by KFFL

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Updated: August 11, 2008, 2:03 PM EST Comment

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Dr. Alan Knopf has been a clinical Professor of Orthopedic Surgery and Joint Implant Service at the University of Southern California School of Medicine in Los Angeles. He is an attending staff member of the school's County General Hospital - Keck School of Medicine. He specializes in knee, shoulder, ankle, hip and trauma surgery. Dr. Knopf is board certified by the American Academy of Orthopedic Surgeons and the American Board of Arthroscopic Surgery.

For more information regarding Dr. Knopf's work, please click here.

Joba Chamberlain, SP, New York Yankees - Rotator cuff tendonitis in right shoulder, Placed on the 15-day DL

Rotator cuff tendonitis is an impingement syndrome of the shoulder that is classified as an overuse syndrome. It can involve the rotator cuff tendons, biceps tendon, shoulder bursa or shoulder bones. The shoulder mechanism works just like a crane. The steel cable that lifts the weight and swings it to another position is an analogy to the function of the rotator cuff.

The rotator cuff is composed of four muscle tendon connections that cover the entire head of the shoulder bone (humerus). This complex stabilizes the humerus against the shoulder blade (scapula) and is covered on top by a bony projection of the scapula called the acromion process. It is this narrow area that needs to be lubricated in order to prevent fraying of the cable (like oil lubricating a gear).

Bursitis is an inflammation of the sac preventing the breakdown of the rotator cuff (cable analogy). The sliding motion of cable on the pulley of the crane needs constant lubrication. A repetitive motion, like throwing with velocity or lifting heavy weight, can cause an irritation and cause swelling of the bursa, which can lead to chronic change in the bursa as well as a change in the rotator cuff itself.

If left untreated eventually a rotator cuff rupture will occur with repetitive use.

Treatment includes rest, ice, anti-inflammatory pills or steroid injections into the bursa sac (not more than three per year). The inflammation usually resolves in four to six weeks.

Throwing a curve and over the shoulder delivery of a pitch will cause increase stress and wear of the rotator cuff. There will be less stress with a side arm delivery but more stress on the elbow. As a result, elbow tendonitis may develop, which could break down the collateral ligament (Tommy John Surgery).

When the tendonitis is no longer symptomatic (four to six weeks), a gradual return to the throwing motion is recommended.

C.J. Wilson, RP, Texas - Bone spurs in left elbow, Placed on the 15-day DL

Compared to players in other positions and other types of sports, baseball pitchers have a greater chance for an elbow injury. This relates to the remarkably high forces placed on the elbow joint during the pitch. The primary diagnosis in pitchers is bone spurs along the inside edge of the olecranon bone, the main bump on bottom of the elbow. Forceful straightening of the elbow during the pitch sometimes brings the bones of the elbow into contact. Repeated contact eventually causes bone spurs to develop where this contact occurs.

The second most common condition affects the ulnar collateral ligament. This ligament crosses the inside edge of the elbow. It normally keeps the elbow from bending out to the side. Pitching puts tremendous strain on the elbow in this awkward angle. To visualize this angle, straighten your arm with your palm up. Now try to make your forearm angle sideways where it meets the elbow joint. In a healthy elbow, the ulnar collateral ligament makes this action nearly impossible.

The repetition of pitching compounds the strain on this ligament. This can lead to problems of overuse, eventually allowing the elbow to be strained into this awkward outward position.

Every time that young pitcher goes over a certain pitch count, here is what happens: The soft tissue fibers begin to get what are called micro-tears - the beginning stages of injury. These tendons start tugging on the bones. Since these bones are not fully developed and are actually bone cartilage (bone waiting to happen), the tendons can actually pull a piece of bone away, leading to bone chips and/or bone spurs.

Bone chips are pieces of bone and/or cartilage that are inside the joint and can block motion as well as cause traumatic arthritis or destroy the joint surface. Therefore, surgery should be done.

This can now be preformed by arthroscopic surgery. The joint motion after removal is started immediately post surgery. The rehabilitation will take four to six weeks.

