The Yankees screwed up the Mark Teixeira injury

Yesterday we got the bad news that Mark Teixeira will be out for the remainder of the season after yet another test revealed he had a fracture in his shin. It's been nearly a month since the Yankees first baseman fouled a pitch off his leg that caused him to play in just two games since that August 17 contest. Originally believed to be a bone bruise, it felt like the team consistently had no answers for why Tex's leg wasn't getting any better, and now that we know the truth, I have to at least ask why we didn't find out about this sooner.

Regardless of what the doctors did or didn't see, the Yankees messed up with their handling of Teixeira. No one is currently blaming the doctors for misdiagnosing him–Tex even came out and said he felt the fracture was always there–but they definitely took too long to figure things out. To get some information as to what took so long on the diagnosis, I talked to Richard Cohen, an X-ray technician for over 30 years, who also happens to be my father. He gave me some interesting information [translated from weird dad-text-speak]:

Some fractures you don't see for up to seven days. Happens all the time...Needs time for bone to separate sometimes.

That sound perfectly reasonable, but when you take into account that it's been almost a month, it seems like someone must have messed up somewhere along the way, and he agreed [again, translated from weird dad-text-speak]:

They missed it if it's been a month. I think they did an MRI right away then another about two weeks. They should have seen it then, unless it's a very small fracture.

Yes, my "source" is my dad, but he does know his stuff when it comes to medical imagining and radiology. Working at several different medical facilities on Long Island, he's had many athletes as patients over the year, including Steve Howe before he signed a free agent deal with the Yankees back in the '90s (he says his arm was in bad shape), and even a very much retired Whitey Ford. He knows his stuff.

So it would seem that we can accuse the medical staff of one of two things:

1. They didn't catch an initial break and allowed him to play on it.
2. It was just a bone bruise, but they allowed the Yankees to push Teixeira until it broke.

While no. 2 might be the juicier story, it sounds no. 1 is more likely. If it can take up to about a week for a fracture to show up–especially a small one–they wouldn't have caught anything on the initial scan on August 17. Instead, he should have been shut down until they could determine, without question, what exactly was going on. If we look at the sequence of events from August 17 to September 11, we start to see a story of confusion and possibly incompetence.

August 17: Mark Teixeira fouls a ball off his leg, gets removed from the game, and is taken for precautionary X-rays at the stadium. Everything came out negative. Of course they did, because that's how this works.

August 18: Still in an incredible amount of discomfort from his injury on Monday, Tex gets sent for a CT-scan and MRI on Tuesday and is initially diagnosed with a bone bruise. Brian Cashman had a ton to say about the thought process at this point:

"A bad bone bruise, day to day," general manager Brian Cashman said. "Took an X-ray [Monday], when he woke up [Tuesday] and it wasn't any better, so all of a sudden the alarms went off. We did all that to make sure we weren't dealing with something that wasn't more of a problem.

"Bottom line [it] is a significant bone bruise. I called [trainer] Steve Donohue and asked, ‘What's the time frame on this?' and he just said, ‘Let's see when [team physician Chris] Ahmad gets here.' I asked, ‘Is it DL?' and he said, ‘I don't think so.' Biggest concern for me when he wasn't feeling any better was that there was a break. If there was a break in there, we'd be in real trouble as far as he was concerned.''

This is all pretty great, considering how it all ended up turning out.

August 19: Tex was rule out of his second game in a row on Thursday as Joe Girardi hilariously said "It's not a whole lot better. We know it's day-to-day." Riiiiiight.

August 20: By Friday, things took on a more positive tone as he missed his third game in a row, but Girardi believed that "today we saw improvement. Not in the lineup yet, but he's better." The Yankees manager even considered him for a potential pinch-hitting role that night, but what exactly was he looking at?

Cashman was also happy to see an improvement in Tex, saying he was going in the right direction after a "significant bone bruise" and was encouraged that his first baseman was no longer on crutches.

August 22: That weekend, Teixeira started playing catch on the field, but was still not close to returning. Girardi had hoped he could return to the field, but Teixeira offered a more conservative, yet positive, look to things:

It's been getting a lot better, so we'll just see," Teixeira said of his potential availability this weekend. "Two days ago, I couldn't walk. The first two days were really bad, the last two days really good. If I keep getting better at this pace, I'll be fine in a few days.

Famous last words.

August 23: He even took batting practice on Sunday with Girardi commenting, rather bizarrely:

"He's still fairly gingerly. Obviously it's a good sign that we got him on the field today to do some stuff, but it's still not where it needs to be. I think he needs to be able to run comfortably is really what it comes down to and just feel that he can do all the things that he needs to do, and he's not at that point yet."

Playing catch and taking BP seem innocent enough, but when you consider all the stretching and warmups he likely did before each activity–not to mention the possibility that he could have hit his shin again–this seemed a little rash and just a little irresponsible.

August 24: This was quite the timetable (five days!) they put him on for no good reason.

Tex thinks he could PH if needed, and he and Girardi think he's a player by Friday at the latest. "If I'm not, I'm really disappointed."

— Lou DiPietro (@LouDiPietroYES) August 24, 2015

This is the seven-day mark, so a fracture should be able to show up at this point.

August 25: Mark Teixeira commented on his improvement at the plate and fielding the ball, but still admitted that he was having trouble running the bases. Girardi also hit us with this beauty:

"My feeling is he will definitely be better by then. It's just a feeling. I don't have any medical knowledge or anything special. I just feel like by Friday, I really think he'll be ready.''

