• I am going to recomend a couple must-read articles for the week which look at the differences and “results” of stem cell and platelet rich plasma (PRP) injections. The first one starts with the Angels Garrett Richards and Andrew Heaney choice to use them, but ends up being a great overview of the entire subject.

On May 2, Steve H. Yoon, a physician at the Kerlan-Jobe Orthopaedic Clinic in Southern California, extracted stem cells from Andrew Heaney’s bone marrow and injected them into the damaged ulnar collateral ligament in his elbow. Fourteen days later, Yoon did the same with Garrett Richards.
Now the Angels’ two best, most promising starting pitchers are left to wait, and hope.

If the stem-cell therapy works, Heaney and Richards will be lined up to pitch for a full season in 2017 and may even be able to contribute toward the end of this very summer. If it doesn’t, they will undergo Tommy John surgery that, at this point, is certain to knock them out until the start of 2018.

The second article is a study by the American Journal of Sports Medicine which found “no significant” positive effect for using PRP injections.

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• Sonny Gray will miss some time with a strained right trapezius (back/shoulder/neck muscle).

Gray said he got a cortisone/anti-inflammatory shot for the issue Friday and he believes he will not miss a great deal of time. He said he got treatment for the muscle strain in the trapezius and his neck before his start at Tampa Bay last Sunday and it felt OL during that game but it nagged a bit during the week.

“Warming up against the Yankees in the fourth inning, it locked back up the way it did in the bullpen in Tampa,” Gray said. “I definitely noticed a difference warming up the inning. It’s just a matter of getting extension and getting out in front.”

Said A’s manager Bob Melvin: “I don’t think it’s really affected his velocity, but it’s affected the command. It’s like pitching with a rock in the bottom of your neck.”

Sounds like minimum time lost and not a major injury.

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• Carlos Gomez is on the DL to work out some mechanical issues with bruised ribs.

Astros manager A.J. Hinch said prior to the series opener at U.S. Cellular Field that Gomez was kneed in the ribs diving back into second base during a play in Sunday’s loss in Boston and informed the team on the flight to Chicago that he didn’t feel well.

“We talked to our doctors and had him evaluated, and it’s in the best interest to everybody to get him healthy and not play short,” Hinch said. “He wasn’t going to play in this series based on the injury, so we felt no need to keep him here as a bench player that wasn’t available.”

I bet he either had this injury for a while or it is totally made up.

• Geovany Soto will be out a few months after tearing the meniscus in his knee.

Soto’s right knee bothered him a bit during Tuesday’s Freeway Series game at Dodger Stadium, but he showed up to the ballpark planning to play Wednesday. His knee then locked up while he rode the elliptical early in the afternoon, then again as he walked to the trainer’s room, prompting an MRI that showed surgery was necessary.

I am estimating he will miss a couple of months, it might even be a bit longer since he is a catcher and his knees get suck a workout.

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• I am going to start with a report which just came out from the Journal of Shoulder and Elbow Surgery on UCL tears. Here is the conclusion:

MLB pitchers requiring UCL reconstruction do not pitch at higher velocities than matched controls, and pitch velocity does not appear to be a risk factor for UCL reconstruction. However, MLB pitchers who pitch a high percentage of fastballs may be at increased risk for UCL injury because pitching a higher percent of fastballs appears to be a risk factor for UCL reconstruction.

I agree with every aspect of the findings expect “pitch velocity does not appear to be a risk factor for UCL reconstruction”. The problem with the study is that the difference was between pitchers with similar velocities (less than 1 mph difference). I would not expect a huge injury rate difference in pitchers throwing 91 and 92 mph. As I previously found, harder throwers do see an increase in Tommy John surgeries. Their velocity statement may be true under their limited conditions, but it isn’t stated as so. It is made to read like a major breakthrough, but it isn’t.

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• Garrett Richards will need Tommy John surgery to repair a torn UCL.

The Angels, already dealing with an assortment of injuries throughout their starting rotation, were dealt a debilitating blow on Friday, when it was revealed that their best starting pitcher, Garrett Richards, will likely require season-ending Tommy John surgery to repair a high-grade tear of his ulnar collateral ligament.

Richards will seek a second opinion, presumably from Dr. James Andrews, but Angels general manager Billy Eppler acknowledged that the invasive procedure, which would keep Richards out until at least the middle of the 2017 season, is “likely at this point.”

This sucks.

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• I may be reading too much between the lines here, but I don’t expect Jung-ho Kang to be playable in mixed leagues because of a lack of playing time when he returns. The Pirates have said that he won’t play more than two days in a row.  Also, I think there is a decent chance he gets sent to the minors to continue his progress. Here are the quotes which I make my stance on.

