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Over the past few weeks, Blue Jays general manager Alex Anthopoulos has orchestrated an organizational overhaul of Pygmalion proportions. Essentially, he’s turned a perennial non-threat in the American League East into the division’s foremost…uh, well the baseball equivalent of Audrey Hepburn. You know, she played Eliza Doolittle in My Fair Lady.

Since brokering a massive trade with the Miami Marlins that brought over Josh Johnson, Jose Reyes, and Mark Buehrle (et al), signing Melky Cabrera to a two-year deal, and swapping two of the team’s best prospects (catcher Travis d’Arnaud and pitcher Noah Syndergaard) for reigning NL Cy Young award winner R.A. Dickey, Anthopoulos has put his team in a position to contend for a playoff spot for the first time in recent memory.

But despite that offseason influx of talent, there’s an outstanding concern that this rapid transformation has managed to divert everyone’s attention away from: the health of Jose Bautista.

Normally, it’d be easy to overlook the health of one player when you’re sporting a revamped roster replete with shiny new toys. But when that player is responsible for more home runs than any other human since 2010, it’s a different story.

An Eliza Doolittle in his own right, the journeyman-turned-superstar missed virtually the entire second half of 2012 after sustaining an injury to his left wrist just four days after the All-Star break*. On July 16, while batting against the Yankees’ David Robertson in the eighth inning of a 2-2 game, Bautista ripped a seemingly innocuous foul ball down the left field line. Then the right fielder proceeded to double over, clutching his arm in pain as Jays fans rolled their eyes to the heavens, their faith in Murphy’s Law confirmed.

*It should be noted that Bautista participated in the 2012 Home Run Derby. (Insert obligatory insinuation that the Home Run Derby is responsible for the injury, his inevitable demise, and world hunger here.)

Bautista was removed from the game—Ben Francisco wound up walking in his stead—and sent for an MRI. He was placed on the 15-day disabled list the next day after the test revealed inflammation in his wrist, or what Bautista referred to as a “strain.”

Despite a series of optimistic prognoses, Bautista ended up missing 34 games and went for a follow-up MRI on August 9 to investigate the prolonged discomfort. However, no additional damage was found, and after a short rehab stint, Bautista rejoined the Blue Jays on August 24, going 0-for-4 with two strikeouts as the Jays fell to the Orioles 6-4.

Two days later, Bautista was consigned to the disabled list yet again after the discomfort returned. Later that week, the Blue Jays announced that Bautista would undergo season-ending surgery to repair what proved to be a damaged tendon sheath in his left wrist. The organization maintains that its star right fielder will be ready for spring training, but there may be reason to believe it won’t be quite the same guy taking the field in 2013.

“If you have surgery on your fingers or your hands, it is so easy to screw up the mechanism,” says Edward McDevitt, an orthopaedic surgeon and member of the American Orthopaedic Society for Sports Medicine. “And if you’re a professional baseball player, where the ability to use your fingers and your hands is so critical to holding a bat . . . it’s not always easy to come back.”

McDevitt, who also serves as team physician for the men’s and women’s basketball teams at the United States Naval Academy, adds that the tendon sheath—a tiny bit of tissue—is particularly difficult to operate on and requires a skilled hand surgeon “to get that thing working properly.”

Tracy Ray, director of Duke University’s Primary Care Sports Medicine program, says the sheer irregularity of the injury makes it difficult to predict how Bautista will perform going forward.

“I’m not sure that you have a whole lot of precedent to go on with this particular injury and this particular player,” he says. “I don’t know that you can guess what your outcome is going to be.”

“Most of the overuse injuries in baseball are with pitchers—the shoulder and the elbow—so to have what is probably an overuse injury in the wrist of a batter just in of itself is unusual.”

And the injury is indeed rare, especially in its severity. Since 2008, only four other players have required surgery to fix faulty tendon sheaths in the wrist: Rickie Weeks, Nick Johnson, Sam Fuld, and Mark DeRosa, who actually needed two operations to repair his. In the seasons following their respective surgeries, Johnson—who also had a ligament tear repaired while cleaning up the tendon sheath—recorded the lowest isolated power of his career, while DeRosa managed to play just 26 games before his second procedure ended his season in May. Fuld, who opted for surgery this past March, played 44 games in 2012, managing just five extra-base hits. Among this afflicted crew, Weeks was the only one to avoid either a significant power regression or re-injury the year after surgery.

