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MRI Reveals Torn UCL For Trevor May

Plans to turn around the Minnesota Twins rotation took a hit today with the news that Trevor May, a big factor in those designs, has suffered a tear to the ulnar collateral ligament in his right elbow.

Read on for details and quotes regarding the right-hander’s very unexpected setback.
Image courtesy of Seth Stohs
In a decade of playing professional ball, May has amazingly been able to avoid any kind of significant elbow or shoulder issues. “I’ve literally never missed a day of baseball activity because my arm hurt,” he said.

So it isn’t too surprising that when he felt a “grab” on an 0-2 pitch against Andrew McCutchen while facing Team USA on Wednesday night, he downplayed it. When speaking to reporters after the game, he was very positive, signaling no distress or concern.

He came in the next morning and felt soreness, and then on Friday the tear showed up on a scan, which even in the pitcher’s non-medical opinion was “pretty conclusive.”

Standing outside the clubhouse on Saturday morning alongside top baseball executives Derek Falvey and Thad Levine, May was subdued but searching for silver linings. So, too, was the general manager.

“When the results of the MRI came back, it was a little bit unique in the sense that it sounded as if the wear and tear component, or the cumulative impact, was very minimal," Levine said. “It really was an acute injury ... That’s very atypical for a guy who has logged 10 years worth of pitching on his arm.”

“That gives us cause for optimism that maybe the health of the overall region is very strong but for this one acute area."

Of course, this doesn’t change the basic realities. May will seek a second opinion – no date or doctor has been scheduled as of yet – and there are a few potential options on the table, but Tommy John surgery seems likely.

Levine expressed no plans for reactive moves by the team, noting that injuries are always an expectation.

“I don’t think you ever have any misgivings that you’re going to go through the process without needing significantly more than five starters. You hate to have it happen at this point to a player who’s put in the that work he’s put in, but the reality is that’s why we built up some of the depth we did coming into camp and it’s going to give other guys opportunities.”

Among those guys are Tyler Duffey, Jose Berrios, Adalberto Mejia, Rule 5 pick Justin Haley and non-roster invite Ryan Vogelsong. Duffey pitched well in a road start for the Twins against Miami on Friday and Berrios is preparing to make his first start for Puerto Rico in the World Baseball Classic.

For May, who was the subject of a feature here on Twins Daily just a couple days ago, it’s a difficult pill to swallow but he vows not to let it derail his determination.

"If it comes down to getting good old fashioned Tommy John, I’ll go from there,” May said. "I’m not a guy who’s gonna sit here and mope about how hard I worked and now it’s not gonna happen.”

“Yesterday was tough, but I’m probably going to go right back to that little notebook I have with me, and those goals I write down every day are just going to change from this year to next year.”


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121 Comments

 

Doing the Hokey Pokey never made anyone a better dancer.

 

But that's what it's all about.

    • USAFChief, Jerr, flpmagikat and 4 others like this
Sorry I'm late to the thread, at a family function presently. Will try to contribute more when I get a chance.
    • Carole Keller, glunn, Vanimal46 and 1 other like this
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Walter's Whites
Mar 11 2017 12:00 PM

 

If the starting rotation starts with Santana, Santiago, Gibson and Hughes, then choose from one of the young guys:Berrios, Duffey or Mejia. 

 

I also think, of the last 3 already mention for the rotation, at least one of them should go. I don't really agree with the resigning of both Santiago and Gibson.At some point, you have to move on with youth.

I know there is basically a zero percent chance of this happening, but if Ryan Volgelsong wins the fifth starter job I'll probably have a stroke.

    • Twins33, HitInAPinch, d-mac and 2 others like this
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Carole Keller
Mar 11 2017 12:01 PM

 

I can't say I'm aware of any data on switching between roles (SP/RP) but there is some fairly good data that discusses the effects of core injuries and that it can result in increased stress on the shoulder and elbow. So perhaps indirectly, if we believe his transition to the bullpen was a contributing factor to his back issues, we could say that switching may have been related to the current problem. A more interesting question to me is, since this was an acute injury, is he a candidate for a direct repair instead of TJ...

As if on cue! Thanks! I consider you TD's expert in residence for these types of discussion! :)

    • PseudoSABR, Heezy1323, HitInAPinch and 3 others like this

 

Sorry I'm late to the thread, at a family function presently. Will try to contribute more when I get a chance.

