Who Ya Gonna Call?
"If it's somthin' weird an' it don't look good..."
Letting Aramis Ramirez walk for the 2012 season was the easy part. The new Cubs braintrust loves supplemental round draft choices. Picking up the one year, $16 million option on ARam, with the expectation that he would decline and lead to a supplemental 1st rounder (which turned into pick #43, college pitcher, Pierce Johnson from Missouri State U.) was highly predictable.
The more problematic other side of the coin was to replace ARam for the near term. If the cliche' buy low, sell high... doesn't do it for you, at least Jedstein believes in buy low. Here's the checklist: 2003 1st round draft choice (10th pick), 2005 overall #4 prospect from Baseball America (after Mauer, King Felix, and Delmon Young), hitting setbacks because of injuries (knee contusion then left wrist) but with recovery possible based on medical reports, still young and relatively inexpensive, left handed bat, decent defender. OK, that all checks for Ian Stewart (no not that Ian Stewart, just checking to see if you use the links).
Here's where things jump the tracks. He's had a bad wrist for over a year and nobody in Colorado or Chicago has a diagnosis.
Ian Stewart's 2009 season was pretty interesting for a young-un (age 24). As in 25 HR's and 70 RBI's. His 2010 season was better in terms of batting average (.256) and OBP (.338) and about the same in OPS (.781 vs. .785). I found a series of articles on Ian Stewart from the 2010-11 offseason from Purple Row Blog by Andrew Fisher (part 1, part 2, part 3) and a followup article on his 2011 disaster season where his wrist problem started. Yet, even in that article the Rockies fans considered unloading Stewart an act of selling low:
The problem with Stewart, not only in 2011 but in his career, however, is what is found off of the paper. Without directly pointing his finger at the Rockies 2003 1st round pick, Dan O'Dowd has essentially made Stewart the face of this offseason's roster purge of nefarious characters. Preaching the need for accountability and proper focus, O'Dowd sold "low" on Stewart by sending him with Casey Weathers to the Cubs for outfielder Tyler Colvin and infielder DJ LeMahieu, neither of whom are guaranteed a roster spot in 2012.
So I understand why Ian Stewart is here. The picture is now clearer. He's broken. The more important question is, can he be fixed?
Having a sore wrist for a professional hitter is a bad thing. I remind you of Derrek Lee's broken right wrist from a collision with then Dodger, Rafael Furcal, in 2006. Lingering effects on Lee seemed to result in the loss of much of his power for the remainder of 2006 and it didn't rebound until 2009.
Now to the medical side. Supposedly all diagnostic imaging (MRI, X-Rays and EMG which is a nerve conduction test) are all negative. Stewart said in a CSN interview with Patrick Mooney:
“It was just always there in the back of my mind that there’s something not right, even though nothing showed up on the MRI or the X-rays. That was the frustrating part, because I still feel it there bothering me.”
Stewart described a tingling sensation, and having trouble with his swing on inside pitches. He said nerve tests came back negative last season when he played for the Colorado Rockies.
Previous medial opinions from Colorado and Chicago say nothing is structurally wrong. That doesn't mean it is a psychosomatic , somatoform or a malingering problem. Monday, Stewart will be visiting a doc at the Cleveland Clinic for another opinion. Although names have not yet been mentioned in the media, the biggest name that makes sense to me for a tertiary opinion is Dr. Thomas Graham, aka "hand surgeon to the Professional Athlete."
Dr Graham did a hand fellowship at the Indiana Hand center then did special training at the Mayo clinic in elbow surgery before started his careeer at the Cleveland Clinic in 1994. In Cleveland, he blossomed into the superstar hand specialist to the stars.
Graham was hand surgery consultant for professional sports teams in
Cleveland — still is for the Cleveland Indians and the Cleveland
Cavaliers. He also consulted for the Cleveland Symphony and the Rock and
Roll Hall of Fame and Museum.
In 2000 he went to Baltimore's renown Curtis Hand Center (the world's largest hand center). More recently he returned to Cleveland in 2010 as the head of the Cleveland Clinic's corporate venture called "The Cleveland Clinic Innovations." Graham is more than just a surgeon, he's well known as an entrepreneur and holds patents on several products for elbow joint replacements and upper extremity fractures.
Rock & Roll Hall of fame credits include David Crosby's hand. Make's one wonder if CSN&Y reference is to both Dr. Graham and Graham Nash.
"although Dr. Graham eschews the mantle, "physician to the stars, " usually two to five pro athletes are coming in per week to see him."
What could be wrong with Ian Stewart's wrist? Supposedly he's had pain and swelling of the left wrist and some tingling in his hand only upon certain activities but not all the time. From a Cleveland.com article on Stewart (and quoting Stewart):
"He said his wrist feels fine much of the time, but certain movements cause the pain to pop up again. It's more when it gets into certain positions," he said. "I dive for a ball and have to put the weight on my hands to push myself up. Certain swing path. Balls in, not so much balls away. But nothing where it's just hurting as we're talking right here."
So that might explain what has been a complaint by posters here at TCR about Stewart's "one-plane swing"
What possible diagnoses are under consideration? Remember this is just my speculation list of diagnoses. It will be Dr. Graham's job to sort out what where nobody so far has been able to do.
The most common cause of tingling at the wrist level is Carpal Tunnel Syndrome. Sometimes the symptoms can be quite subtle. CTS is a compression of the median nerve on the palmar side of the wrist underneath a thick transverse carpal ligament. The median nerve provides sensation to the thumb, index, long and half of the ring finger. It also provides motor function to the thumb. Symptoms usually develop gradually over time. Diagnostic studies such as EMG are often negative so it's often a clinical diagnosis but certain provocative maneuvers on exam can be helpful to make the diagnosis. More recent use of ultrasound imaging of the wrist can show if the median nerve is compressed or has unusual anatomic patterns. The treatment is on a conservative basis (for an athlete) probably a cortisone injection into the carpal canal but more reliably a surgery that decompresses the pinched nerve. Recovery for a hitter would depend on the surgical technique but could be as little as a month. The prognosis here is very good if that is the diagnosis.
