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.
More bitching about him being traded than Archer
good...he's been stinking up the durham bulls for a couple years now.
Rays DFA Hak-Ju Lee.
Olt for Lee and the circle of life is complete
dusty would have to start baez because both lastella + castro would be pitching because all the other pitcher's arms would have fallen off months ago. it would piss dusty off because baez is a rookie and theo couldn't go out and get him a 39 year old DH to play 2nd. i imagine it would be a 2-box-of-toothpicks night.
lou would have quit his job already, so that's irrelevant and a trick question.
just a theoretical thought...if Dusty was manager (WWDD) or if Lou (WWLD) was manager...
would Javy Baez be in tonight's lineup?
my thought is:
Dusty... Bonifacio would have been brought up and started at 2B
Lou..."I like playing the kids, really I do, but but but Jonathan Herrera really needs to play to stay sharp."
He was replying to tweet who said error should have been hit
Added a 'recent comments' block to the bottom of every 'story' page. Thought it might be helpful. Comments welcome
Jeff Russell and Rafael Soriano DFA's to make room for the callups (Berry and Cahill)
The next 4 weeks should answer this for us. If Castro starts hitting again and neither Baez or La Stella perform, he'd be on a playoff roster. If not, and one of those other two guys does well, I wouldn't be surprised if he was left off. A key error or mental lapse in a one game playoff would be killer and he is too prone to them.
To put a finer point on it, Baez playing second and hitting 7th tonight.
"This is the show. We have certain expectations here. That's why you don't play." from a Tweet from Arrieta. I who do you think he is talking about.
"This is the show. We have certain expectations here. That's why you don't play." --Jake Arrieta on Twitter.
I'll check back in on a day that Starlin doesn't make three errors. But for now I would say him not making the playoff roster is a stretch. Who do you trust more than Starlin to be a RH backup middle infielder? Herrera has no bat at all, and Baez has been in AAA all season and may be as error prone as Castro and may strike out a giant proportion of the time he's at the plate. I'm also less than convinced that La Stella will step in and be a significant contributor. Starlin is at least a big part of the 2B picture for the remainder of the year.
Sadly, nothing is sticking to the wall. The only thing still lingering is the smell from their pitching outings.
i think they were just throwing shit at the wall to see what sticks.
they wanted to push for the post-season without giving up anything. thank gawd for the cubs winning tear and SF's failure tear...hopefully that holds up until the season ends.
once we're into the post-season (if that happens) then it doesn't matter about the 4-5 slot pitchers. arguably, the pen is much more important at that point when it comes to anyone but the top-3 starters.
Signing Haren was very curious, at best. An over-the-hill fly ball pitcher can survive at Wrigley in April, May & June, when it's cold and the wind tends to blow in (i.e. the ballpark plays "big"). But, signing him to pitch at Wrigley in July, August & Sept., when it's warm and the wind tends to blow out...well, Theo, what did you expect? Gotta believe the Reds will be running up to the plate to get their swings against Haren tonight.
Come on, offense -- we're gonna need another 6-7 runs tonight!