ROTISSERIE: Injury terminology—Reading between the lines

[Ed.—James Ferretti, DO, has over 10 years experience as a diagnostic radiologist and has been in practice since 2012.]

“Time is money.” 

 - Benjamin Franklin 

It used to be enough in fantasy baseball to have more and better information. Now, information flows freely, so one the biggest advantages has become reading between the lines and acting quickly. In fantasy baseball, especially with player injuries, time really is money. 

My goal is to take my 15 years of medical training and injury evaluation experience and distill it down to a few paragraphs of information that you can use to evaluate player injuries yourself, without waiting for an official diagnosis or projection, and to do so without having to attend medical school. 

We’ll get started by addressing some commonly used terms bandied about by managers and medical staff and looking a little deeper into what they’re really saying. Hopefully, you can gain an advantage by reading between the lines. 

"No structural damage"
We hear this a lot—it sounds reassuring, right? The first problem is that it’s not a real radiology/imaging diagnosis. When I make a diagnosis, I say things like "anterior dislocation of the shoulder" or "nondisplaced fracture of the distal fibula," (the bad news). In other cases, I say "normal," "negative," or "no injury seen" (the good news). Do you want to guess how many times "no structural damage" has shown up in one of my reports? A hundred? A couple dozen?  

How about zero? Zip. Not once. 

It's not a diagnosis—though taken at face value it sounds reassuring. But it’s what the reports are not saying that matters. 

What "no structural damage" tells you is that whatever is being imaged is intact. There is no break and tear of the soft tissues (cartilage, muscles, tendons, ligaments, etc.). However, it’s not the same as "normal" or "negative" (where there is no injury seen) because there can still be an injury present—specifically things like tendinitis or a low-grade (grade 1) sprain or strain. Those injuries are not technically "structural damage" but they do come with the inconvenient effect of often being very painful. 

THE TAKEAWAY: If your player's imaging shows "no structural damage" that’s usually better than a broken bone, damaged cartilage, or a significant tear, but it doesn't mean your player isn't still dealing with a serious injury that could keep him out for a while. You still need to keep a close eye on the situation, watch for updates/clarification, and maybe even get that replacement player lined up. 

This might be my favorite, as it’s saying something without actually saying anything. A player gets injured and someone from the team announces that he’s "day-to-day." That sounds kind of reassuring too, like it only might be a day or two until the player is back. 

Not so fast. It usually means that they are going to assess his condition on a "day-to-day" basis. As in "we'll get a medical evaluation now, maybe run some tests and get some images. Then we'll see what that shows and maybe run a few more tests and get some more images. Then maybe we'll tell you something useful (and maybe not)." 

"Day-to-Day" doesn't really tell you anything (except maybe that the player isn't "week-to-week" which would be terrible news indeed). In fact, when it comes down to it—as many have noted over the years—we’re all “day-to-day.” 

What they are really saying? It pretty much boils down to something like this "we aren't sure how bad the injury is or how long he is going to be out. But the media need something, so we’ll go with this until something better comes along." Or put more succinctly: "We have no idea what's going on right now. We hope to know more soon, but for right now, we got nothing." 

Try this exercise: going forward, whenever you hear someone say "he's day-to-day," translate it as, "we have no idea as to the nature or severity of the injury right now." That’s far more worrisome than a banal “day-do-day” (as it should be). 

THE TAKEAWAY: If one of your players is hurt and his status is "day-to-day," stay vigilant and watch for any further updates while your opponents are potentially lulled into a false sense of security. It’s not exactly rocket science, but you'd be amazed at how many times you can get the jump on grabbing a potential replacement because you stayed on "yellow alert" while a player was "day-to-day" and your opponents did not. 

"X-Rays are negative" 
Okay, now we're getting into my actual wheelhouse. 

What usually prompts imaging for a player is either a sudden onset of pain or other symptoms suspicious for injury (a "pop," loss of range of motion, tightness or looseness in the joint, etc.), or pain that is either more than "normal," or pain that is increasing in intensity. 

An x-ray is usually obtained first, though more often as a complement to an MRI, rather than specifically searching for a bone or joint injury. The main reason is that x-rays are really good at looking at bones and not much else, while an MRI is not as good at looking at bones and really good at looking at pretty much everything else. If the doctor looks at both together, he can be pretty sure he’s seeing the whole picture. 

Most baseball injuries are to soft tissue, and you would never diagnose these with an x-ray. Unless there’s a suspicion that a bone has been broken (such as being hit on the wrist with a pitch), or a joint injury,the x-ray isn’t going to tell you much. Often, I see well-meaning writers and analysts take a negative x-ray report in the setting of a non-traumatic injury and use that to justify reassuring their readers that an injury is "not believed to be serious." 

THE TAKEAWAY: X-rays are only one part of the diagnostic process. While a clean x-ray eliminates some possible injuries, they’re often the least likely injuries to begin with. An x-ray almost never tells the whole story. 

It's fine to hope that a player isn't seriously injured because his x-rays are negative, but you would be wise to take the time to line up a potential replacement while you wait for better or more definitive info. Knowing this will hopefully help you avoid the confusion and the frustration of "where did this injury come from and why didn't they see it the first time on the x-rays?! I coulda moved on this days or weeks ago!" It may also give you a leg up on fellow owners who are lulled into a false sense of security while awaiting the (almost always) more important and definitive MRI results. 

In Conclusion 

Injuries suck. But they do help pay the bills. 

I do hope you found this exercise useful. Please hit me up with any questions, comments or suggestions in the comments section. 

In the meantime, best wishes for continued health and productivity for your players. But if they do get hurt, hopefully now you have a better idea on what to be on the lookout for and how to alter your approach and manage your roster going forward.

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  For more information about the terms used in this article, see our Glossary Primer.