Other pinched nerve syndromes exist as well. The ulnar nerve can be compressed causing tingling into the little/pinky finger at an anatomic site called Guyon's canal. Surgical release of this nerve is the treatment when the problem is chronic.
The wrist joint proper is complex with eight carpal bones. Medical students trying to learn their anatomy have used several clever Mnemonic tricks to help recall all eight (please check out this link). The wrist bones are arranged in two rows of 4. Proximal row: Scaphoid (or Navicular), Lunate, Triquetrium and Pisiform. Distal row: Trapezium, Trapezoid (thumb side), Capitate and Hamate. Not to be forgotten are the two bones that end the forearm, the radius and ulna. There are multiple significant ligaments that connect the carpal bones permitting stable transmission of forces and permitting the foundation for hand function ranging from precision fine motor control to power grip activity.
Carpal bone injuries often show up on MRI imaging, so this is less likely unless it's really subtle. Baseball players have sustained scaphoid fractures and hamate fracturess, pisiform and triquetrium fractures are rare but not unheard of. Phillies OF Domonic Brown had a hamate fracture in 2011. So something more subtle might turn up yet in diagnosis with more expert evaluation.
One diagnostic test not mentioned is the wrist arthrogram, which is either an X-Ray with contrast material injected or an MRI with contrast material injected. Much had been written on shoulder injuries that get worked up with MRI imaging that can be more useful when dye is injected to add contrast to structures in the joint. The same is true for the wrist. Tears of a specific cartilage known as the Triangular fibrocartilage/TFCC can be seen better with this imaging. Also more subtle wrist ligament tears can be assessed since the wrist can be moved after the dye injection and the pattern of where the dye tracks can be useful.
Wrist arthroscopy is used to sort out and treat several conditions that might not show up on diagnostic imaging. When Stewart refers to needing surgery on his wrist. This is a very probable possibility. From the American Academy of Orthopedic Surgeons (AAOS) website on Wrist Arthroscopy:
Chronic wrist pain: Arthroscopic exploratory surgery may be used to diagnose the cause of chronic wrist pain when the results of other tests do not provide a clear diagnosis. Often, there may be areas of inflammation, cartilage damage, or other findings after a wrist injury. In some cases, after the diagnosis is made, the condition can be treated arthroscopically as well.
Monday in Cleveland, I'm betting that Ian Stewart gets a recommendation that will lead to a diagnosis and treatment...and maybe more than one plane to his swing.
Cubster 1 hour 58 min ago (view)
Chiming in that TCR is still a major part of my daily Cub routine and has always been my browser homepage. The site contains much love for AZ Phil and his subtle sense of humor as the war correspondent for the Arizona Scoring Service.
"Just because it isn't official doesn't mean it didn't happen"
Hagsag 4 hours 37 min ago (view)
Thank you forTCR, and it is the first site I check daily. Please keep it going.
Karl Pagel Blues 7 hours 19 min ago (view)
Thank you for this site. It's the first one I turn to every single day. There may be other sites with more daily content, but there's only one TCR. Again, a big thank you to everyone actively contributing here!
crunch 11 hours 53 min ago (view)
no matter the future, i've learned a whole lot being here and i'm still learning. phil's post earlier with the end-season instructs stats is a great example of this. lots of love for the team, the farm system, and the game here.
also, it looks like dusty's crew is 3 outs away from going to the WS with 5 runs to cushion.
George Altman 13 hours 40 min ago (view)
Please keep it going if at all possible. No other Cubs website compares. I've spent 15 years with AZ Phil, Crunch, Cubster. Don't want to see that end.
Alexander Dimm 15 hours 42 min ago (view)
Like the others, I don't post often, and it's not the only Cubs baseball site I read. However, it is the first site I read each day and if I only read one, this is it. I hope you can hang in there.
Cubs baseball will be a little less fun without TCR.
Childersb3 16 hours 19 min ago (view)
I've been reading, commenting and asking questions here for over a decade now. Cubdom wouldn't be whole without TCR.
Hope it stays in any form possible.
Whatever is most manageable, cheapest, time efficient manner you.
bradsbeard 16 hours 59 min ago (view)
Absolutely want to see if stay if possible.
Sonicwind75 19 hours 14 min ago (view)
Thank you for hosting and maintaining the site. I don't post often but have been visiting since mid 2000s. Really appreciate the information and community of The Cub Reporter. I understand it can be a lot of work to maintain a site but would really hate to see it end.
Hagsag 1 day 4 hours ago (view)
Thank you Phil, I can see this is a work of love.
Wrigley Rat 1 day 20 hours ago (view)
Cubs Reportedly Sign Powerful Infielder Alejandro Rivero Out of Indy Ball: https://www.bleachernation.com/cubs/2021/10/21/cubs-reportedly-sign-powe...
crunch 2 days 16 hours ago (view)
* except for playing 1st base
crunch 4 days 12 hours ago (view)
a lot of people were all-in on it being a 2022 thing, but given how MLB has held the DH over the player's heads like it's some kind of extremely valuable chip worth more than the players seem to think it's worth...who knows...
Cubster 4 days 14 hours ago (view)
any estimates on the chances of the DH in the NL anytime soon?
crunch 4 days 14 hours ago (view)
k.schwarber is hella good at post-season baseball.