MLB injury mailbag: Cloudy rehab forecast for Eloy Jimenez, checking in on Stephen Strasburg and more

In this mailbag: Why Eloy Jiménez might not return until the second half of 2022, an update on Stephen Strasburg, and more!

Inside Injuries was founded by an orthopedic radiologist, Dr. Anand Lalaji (aka Dr. A), who contributes to all of the injury write-ups. Dr. A put together a team of doctors and data scientists to create an algorithm to evaluate the impact that injuries have on a player. This algorithm powers all of Inside Injuries’ analysis and determines each player’s Injury Risk, Health Performance Factor (the level a player is expected to perform at if they return too soon, for example) and Optimal Recovery Time. This information is based on years of medical experience and historical injury research and has proven to be incredibly accurate in determining how injuries will impact a player’s performance and risk of future injuries.

A quick description of terms from our injury algorithm:

  • IRC = Injury Risk Category (Low, Elevated, High) – the overall likelihood a player will get injured
  • HPF = Health Performance Factor (Peak, Above Average, Below Average, Poor) – our metric to predict player performance
  • ORT = Optimal Recovery Time – the amount of time a player needs to fully recover from an injury (not the same as how much time they will actually miss)

Thoughts on Eloy Jimenez? – Michael C.

Eloy Jiménez is looking at another lengthy absence. While legging out a ground ball on Saturday, Jiménez stumbled after stepping on first base. He remained on the ground grabbing at the back of his right leg. Jimenez was then carted off of the field. An MRI showed a significant hamstring strain. The Inside Injuries algorithm has him listed with a grade 3 injury, indicating a partial tear to the muscle. This is a severe strain, and it comes with a 10-week Optimal Recovery Time. His current estimated timeline is 6-8 weeks, but realistically his absence will last past two months.

Jiménez has a lengthy injury history that includes a torn pectoral tendon that required surgery in 2021. Other notable injuries include a mid-foot sprain, quad strain and left adductor strain. He does not have any significant hamstring strains to his name, though. If Jiménez does not experience any setbacks, I’m expecting him back around the All-Star break, although he will still come with a High Injury Risk as hamstring strains are highly recurrent.

Any news on Stephen Strasbourg? – Joe F.

Strasbourg underwent thoracic outlet surgery back on July 28. This is one of those procedures that seems to have become more common in recent years. Other notable pitchers to undergo this procedure include Matt Harvey, Phil Hughes and Chris Archer. There are two types of thoracic outlet syndrome – neurogenic and vascular. Neurogenic TOC is more common. It occurs when the nerves in the thoracic outlet (a pathway between the collarbone and the first rib) are constricted, leading to weakness, tingling and numbness in the hand and arm. Pitchers can also experience pain or weakness in the shoulder and neck due to the compression of nerves and blood vessels. TOC will get worse over time if left untreated, especially with a repeated overhead motion such as throwing. In some cases it is possible to avoid surgery and focus on strengthening the surrounding muscles but, for a majority of pitchers, surgery is unavoidable. During most surgeries a portion of the first rib is removed, opening up space for the nerves. It sounds simple enough, but unfortunately this is a very tough injury to come back from. Most pitchers are back on the mound in 10-12 months, but they aren’t the same player when they return.

Injuries have been a problem for Strasbourg in recent years, and his latest surgery is the most concerning long-term. He has been limited to just seven starts over the past two seasons due to injury, also battling shoulder inflammation and then carpal tunnel neuritis that required surgery in 2020. Other notable injuries in his career include a nerve issue in his right elbow, Tommy John surgery , a partially torn pronator tendon and cervical nerve impingement.

So what does all of this mean for Strasbourg? Right now he is on track to return to the Nationals rotation in the next month or so. His progress has been slow, but he is moving in the right direction. Strasbourg threw a 27-pitch bullpen session last week but there isn’t a timeline for a rehab assignment yet. A very slow, methodical approach is needed due to the complexity of TOC and its lengthy injury history. I do not see Strasbourg ever looking like the ace he once was, and his Injury Risk will remain very High for the entirety of the season. It’s unlikely he will make it through the year without some sort of a setback.

Any good news on Riley Greene? – Ernie M.

Greene suffered a fracture to the bottom of his right foot on April 1 when he fouled a ball off of it. It was a non-displaced fracture that did not require surgery. Before the injury he was trending towards making the Tigers’ opening day roster, but now he is looking at a 6-8 week recovery. Realistically it will be on the longer end of that timeline before he is cleared for a rehab assignment.

Right now Greene just needs time for the bone to heal. He should be able to take some swings and do some stationary fielding drills before he hits the eight-week mark, but activities like running that put pressure on the foot will need to be avoided for a while. Greene could be cleared for a rehab assignment by mid-June, with a target to get called up to the major leagues in late June or early July, depending on how he looks at the plate.

How soon until Luis Urias is ready for the every-day MLB lineup? – Preston S.

Urías is close to a return after he suffered a left quad strain during spring training. That was five weeks ago, and he has just reached his Optimal Recovery Time, according to the Inside Injuries algorithm. The Brewers initially believed this was a minor injury, but as we often see with muscular injuries, this strain was more severe than they let on.

Over the weekend, Urías was cleared for a rehab assignment at Double-A. I’m expecting him to make his season debut within the next week, but his Injury Risk will remain High. He currently comes with a Below Average HPF, although our projections show it will improve to Above Average by May 3 if he can avoid a setback.

How is Lance McCullers doing? – Ernie M.

McCullers remains on the 60-day IL as he continues to recover from a flexor tendon injury. It started when he made an early exit from his start in Game 4 of the ALDS. The initial plan was to shut him down from throwing for a few months. An MRI on his elbow in December confirmed that his surgically-repaired UCL still looked good following 2019 Tommy John surgery, but the flexor tendon strain was significant. In February a report came out that he was throwing but was behind in his recovery. The lockout led to a choppy rehab process that affected him, and McCullers also indicated that the injury was more severe than the team initially let on. He said, “I had a pretty good strain in my flexor tendon in my forearm, it was off the bone quite a bit.” Tendons attach muscle to bone, and this quote indicates a significant tear. Inside Injuries has this as a grade 3 injury, which is very concerning, especially for a pitcher’s throwing arm.

When asked if he might need to undergo surgery, McCullers responded, “We’re not going to cross that bridge unless we absolutely have to.” It’s been six months and that forearm tendon is still not fully healed, so we’re approaching the point where it may be necessary. McCullers received PRP and stem cell treatments last month to aid in his recovery. He did recently say he is throwing pain-free, but one more setback and he needs to just shut things down for the year and undergo surgery. The best-case scenario right now is a return in mid June, but I do not see McCullers making it through the season without a setback. That could mean the forearm flaring up again or a new compensatory injury as he works his way back.

Thoughts on Javier Báez and his thumb injury? Will he likely have a power issue when he returns? – Scott G.

Báez is already back in the Tigers lineup after a brief IL stint. The injury occurred when he jammed his right thumb while celebrating a walk-off, causing swelling at the joint. He did not initially miss any time but aggravated the injury during an at-bat a few days later. X-rays were negative. The Inside Injuries algorithm is considering this a grade 1 (mild) sprain, and its Optimal Recovery Time is two weeks. There may still be a lingering effect over the next week, but this isn’t a long-term concern. Baez currently has an Elevated Injury Risk but an Above Average HPF. At this point it should not affect his throws in the field, but his power may be slightly reduced.

(Top photo: David Berding / Getty Images)

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