Medical Corner: Clayton Kershaw, David Price, Jacob deGrom, and Other Injury Updates
Clayton Kershaw, Los Angeles Dodgers
For the record, Kershaw was not in my tier one of starting pitchers. I have no idea why you’d expect more than 150 innings at this point his career. Chronic back problems and the Dodgers’ generous utilization of the DL are enough to bump him to the top of tier two for me.
Speaking of evaluating Dodgers injuries, it can be a bit tricky because of their … ahem, shall we say “creative use” of the DL? So we have two very different scenarios. First, this could be DL manipulation to manage/limit innings, which would mean Kershaw may miss one or two starts. The latest report was that Kershaw “avoided any structural damage” and he is already playing catch. Not something I’d expect with acute biceps tendonitis (BS flag is raised).
The second scenario is that he has biceps tendonitis. Kershaw would not be allowed to throw for 2-3 weeks and receive extensive treatment to reduce inflammation. The biceps tendon acts as an anchor and decelerates the arm during follow-through. After a few weeks of rest, he would ramp up his efforts and require at least one rehab start, missing a total of 4-6 weeks. Estimated Return: DL Manipulation – 2 weeks, Actual Injury – mid June. I’m betting on the two-week timetable.
David Price, Boston Red Sox
Ligament injuries (like those that require Tommy John) do not cause numbness; nerve irritation/impingement result in numbness. Price left one of his previous starts with a “strange sensation” in his hand. It was later reported that he experienced a lack of feeling in his fingertips. Nerve impingement commonly occurs at 2-3 locations in a pitcher – the base of their neck (thoracic outlet syndrome), their elbow (ulnar nerve irritation), and the wrist (median nerve irritation). Price’s description is troubling: “My whole hand — didn’t have any feeling in my fingertips. That’s something that I’ve felt before, but it didn’t go away.” Yesterday’s report of mild carpal tunnel syndrome matches up well with his symptoms.
Carpal tunnel can be treated with rest, rehab, immobilization or surgery. We chose surgery when one of two scenarios are present (or both): pain that doesn’t go away or progressive numbness/tingling or loss of strength. Carpal tunnel causes weak grip strength and decreased fine motor coordination (probably a big deal for a pitcher). His numbness hasn’t gone away, so it’s likely he is shut down, given rest to see if the inflammation/numbness go away. And if it doesn’t, surgery will address the problem.
Price exited his start early due to these symptoms and failed in his attempt to return. His velocity is down about two mph, and he has persistent numbness. I’m not optimistic he’ll avoid surgery. Expected Return: Post-All Star break to early August. Worst-case scenario: 2019
Jacob deGrom, New York Mets
Kudos to the Mets’ new medical staff for exercising caution and not acting like the Mets. A hyperextended elbow means the joint bent in the wrong direction, and ligaments were stretched but broken or torn. At the microscopic level, some tears did occur, but a few days rest can often be enough to heal the minor damage.
deGrom is projected to start Sunday (bumped six days), and while I would prefer to see more rest, it is better than nothing. The injury occurred while swinging, which does matter. A hyperextended elbow during a followthrough will tax a slightly different portion of the elbow than a pitch (think more middle than outside). Expected Return: Sunday, May 13 – elevated injury risk
Danny Salazar received a PRP (platelet-rich plasma) injection on May 8. A PRP injection a few months ago is routine treatment. This late, it is a sign that pain is not subsiding. Don’t expect Salazar back anytime soon, and, yes, this is an indication of a setback.
Greg Bird hit a moonshot while playing DH in his first rehab start. I’d expect him back in the next two weeks, and he will be worth the add in most 12-team (or deeper) leagues.
Alex Reyes is ramping up his activity and is eligible to return in late May. He likely begins in the bullpen, but if you are in a keeper/dynasty format, he’s worth a target. If he’s in the bullpen, his value is limited in redraft leagues.
Justin Turner appears to be about a week away from returning and is worth a look in most formats. I expect his power to be a bit muted early on, but if he regains his spot in the order, he contributes in three categories (runs, avg, RBI).
Daniel Murphy remains on track for an early June return. Knee pain with running isn’t all that uncommon at this juncture of rehab. It’s not ideal, but that’s why I said back in March that he wouldn’t return until June.