Thanks in advance for your valuable contribution to this thread!

    • Heezy1323 and Vanimal46 like this
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KirbyDome89
Mar 11 2017 12:06 PM

 

I know there is basically a zero percent chance of this happening, but if Ryan Volgelsong wins the fifth starter job I'll probably have a stroke.

My thoughts exactly. The problem is I can see this as a realistic scenario....

    • d-mac and jud6312 like this

 

 . A more interesting question to me is, since this was an acute injury, is he a candidate for a direct repair instead of TJ...

Can you elaborate on that specifically please?  Difference in effect, and recovery time to be included.

    • glunn likes this

 

Doing the Hokey Pokey never made anyone a better dancer.

Sounds  like just your opinion.  I know people that would only get out there for the Hokey Pokey so whatever dancing skills they might have had would only get better, in my opinion. Any sportswriters with opinions on this?  Any factual evidence?  If in fact the Hokey Pokey is what its all about then all other dancing would be for the purpose of getting better at the Hokey Pokey rather than otherwise.

    • glunn, AlwaysinModeration, Heezy1323 and 2 others like this

 

First Kirillof, then Gonsalves (still hoping for him), now the coup de grâce.  Goodness gracious what the hell did the Twins do that upset the baseball gods so?

Prior to that it was Sano and what feels like every other pitcher in the history of the Twins.  Just curious. Is this their stretching routine?  

    • ashburyjohn, glunn, Han Joelo and 2 others like this

 

My thoughts exactly. The problem is I can see this as a realistic scenario....

I've been predicting it since they signed him. I'm guessing he has an opt-out, and no matter how below average the veteran is, the Twins seem to fear losing that veteran more than anything else.

 

I can't imagine a worse scenario than going a rotation featuring Hughes, Santiago, Vogelsong and every other start Gibson.

 

Yikes.

    • KirbyDome89 likes this
This is really unfortunate for May.... Guy hasn't been able to catch a break the last 2 years. Wishing him a quick and successful recovery.

As we move on, let's win a job in the rotation Berrios or Mejia!
    • Carole Keller, glunn, Blake and 9 others like this

 

Was it the Twins who told us that, or was it pundits on forums such as this who were assuming that it's easier to split the atom than to move a pitcher to the bullpen?

It's the third time May has missed time with a back injury this season, as he also missed 23 games in June with back spasms. He saw a specialist at the Mayo Clinic before his return and thought he had found the root of his problem, but will seek another opinion and will see specialist Dr. Robert Watkins in California.
"It's been tremendously frustrating [for him]," Molitor said. "At some point you even wonder when you can't find the exact source of the problem, you start thinking worst-case scenario. I think he's going to be OK over time, but we need to start putting together a program where his focus this winter will be on being healthy."

May's back issues have only flared up when pitching in relief, so Twins interim general manager Rob Antony said he's hopeful May will start next year.
"He'll be told as he was last year to go home and prepare to be a starter and hopefully he comes in and wins a spot in the rotation next spring," Antony said. "He didn't earn one this spring and he had success as a reliever so it was easy enough to put him back in the pen. But I'd like to see him earn a job as a starter next year."

By Rhett Bollinger / MLB.com | @RhettBollinger | September 13th, 2016

    • glunn likes this

 

Can you elaborate on that specifically please?  Difference in effect, and recovery time to be included.

I'm not sure how much detail you'd like me to go into (I sort of 'geek out' on this stuff), so I'll start with a little  and can add more if people would like.

 

1) So everyone is on the same page, traditional TJ uses tissue from another source (usually either a small forearm tendon called the palmaris tendon or a hamstring tendon called gracilis) to 'reconstruct' a new ulnar collateral ligament (UCL). Repair is a similar operation, though instead of making a 'new' UCL out of other tissue, a surgeon simply repairs the injured tissue back to the bone (where it tore away from). 

 

2) Only certain types of tears are amenable to the 'repair' surgery. The UCL can be injured at its attachment on the sublime tubercle (ulnar attachment), medial epicondyle (humeral attachment) or in-between (what we call mid-substance). Uncommonly the ligament can be injured at more than one of these locations, but usually just one. If the ligament is injured at one end, and the quality of the tissue is good, it can be considered for the 'repair' surgery, back to the bone where it tore away from.