Saturday is the final day of Kang’s 20-day rehab assignment with Triple-A Indianapolis. The Pirates essentially have three options. They could choose to activate him and add him to their roster this weekend in St. Louis. They could pause his rehab assignment and resume it shortly afterward, resetting that 20-day clock. Or they could activate him and option him to Triple-A to get more playing time.

The Bucs are mulling over those options, head athletic trainer Todd Tomczyk said Wednesday, but they remain encouraged by the third baseman’s progress.
……
In 13 games with Indianapolis, Kang has hit .150/.217/.225 with four walks and nine strikeouts. He’s taken 40 at-bats, nearly reaching the threshold of 45-60 that the Pirates set for their players in Spring Training.

Over the past two weeks, Kang has played on back-to-back days before taking a partial day off to pinch-hit or come off the bench to play defense. General manager Neal Huntington recently said Kang likely will continue on that schedule when he returns to Pittsburgh.

• Devin Mesoraco is going to be out for a while with a torn shoulder labrum.

After he missed most of last season with a hip injury, Reds catcher Devin Mesoraco is now facing the specter of losing most of 2016, too. On Monday, Mesoraco was placed on the 15-day disabled list with another serious injury — a torn labrum in his left shoulder.

Surgery is a possibility, which would mean Mesoraco would miss the rest of the season.

I would expect nothing from him this season even if he comes back. I would begin now looking for other options at catcher if you rostered him.

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I have finally finished Jeff Passan’s new book, “The Arm” and have a few pieces of information I found interesting.

• When the ulnar nerve is brought in injury discussion people get excited. Here is why, “… ulnar nerve, a tube of fibers that originates at the spine snakes down the arm and controls fine-motor movement in the hand.” The nerve may need to be moved to get away from bone chips.

Mike Marshall would even take it a step further

“… when a pitcher showed professional potential, he would go in for surgery to transpose the ulnar nerve.”

• The major issue with a second Tommy John surgery is the holes drilled in the arm weakening the bone like it has with Jarrod Parker. Here is a description when the book mentions Todd Coffey’s second surgery:

“Surgery dabbles in fractions of a millimeter. The drill holes from Coffey’s first surgery left his ulna in danger of cracking.”

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• Raisel Iglesias is on the DL with shoulder impingement.

Iglesias, 26, felt a “pinch” in the shoulder while throwing a bullpen session on Friday. It’s unclear at this point how long he’ll be sidelined.

“It looks like it’s an impingement inflammation,” Reds manager Bryan Price said. “We will know a lot more when we see him on Monday. However, it doesn’t sound like it’s going to be a long-tenured stint on the DL.”

I am not surprised one bit with Iglesias’s injury. I own him in several leagues and have noticed his velocity (91.7 to 90.4) and Zone% (50.5% to 46.3%) down compared to last year. Not surprisingly, he showed up my initial PAIN Report as a pitcher with a possible injury.

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• Travis d’Arnaud was placed on the DL with a strained rotator cuff

Returning from the DL after 15 days, d’Arnaud added, is a possibility in his mind. But the Mets are not committing to a timeline, fully aware of how many injuries their starting catcher has suffered in his young career. Among d’Arnaud’s library of past maladies are a partially torn knee ligament, a hyperextended left elbow, multiple broken bones and a concussion. He was hitting .196 through 13 games this season, with zero home runs and one RBI.

“It’s always going to be wait-and-see, but there are two positions where arm injuries can be pretty devastating, and one’s behind the plate,” manager Terry Collins said. “We’ll wait to see, rest him a few days, see how he comes out of that. And then when he starts to rehab back, you’ll see how long it’s going to take. It’s certainly something we’ve got to keep a close eye on.”

It seems like d’Arnaud could be out for around a month.

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• The most impactful injury this week is the hamstring injury sustained by Carlos Carrasco.

The severity of the setback is not immediately known, but manager Terry Francona said Carrasco will be placed on the disabled list, meaning Bauer could be poised for a move back to the starting rotation.

….
After his abrupt departure in the third inning, when he sustained the injury while hustling to cover first base, Carrasco headed back to Cleveland to undergo an MRI exam.

Francona said the team will likely have more details on the extent of the issue on Monday, when the Tribe opens a three-game road series against the Twins.

Right now we know he is out at least 15 days with more information coming today (the news might be available by the time this article runs). Just looking back at pitchers with hamstring strains and sprains, they usually return in just over 30 days.

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