Spur formation occurs outside the joint usually along the elbow tip (olecranon) and will block full extension (as described above). This can also be removed by arthroscopic surgery with a four- to six-week recovery. 

Catchers

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Ivan Rodriguez	NYY	knee	Friday, Aug. 8	Jose Molina	Return to lineup
Victor Martinez	CLE	elbow	Late August	Kelly Shoppach	Retain in all setups
Brian McCann	ATL	concussion	Returned Monday, August 4	N/A	Reinsert into starting lineup
Mike Napoli	LAA	shoulder	Friday, Aug. 8	Jeff Mathis	Add in AL-only

 

First Basemen

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Adam LaRoche	PIT	ribcage	Mid-August	Doug Mientkiewicz	Add LaRoche if available
Todd Helton	COL	back	No timeframe	Ian Stewart	Retain Helton in NL-only
Kevin Youkilis	BOS	hand	Day-to-day	Sean Casey	Hold in all formats

 

Second Basemen

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Robinson Cano	NYY	hand	Returned Monday, Aug. 4	N/A	Return Cano to lineup
Luis Castillo	NYM	hip	Within a few days	Damion Easley	Castillo an option in NL-only
Aaron Hill	TOR	concussion	Season may be over	Joe Inglett	Discard Hill in all
Mark Grudzielanek	KC	ankle	May be done for the year	Esteban German	Add German in AL-only
Alexi Casilla	MIN	thumb	Season-ending surgery likely	Nick Punto	Pick up Punto in AL-only

 

Third Basemen

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Chipper Jones	ATL	hamstring	Friday, Aug. 8	Omar Infante	Activate Jones once he's starting again
Evan Longoria	TB	wrist	Day-to-day	N/A	Hold in all
Ryan Zimmerman	WAS	hand	Started Tuesday, August 5	N/A	Insert in starting lineup
Joe Crede	CHW	back	Mid to late-August	Juan Uribe	Stash in deep mixed
Mike Lowell	BOS	hip	Returned Tuesday, August 5	N/A	Return to lineup
Andy LaRoche	PIT	thumb	Day-to-day	Jose Bautista	Hold in NL-only
Scott Rolen	TOR	shoulder	Returned Tuesday, August 5	N/A	Reinsert in AL-only lineups
Eric Chavez	OAK	shoulder	Done for season	Jack Hannahan	Drop in all leagues
Pedro Feliz	PHI	back	Mid-August	Greg Dobbs	Reserve Feliz in NL-only
Hank Blalock	TEX	hamstring	Mid-August	Ramon Vazquez	Retain in AL-only

 

Shortstops

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Rafael Furcal	LAD	back	September	Angel Berroa	Drop in mixed
Jerry Hairston, Jr.	CIN	hamstring	Day-to-day	Jeff Keppinger	Stash in deep mixed
Cristian Guzman	WSH	thumb	Returned Thursday, August 7	N/A	Put back in lineup
Ryan Theriot	CHC	foot	Day-to-day	Ronny Cedeno	Retain Theriot in all
Khalil Greene	SD	hand	Likely out for season	Luis Rodriguez	Drop in all leagues
Julio Lugo	BOS	quadriceps	Mid to late-August	Jed Lowrie	Retain in AL-only
Maicer Izturis	LAA	thumb	Day-to-day	Erick Aybar	Hold in AL-only

 