 

3) The repair operation has really only gained popularity over the past 3-5 years, and has only been done a very few times on pitchers at the major league level. However, initial studies do appear promising.

 

4) For biologic reasons (that I can expand upon if people are interested, though it may put people asleep), a repair heals and becomes stronger more quickly than a reconstruction. Again, due to the small number of cases done at the ML level, the timeline is still somewhat unknown, but at lower levels, many players are back to pitching at around 6 months post-surgery, rather than 9-12 months as in TJ.

 

5) You asked about 'difference in effect', and I guess I'm not quite sure what you mean by that. The overall effect of the surgery is, of course, the same- to stabilize the elbow against the significant forces of throwing. It is only the manner in which it is done that varies. If that doesn't answer your question, please clarify and I'd be happy to try again.

 

Hope this helps. Happy to entertain follow up questions. Too bad for May, I was certainly hoping for a bounce-back year from him (as we all were).

 

 

    • Carole Keller, USAFChief, glunn and 17 others like this

 

I'm not sure how much detail you'd like me to go into (I sort of 'geek out' on this stuff), so I'll start with a little  and can add more if people would like.

 

1) So everyone is on the same page, traditional TJ uses tissue from another source (usually either a small forearm tendon called the palmaris tendon or a hamstring tendon called gracilis) to 'reconstruct' a new ulnar collateral ligament (UCL). Repair is a similar operation, though instead of making a 'new' UCL out of other tissue, a surgeon simply repairs the injured tissue back to the bone (where it tore away from). 

 

2) Only certain types of tears are amenable to the 'repair' surgery. The UCL can be injured at its attachment on the sublime tubercle (ulnar attachment), medial epicondyle (humeral attachment) or in-between (what we call mid-substance). Uncommonly the ligament can be injured at more than one of these locations, but usually just one. If the ligament is injured at one end, and the quality of the tissue is good, it can be considered for the 'repair' surgery, back to the bone where it tore away from.

 

3) The repair operation has really only gained popularity over the past 3-5 years, and has only been done a very few times on pitchers at the major league level. However, initial studies do appear promising.

 

4) For biologic reasons (that I can expand upon if people are interested, though it may put people asleep), a repair heals and becomes stronger more quickly than a reconstruction. Again, due to the small number of cases done at the ML level, the timeline is still somewhat unknown, but at lower levels, many players are back to pitching at around 6 months post-surgery, rather than 9-12 months as in TJ.

 

5) You asked about 'difference in effect', and I guess I'm not quite sure what you mean by that. The overall effect of the surgery is, of course, the same- to stabilize the elbow against the significant forces of throwing. It is only the manner in which it is done that varies. If that doesn't answer your question, please clarify and I'd be happy to try again.

 

Hope this helps. Happy to entertain follow up questions. Too bad for May, I was certainly hoping for a bounce-back year from him (as we all were).

Thank you for the info.  I meant is the result stronger from one type or the other.  Is there more likely a reoccurance from one or the other?   

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TheLeviathan
Mar 11 2017 01:29 PM

I don't think you can prove or have data on whether yanking guys back and forth from the pen to the rotation can cause injury.  And the Twins are far from the only ones doing this.

 

That said, athletes train their bodies to do certain things, in a certain way, many times.  I have to imagine for some players a change like that can be a precursor for injury.  Whether it was for May or not is hard to tell, but I think he's said publicly that the bullpen role caused the back injuries and our resident medical expert has acknowledged there could be a connection there.

 

Either way, devastating news.  Trevor can't catch a break in his goal of being a major league starter.  

    • Carole Keller, glunn, Heezy1323 and 3 others like this
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FormerMinnasotan
Mar 11 2017 01:40 PM
That's too bad for May, I expected him to take the 5th spot in the rotation over Berrios. With that said I believe Berrios should get the 5th spot over Mejia and Duffey. Berrios has shown improvement from last year and seems much more prepared to start in the Bigs this year. Mejia can come up once either another injury happens to any of the other starters get hurt. Duffey? No thanks, with being a two pitch pitcher he won't be any better of a starter than he was last year.

 

Thank you for the info.  I meant is the result stronger from one type or the other.  Is there more likely a reoccurance from one or the other?   

Apologies for misunderstanding- now your question makes more sense. 

 

Since this procedure is fairly new (in this iteration), and obviously therefore doesn't have 10-15 years of research behind it, I don't think we know the answer to your very appropriate question. It is my belief that, carefully selected, these repair patients should do no differently from TJ patients.

