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September 8, 2010

Under The Knife

Before there was Tommy John

by Will Carroll

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UTK Flashback

One of my obsessions is with early sports medicine. Whether it was the first proto trainers and pitching coaches or the concoction of capsacin that Sandy Koufax rubbed on his arm before starts, those kinds of things fascinate me. In the midst of Joe Posnanski's piece on the fastest pitchers of all time, he reminded us that Dazzy Vance came back after some sort of arm surgery performed in 1920. I'd dug into it at one point during the research for "Saving The Pitcher," but I'd never dug in hard. I made a lucky find after digging through Yojimbo:

While there, in 1920, at the age of 29, he had a decent season, but nothing too impressive. Again, though, his arm problems were the key—his sore arm robbed him of any dynamism he might have. And then his saving grace came around this time, in the unlikeliest of places. While playing poker, Vance banged his elbow on the table, and suddenly his “sore” arm was now very much not “sore,” but rather actively shooting pain into his arm. He was in agony. His friends brought him to a surgeon, who performed surgery on the elbow (no one knows what exactly) and when it healed, suddenly not only was the SHARP pain gone, but so was the chronic soreness (no one knows exactly what the surgeon did, but it sure sounds like he removed either bone chips or bone spurs, doesn’t it?).

Actually, no. It sounds like Vance had an ulnar nerve issue. It's a fairly common problem for pitchers, stretching the nerve or getting it compressed due to the repetitive motion that the elbow makes during a pitching motion. If you can imagine getting hit on the "funny bone" every time you threw a pitch, that "sharp pain" becomes a lot more understandable. An ulnar nerve transposition is a very simple surgery and after consulting with three orthopaedic surgeons as to the description of the problem, they all agreed with the diagnosis and prognosis. There was likely nothing "wrong" with Vance's arm, aside from that pain, and was in fact resting somewhat, at least from the violence of his great fastball. Once that pain was gone, boom, things were back to normal. While there's no record of ulnar nerve transpositions existing in the 1920s—in fact, no one I spoke with was really sure when they first happened, though all three pointed to the transposition needed by Tommy John during the rehab from his reconstructive surgery in the 1970s as the first they could remember hearing about. One key to why this transposition is the most likely solution to the mystery is the ease of rehab. One team doctor said it was the easiest rehab around and that even if someone didn't follow the normal protocol, he'd probably be OK. Because there was no protocol and Vance seems to have more or less just started throwing hard again, I think we have the answer.

Mat Latos (FLS)
Tim Stauffer
Mat Latos' innings increase this season is a worry, but it's nothing compared to the flu. Latos was scratched from his Monday start after coming down with the dreaded flu-like symptoms. The Padres put him back in the rotation last night. Don't be surprised if Latos is skipped the next time through. Though with the NL West tightening, it may end up an "all hands on deck" finish to the season. How the Padres deal with their young pitchers is going to be a real balancing act and a tell on the new front office. With Latos scratched Monday, Stauffer came in and did a nice job for the Padres on short rest. If you don't remember, Stauffer signed for well below his expected level after the Padres found some shoulder problems during his post-draft physical. It's a bit reminiscent of Barret Loux (who remains unsigned) but functions as a reminder that risk is just risk. It's not a curse, just something for which we have to account. Stauffer is a major-league pitcher who can help a team, but he's also had precisely the issues that one would expect given that long-ago physical. At the price he got, he's a good value, and risk can be fairly priced. (Don't think so? The insurance industry is doing fine, thank you, and that's all they do. Maybe front offices should stop listening to Bill James and start listening to Flo from Progressive.) 

Andy Pettitte (strained groin, ERD 9/18)
The Yankees have been a bit all over the place with Pettitte. They've brought him back very, very slowly, a reflection of their lock on a playoff spot and a new-found conservatism towards injuries that we've seen this season. At first, I thought it was a reasonable direction, given the team was operating without longtime athletic trainer Gene Monahan at the beginning of the season. Since Monahan's return, the slow returns and conservative bent have stayed, so we may be looking at something new or perhaps nothing more than an aberration. Pettitte was originally scheduled to pitch today at Trenton, as the team headed into the Double-A playoffs, but now his new schedule is to pitch tomorrow. Pettitte threw on Saturday, so this puts him on a normal five-day schedule. There's no word yet on how deep he'll go (or how ticked off the New Hampshire Fisher Cats are that they have to face Andy Pettitte instead of Manny Banuelos), but there is some suggestion that Pettitte might be back for a second rehab start if the Thunder make it to the next round. That could push Pettitte's return back just past mid-month, which Ben Shpigel of the New York Times called weeks back. It's clear that the Yankees only care about Pettitte being ready for October.