Outfielders

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Ryan Church	NYM	concussion	Possibly done for the season	Fernando Tatis	Stash in NL-only
Rick Ankiel	STL	abdomen	Day-to-day; available to pinch hit	N/A	Place in lineup when healthy
Carl Crawford	TB	hamstring	Returned Thursday, August 7	N/A	Return to starting lineup
David Murphy	TEX	knee	Early September	Brandon Boggs	Hold Murphy in deep mixed
Vernon Wells	TOR	hamstring	Monday, Aug. 11	Brad Wilkerson	Add Wells if he was dropped in all leagues
Michael Cuddyer	MIN	finger	Monday, August 11	Denard Span	Add Cuddyer in deep mixed
Justin Upton	ARI	oblique	Mid-August	Alex Romero	Stash in deep mixed
David DeJesus	KC	ankle	Day-to-day	Mitch Maier	Retain in deep mixed
Michael Bourn	HOU	ankle	Returned Thursday, August 7	N/A	Deep mixed steals option
Ryan Spilborghs	COL	oblique	No timeframe	N/A	Hold in NL-only
Jack Cust	OAK	thumb	Day-to-day	Emil Brown	Retain in AL-only
Adam Jones	BAL	foot	Likely out for the season	Jay Payton	Discard in single-year setups
Elijah Dukes	WAS	knee	Mid-September	Willie Harris	Drop in all mixed
Rocco Baldelli	TB	fatigue	Mid to late-August	N/A	Worth a flier in AL-only

 

Designated Hitters

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
David Ortiz	BOS	wrist	Wrist clicking; hasn't missed time	N/A	Monitor in case it worsens
Frank Thomas	OAK	quadriceps	Returned Friday, August 1	N/A	Deep mixed option
Travis Hafner	CLE	shoulder	No timeframe	David Dellucci	Drop in mixed
Milton Bradley	TEX	quadriceps	Weekend of August 8	Frank Catalanotto	Prepare to activate Bradley
Hideki Matsui	NYY	knee	No timetable	N/A	Be prepared to discard Matsui

 

Starting Pitchers

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Andrew Miller	FLA	knee	No timeframe	Josh M. Johnson/Anibal Sanchez	NL-only option; may return as a reliever
Adam Wainwright	STL	finger	Mid- to late August	N/A	Possible move to bullpen; add in mixed
Tim Hudson	ATL	elbow	Done for the year	Charlie Morton	Drop in all leagues
Chien-Ming Wang	NYY	foot	May not return this season	Dan Giese	Discard in all but deep AL-only
Erik Bedard	SEA	shoulder	September	R.A. Dickey	Continue holding in all
Aaron Harang	CIN	forearm	Possibly Sunday, August 10	Homer Bailey	Monitor Harang and be ready to activate
Jason Schmidt	LAD	shoulder	Likely out for the season	Clayton Kershaw	Discard Schmidt in all leagues
Jose Contreras	CHW	elbow	Saturday, August 9	Clayton Richard	Keep Contreras in AL-only
John Maine	NYM	shoulder	Wednesday, August 13	Brian Stokes	Be prepared to activate him
Joba Chamberlain	NYY	shoulder	No timeframe	Ian Kennedy	Retain Joba in all mixed
Jeff Francis	COL	shoulder	Returned Thursday, August 7	N/A	Speculative add in deep mixed
Brad Penny	LAD	shoulder	Friday, August 8	N/A	Add in deep mixed
Phil Hughes	NYY	ribs	Mid to late-August	N/A	Flier option in deep mixed
Sean Gallagher	OAK	shoulder	Expected to miss one start	Dan Meyer	Hold in AL-only

 

Relief Pitchers

Player	Team	Injury	Status/Projected Return	Fantasy Replacement	Fantasy Tip
Kerry Wood	CHC	finger	Tuesday, Aug. 5	Carlos Marmol	Return Wood to lineup; retain Marmol
C.J. Wilson	TEX	elbow	2009	Eddie Guardado	Discard Wilson; pick up Guardado
Billy Wagner	NYM	forearm	No timeframe	Duaner Sanchez	Hold Wagner
Rafael Soriano	ATL	elbow	No timetable	Mike Gonzalez	Dump in all but deep NL-only
Takashi Saito	LAD	elbow	Could be done for the season	Jonathan Broxton	Drop Saito in all but NL-only
Joel Zumaya	DET	triceps	Returned Friday, August 1	N/A	Potential saves source in mixed
Matt Capps	PIT	shoulder	Possibly end of August	Tyler Yates/John Grabow	Look to stash Capps in mixed