Of course, the preceding sample is too small to yield any kind of definitive conclusions, but the anecdotal evidence can’t be too comforting for the Blue Jays, for whom Bautista has been the offensive engine since his improbable outburst in 2010, when he smacked 54 home runs and recorded a .337 TAv.

And speaking of collar-tightening anecdotes, when Bautista’s AL East contemporary David Ortiz tore his tendon sheath in June of 2008, he was incapacitated for nearly two months, but managed to avoid going under the knife. Upon his return, Big Papi appeared no worse for the wear, recording 31 extra-base hits and a .914 OPS over his final 55 games that year. The following season, however, he posted his lowest on-base percentage (.332), TAv (.268), isolated power (.224), and WARP (0.9) since 2001.

Thanks to Anthopoulos’ offseason exploits, Toronto’s offensive responsibilities will be distributed a bit more evenly in 2013, with Reyes and Cabrera expected to bolster a lineup that managed 4.42 runs per game in 2012, just a touch below the American League average of 4.45. The team will also rely on Edwin Encarnacion to produce something at least reminiscent of the figures from his breakout 2012 campaign, when he launched 42 home runs with a .329 TAv. But when it comes down to it, at least on paper, Bautista is very much the pièce de résistance of this offense, a notion that evokes some ambivalence in the medical community given the 32-year-old’s recent injury.

“When you mess with somebody’s body and try to fix something, it’s not always exactly 100 percent,” says McDevitt. “It’s going to be a little bit different afterwards.”

“Honestly, I think that it’s going to be a tough road for this athlete,” he adds.

Dawn LaPorte, an associate professor of orthopaedics at Johns Hopkins, shares this skepticism.

“I think for a non-elite athlete, they’ll be fine and can get back to their normal daily activity with no problem, but I think getting back to that high level, if you’re a professional baseball player, is tough, and I think a little unpredictable,” says LaPorte, a hand and wrist specialist.

“I think there’s a level of ‘the unknown,’ so you can’t 100 percent rely on where he was at before,” says LaPorte, who adds that “it will be challenging” for Bautista to return to the level he was at prior to surgery.

Jon Schriner, director of the Michigan Center for Athletic Medicine, is more optimistic, but insists that a strong rehabilitation regimen is imperative for Bautista to get back to where he was.

“Physical therapy could and should restore him to full previous abilities,” he says. “You can never guarantee it, but it should.”

Bautista’s time spent on the DL in 2012 is reflected in his PECOTA projections for the upcoming season. He’s pegged to register just 427 plate appearances in 2013, a figure that probably doesn’t compute for the Dominican native, who was the picture of health from 2010-2011, playing in 310 of his team’s 324 games.

In light of the winter feeding frenzy Anthopoulos has conducted, the Blue Jays have invested a lot in the immediate future. The team’s Opening Day payroll will eclipse eight figures for the first time in team history, according to Cot’s, and considering the relatively moribund state of the AL East, the division is there for the taking. In order to take it, the Blue Jays will need the 2013 incarnation of Bautista to perform like the same wonderfully hirsute slugger who carried the Toronto offense for the past two-and-a-half seasons.

That slugger was worth 19 WARP over that span and led the league with a .365 TAv in 2011. Unfortunately for Bautista and the Blue Jays, who’ll be hoping he’s the same slugger next season, performing at a high level in the major leagues isn’t as easy as uttering, “The rain in Spain falls mainly on the plain.”

Thanks to Corey Dawkins and Dan Turkenkopf for research assistance.

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Mostly because I'm too lazy at the moment to look it up, any thoughts on the B-Jays options if he can't play ?
Davis and Sierra probably represent the most likely short-term options. If he's expected to miss a significant amount of time, they might have to call up Gose and reconfigure the outfield a little bit.
Thanks. This roster kinda facinates me with the combination of medium-long term financial risk combined with both health and performance risk.
The idea of having to see Davis play full time again makes me ponder sticking needles in my eyes.
Johns Hopkins should trade LaPorte in a deal for CC Sabathia.
Looks like Ortiz had surgery on his left (power) wrist, making his recovery less relevant to Bautista's prognosis. Weeks, Johnson, Fuld, and DeRosa all had injuries to their non-power wrist, just like Bautista.

Definitely worrisome that the injury was the result of a powerful swing. There can't be any doubt that the next powerful swing will rely on the injured tendon.