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.
Kershaw uses his 132nd pitch for his 15th K (Marlon Juice Byrd, with the tying run at 2nd), and the Dodgers sweep the Giants. Also, Pirates lose to the Brewers for the 5th straight time. So...with 30 to play, we are 6.5 up on SF (7 in loss column) and 8 up on the Nats, and still in contact (4.5 back) of the Pirates. Man, what a roller coaster the last 2 days -- fantastic stuff.
Schlitter still pitching for Iowa? Guess nobody wanted him?
JOHN B: Pierce Johnson and Rob Zastryzny were likely 2015 AFL candidates (I mentioned them as likely candidates to get assigned to the AFL in an article about the AFL last month) because they are starting pitchers who missed part of the season due to injuries and they need to accrue more innings.
Also - what did Bosio say when we went to talk to Rondon? "OK, Hector, tie game, 9th inning, 2 outs, 2-0 count on the hottest hitter in the game. Let's try the ol' fastball right down the middle and see how that works, hmmm?" Terrible pitch. I've never been a fan of using closers in non-save situations -- they are used to pitching with adrenaline pumping and celebrating the last out of the inning. I realize it was a a swinging bunt and an error that caused the problem, but that may have been the worst pitch I have seen Rondon throw in a long time.
Ugly series save a few clutch Homeruns. 2 first inning Homeruns allowed. 2 complete innings (out of 27) with a lead (8th and 9th game 2). 6 Leads/Ties given up top half of the inning after scoring. 9 9th inning unearned runs. Brutal roadtrip coming up while SF plays 22 straight against teams with losing records. Like the Cubs odds, obviously, but long way to go.
No more f'n Pajama Parties, Joe! Losing a series at home to the Reds (who have a worse record than the Brewers) in September is not what we are looking for, gentlemen. 3 series losses in a row -- let's get that fixed immediately. Bad error by KB as Crunch describes -- almost like he was surprised the ball was hit to him. I think if he makes that play we win the game.
solid smack to him...right through his legs. he wasn't even in motion, totally stationary. no bad bounce, either. it was hit very hard, but also squarely wiffed...not even any glove contact. it happens...not a good time for it to happen with 2 outs, though. that was the inning ender, easy.
Can someone tell me about Bryant's error who saw the play? You cannot give the Reds (or most teams) 4 outs. In this case with Joey Votto coming up.
un...fucking...believable... tie a game in the bottom 8th, give up 3 runs in the top 9th...why the hell not. awesome.
DAT TIE THO.
Ugh Hammel...the new Haren. The 3-5 starters have imploded and killed yet another series.
Just about to type the same thing.....Augh!
5 times in the last 3 games, Cubs have taken the lead or tied the game in the bottom half, only to give up runs in the top half.
<p>I'd like to see stats on opposing pitcher batting average. It's probably not real, but seems like we give up hits all the time to f-ing pitchers. </p>
Tony Four Sacks # 27