I hope this wasn't the basis of his decision to then put Tex in Tuesday's lineup because somehow, for some reason, the Yankees actually allowed him play seven innings before finally lifting him. At this point, any DL stint could not be made retroactive to 17th.

August 26: Before Wednesday's game, it was made clear that Teixeira wouldn't be available to play, though he did end up making a rather bizarre pinch-hitting appearance in the ninth inning that night. Girardi once again made some kind of bizarre comment, this time about how he hoped to get Teixeira's leg into action:

"We rolled the dice a little bit yesterday. We were facing a lefty. I just hope that the movement helped him and that he's much better by Friday, but I can't tell you it's going to be that way."

I don't think that's how it works, so if that's how he typically hands these things, we should all be concerned. During the postgame, Teixeira had some more words to say about the injury and, at least for me, sounded very uncomfortable:

"Obviously it still bothers me to run, but a day off tomorrow is really going to help and hopefully it feels a lot better on Friday. ... Tomorrow we're going to rest it. We've been throwing everything we have at it, pushing it a lot and trying to strengthen it and trying to do everything we can. Tomorrow we're going to let it rest, and hopefully that will make a big difference."

Why on Earth do these people think that attacking an injury head on and forcing yourself to do things on it will actually make things better? Your leg is injured, go easy on it!

August 28: Then on Friday, the big day, Mark Teixeira–surprisingly–couldn't play. He still felt like he couldn't run and Girardi was simply shocked because he thought his cleanup hitter would return to the lineup by then, though there's no indication as to whether or not that was a legitimate thing to hope for. At this point, Teixeira started to voice concerns:

The thing that is a little concerning is we've given it time -- we've given it plenty of time -- and it's not getting better," Teixeira said. "I don't think it's going to get worse. I hope it doesn't get worse, because if it does then we're dealing with something else."

August 29: By the next day, Teixeira has essentially shut things down, hoping to get the swelling down and just let the injury heal because–and get this–HE THINKS TRYING TO RUN ON IT MADE THINGS WORSE. As in, if you want to look back up the page and choose option no. 2, this is likely your best case for the idea that trying to play on it actually caused the break. At the very least it didn't help. And at this point, the Yankees have still not reexamined the injury yet.

August 31: Before their series against the Red Sox, the Yankees announce that they have sent Mark Teixeira back to New York for more testing and evaluations. At this point he'd already seen doctors in Atlanta and no one had figured anything out. At this point, the Wall Street Journal brings up the parallels of this situation with the one in 2012 that led to Derek Jeter breaking his ankle after trying to play on a deep bone bruise. Not a good comparison!

September 1: The next day, we got the results, which was basically that the bone bruise was actually a really bad bone bruise. Brian Cashman filled us in:

His bone bruise has not healed at all. There is no stress fracture. That was the biggest worry because he hasn't responded to it. But the bone bruise has not healed in any way, shape or form. He has some soft-tissue inflammation and some inflammation around the nerve. So he received some sort of injection to calm that down. But obviously, the bone bruise is the big issue and there's been no healing . . . He was on crutches initially and came off because he felt better. But they're putting him back on crutches and we're looking at weeks."

...

"He's going to be down for clearly an extended period of time," Cashman said. "They've ruled out any other complications. And it's a timing mechanism and it's just taking a hell of a lot longer than anybody would have expected."

Good thing it's not broken, guys. Good thing you waited so long to look at his leg again. Good thing you had him doing vigorous baseball activities when he should have been on crutches. Good thing even more doctors were able to miss the true extent of the injury after two weeks.

September 4: Finally, after 18 days of sitting on the bench, the Yankees finally decided to place Teixeira on the disabled list. That was that.

September 9: After a few days of silence, we got our first update, and it didn't look promising:

Mark Teixeira had two more injections to calm nerve issues in his leg. Still on crutches. Cashman: "I do wonder" if Tex will return in 2015.

— Bryan Hoch (@BryanHoch) September 8, 2015

He actually had nerve issues because he irritated the area so much while trying to rehab it. Well done, everyone. And at this point Cashman is just all whatever about it.

September 10: If anyone was doubting Teixeira's toughness to get back on the field, he put that argument in the ground with a very disgusting description of what his leg is like at this point:

"I can't walk without pain. But we tried to push it the first time and it wasn't ready. We have to figure out when we can push it again. I would like to run today, but this is a lot worse than we first expected. The injections helped, but there is still a lot more healing to do.

"If it was just a bruise and a little bit of soreness I would be out there. It's a severe bruise and because of it, it causes swelling and nerve pain up and down my leg. My leg really doesn't work right now.''

That sounds extremely painful and not very conducive to playing baseball. This isn't about not trying hard enough–he already went that route and it hurt.

September 11: The Yankees finally ordered another full round of tests and, finally–25 days after the initial injury–it was discovered that he had a fracture and would miss the rest of the year. How could it have taken this long, when it should have only taken a few days for the true injury to show up on tests?

First of all, the Yankees should have been a lot more cautious with him than they actually were. They ran tests the day of and the day after, but then waited weeks before testing him again. Meanwhile, he was allowed to run on it, hit on it, and field on it. The injury pushed back, and thanks to Girardi and company, the Yankees planted their feet and pushed him even more. Maybe it was already broken, maybe it wasn't, but the amount of pain he was in was not normal. They should have waited.

It might not have made a difference, but at least they wouldn't have risked the long-term health of one of their start players. But then again, this is the team that ran Derek Jeter out there on a deep bone bruise until he broke it. For some reason, it seems like the Yankees don't take some injuries very seriously and that's kind of a scary thing.