zobrist both did that too.
Soler BB acumen and plate awareness is excellent. Not unusual for even the best players to react as if they were about to hit them, "even though they weren't that close" from your vantage point sitting on your deck, or wherever.
soler vs inside breaking balls is scary.
he's had 2 inside curve balls today where he reacted as if they were about to hit him even though they weren't that close...one he bailed out of the box on, it was a called strike.
j.urias optioned back to AAA...guess we wont be seeing him in the LAD series.
so is him actually getting 2 hits in a game (2 doubles!)...first time he's even been on base 2 times in a game since 9 games ago on his 3/4, 1bb day.
im ready for him to at least look like a 2-slot hitter since he's gonna be slotted there no matter what he does.
That Heyward move to avoid Bryant's ball hit at him was a thing of beauty too.
9 pitches in and this game already rules.
HR, double...bryant's turn (who came out to a Kris Kross song for some horrible, horrible reason).
...2 run inning...zoobrest hitting streak at 14.
First time I saw Herrera was yesterday. He took like 100 pitches, fouled off a ton off Lester.
Very nice young player and perfect leadoff guy.
Obviously not Phil. But he mentioned this on Wednesday.
"Dominican Summer League (DSL) Opening Day is Saturday June 4th, so probably about 8-10 pitchers and position players presently at EXST in Mesa will be sent to the Cubs Dominican Academy (probably sometime this week) and be assigned to either DSL Cubs #1 or DSL Cubs #2."
In the comments here: http://www.thecubreporter.com/05242016/cub-power-d...
Per FanGraphs, Cubs have a 72.5% chance of winning today. Jinx! Next highest percentage on today's games is D-backs with a 64.7% chance (Greinke vs. Cesar Vargas, in Arizona.)
Phil, when will the Cubs start moving international players from EST to the Dominican for the start of the DSL season?
It was a nice barehand pick-up but he was close enough to 1st where he could underhand the ball to Bryant. The trouble he's had has been with the overhand throw. He's definitely working on it, but I don't know if that play was a good example of progress made.
Phil, have you heard anything about the condition of Oscar De La Cruz's elbow? Has there been talk of a time table? Is he throwing?
i was distracted for most of the game and also missed the first few innings.
but yeah, any time he makes a good fielding+throwing play on D it's worthy of praise and a trip to pizza hut for a personal pan pizza and $1 worth of songs on the juke box.
seriously, i'll take it.