 Now that begs the question, "how do you select?" Right now, especially at the ML level, I would say that this operation is likely only being considered for 'ideal' candidates. Meaning (possibly like Trevor) those players who have a fairly normal elbow and a then a sudden change with a UCL that looks good on MRI aside from the area of the injury at the bone. As more data is collected over time, it seems somewhat likely to me that the selection criteria will be loosened, and this operation will be done on 'less ideal' candidates. That is where we are really going to see how good this procedure is, IMHO. 

 It's hard to know if the injured ligament is completely normal aside from the area of injury, or did the ligament get 'stretched out' a little before it tore and is therefore more likely to have recurrent trouble in the future. We can use the MRI and intra operative evaluation to help us decide, but at the end of the day there are always going to be some ligaments that fall into a gray area. Hard to know what to do with those right now. You would like to get players back to competition sooner. But you also don't want to have them undergo 6 months of rehab, only to find that the ligament was too injured to begin with, then have to resort to TJ and start the clock all over again (in effect, costing them 18 months or more).

    • Carole Keller, USAFChief, glunn and 10 others like this

It could be Berrios, Mejia AND Duffey. Not impressed with Santiago and Hughes is coming off surgery.

    • jorgenswest, glunn, Hosken Bombo Disco and 3 others like this
...and the Twins screw up another career.

Unlimited resources. Profits rolling in that they refuse to spend. All that cash laying around, and they haven't thought to put any of it to a medical and training staff that has a clue on how to get players in shape and keep them healthy.

Pitching is one thing. But, when you're top hitting prospects are also dropping like flies and getting TJ, something is wrong. Sample size is way too big to keep claiming "bad luck."

The ineptitude of this organization knows no bounds.
    • DaveW likes this

I've been predicting it since they signed him. I'm guessing he has an opt-out, and no matter how below average the veteran is, the Twins seem to fear losing that veteran more than anything else.

I can't imagine a worse scenario than going a rotation featuring Hughes, Santiago, Vogelsong and every other start Gibson.

Yikes.


It's the Twins. You really can't imagine a worse scenario? Andrew Albers? Scott Diamond? I could go on all afternoon.

By Twins standards, Santana, Gibson, Hughes, Voglesong, and Mejia is a Starting rotation version of Murderer's Row. There is a chance they're all actual MLB rotation caliber pitchers, even if nothing more than a collection of #5s. They're normally rolling out a couple a guys that wouldn't sniff a 40-man slot on any other club, let alone a rotation spot.
    • notoriousgod71, flpmagikat and d-mac like this
Feel awful for May. I think he was poised for a really solid year.

Not be sparky, but about Berrios AND Mejia as someone else will invariably get hurt or not be ready?
    • dgwills and bighat like this
Well. This just sucks. Good luck in your recovery sir.
    • Carole Keller, USAFChief, glunn and 3 others like this

At his best May was one of the better 8th inning guys in baseball and looking to be a good bet to be a solid #3 as a starter. Not to mention he very likely would have been the Twins second best SP this year.

Hardly mediocre.


Upside of a #3 starter and maybe the second best pitcher on the worst staff in the majors sounds like the definition of mediocre.
    • flpmagikat and bighat like this
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ScrapTheNickname
Mar 11 2017 04:19 PM

119 major league players on 40 man rosters are injured and will not start the season, which averages 3.9 players injured per team.

 

The Twins have 4.

 

As usual, seeing injuries as homegrown incidents with fault laid on coaches, etc. would appear to be more imaginative thinking than sound thinking.

 

A dove recently fell out of the sky and landed in the branches of a tree where it lay suspended for two weeks, then dropped to the ground where it lay for another week before mysteriously disappearing. I blame Sigmund Freud!

 

http://www.cbssports.com/mlb/injuries

    • USAFChief, Han Joelo, DJSim22 and 2 others like this
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Bark's Lounge
Mar 11 2017 04:51 PM

May deserved better than this. He was a good soldier in 2015. I hope that wasn't the start of the domino's starting to fall. I wonder if this might be the end of him as a starter?

 

I hope your recovery exceeds the highest level of expectation.

 

Opinions are mixed, but I was on the side of believing he could cut as quality starter with an ability to miss some bats.

    • Deduno Abides and spinowner like this

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