Paul Konerko (strained back, ERD 9/10)
Gordon Beckham (bruised hand, ERD 9/9)
The White Sox lose a lot when Mark Kotsay is at first base. That's really no knock on Kotsay, because only five players in the American League have a higher VORP than Konerko. Konerko's chronic back problems have acted up at precisely the wrong time. The difference between Konerko and Kotsay is almost half a run (per MLVr), so chasing down the Twins is made tougher by every game missed. Then again, when you consider that Konerko and Carlos Quentin have been on the field for more than 500 plate appearances despite chronic issues that had them in question coming into the season, we have to wonder again whether athletic trainer Herm Schneider might be the team's MVP yet again. The team will also be without Beckham, perhaps for a few days. His bruised hand is still an issue, and the team is going to try some "more aggressive treatment," according to a source. He's expected back quickly, so it's unclear what that treatment might be. The Sox know to trust in their medical staff.

Justin Upton (strained shoulder, ERD TBD)
The issue with Upton's shoulder is, as I said last week, one that's a problem of timing as much as it's a medical issue. With Upton still out and no reason to rush him back, the Diamondbacks' medical staff decided this was a good time to get a look at the shoulder with an MRI. This isn't a setback. Instead, this is the medical staff taking the proactive step of taking a look at how rest has affected the shoulder. If there's been some progress and if rest has helped, then it makes sense that more rest and treatment will help. While this is sure to be presented as a setback, it's not. There's no clarity, but the team is going to have more information to go on for next year, which is what really matters for this team. There is the chance that this pushes things toward surgery, but sources think that this remains the last resort. What it could well mean is that he could be shut down to focus on the rehab, rather than trying to return.

Brian Fuentes (strained back, ERD 9/10)
Fuentes had his back "lock up" on him, but sore backs are something with which the Twins know how do deal. They've given him a couple days off, and things have progressed to where Fuentes can throw again. His bullpen session went well, but the team is still going to be without him until the weekend. Fuentes' back isn't considered serious, but back injuries linger and can really affect mechanics in the short-term. The Twins are going to be on the conservative side with this because they have options at the back end of the bullpen and because Fuentes could end up more important in October than September. If the White Sox stay hot (which does have to confuse the Manny-ssasins in the media), then this rest could count for a lot. The team thinks Fuentes will be back by the weekend.

Jose Reyes (strained oblique, ERD 9/13)
Jason Bay (concussion, ERD 10/4)
The Mets have moved Reyes a bit closer to a comeback and Bay a bit closer to the end of his season. It's really been a tale of two extremes for the Mets, symbolized by these two players and the shadow of last year's injury-marred season. Reyes has been healthy in coming back, his knee/hamstring never a major problem. That he's had minor issues along the way is no more surprising than any other player being injured. His solid campaign puts him back on track, if perhaps not the fantasy darling he was. I still see signs that the speed is coming back at times and wouldn't be surprised if a new manager won't let that happen organically. For Bay, it's bit of a lost season with only some small consolation that his knee wasn't the problem. His concussion symptoms haven't abated weeks after he played through it and didn’t feel the symptoms until he was on an airplane. Moved to the 60-day DL for roster purposes, Bay's season is likely done, though the team will keep him on a rehab to try and gauge how significant this concussion may be for his long-term availability.

Shawn Kelley (sprained elbow, ERD 10/4)
There has been a lot of confusion about what's going on with Kelley, the Mariners pitcher who was said to have "partial Tommy John surgery." That misnomer is the problem. This was not Tommy John surgery, though the team and Kelley were worried going in that he would need a second reconstruction. Often, a surgeon goes into the surgery knowing what he might find but warns the patient of the possibilities and gets permission to do the most invasive procedure so that they don't have to stop, wake them up to get consent, and start over. Kelley was prepped for Tommy John, but the ligament was only frayed in parts. That damage was dealt with, and the surgeons believed that the moderate sprain would heal on its own. Kelley is now on track to be back for spring training rather than losing the 2011 season.

Quick Cuts: I said to watch for signs of power from Jason Kubel. He went oppo for a homer of about 400 feet. Yeah, that's a good sign. ... Jay Bruce did well taking swings yesterday and will take batting practice today. If all goes well, he could be back in the lineup for the Reds this weekend. ... The Tigers aren't making it official, but it looks like the season is done for Carlos Guillen. ... Jason Varitek was activated by the Red Sox, and he'll slide back into his backup catcher role. He's unlikely to be back with the Red Sox next season, but people around baseball think there are a couple landing spots available for Varitek if he's interested. ... Aaron Harang has looked terrible lately and is likely to be left off the playoff roster. That would spell the end of his Reds career, done in more by poor management than anything. If Harang and Bronson Arroyo are both allowed to leave (both have 2011 club options), it will be a very thin but talented Reds rotation.  ... Jamie Moyer is rehabbing in an attempt to come back next year. With a significant tear of his UCL, I'd say that's unlikely to work well, but he has proven a lot of people wrong along the way. ... Congrats to Tim Kremchek, who was mentioned here just the other day. He's been named one of Ohio's top high school team doctors. Yes, besides the Reds, he also finds time to handle duties at Cincinnati's Moeller High School.

Related Content:  Mat Latos,  Back,  The Who,  Surgery

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