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Sano's UCL was completely torn

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#1 notoriousgod71

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Posted 12 March 2014 - 10:21 PM

A revelation found from today's surgery.

#2 h2oface

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Posted 13 March 2014 - 12:00 AM

http://www.startribu.../249982141.html

It appears that Andrews missed the call on this big time!

Edited by h2oface, 13 March 2014 - 12:05 AM.


#3 Seth Stohs

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Posted 13 March 2014 - 05:22 AM

When people review an MRI, they don't see level of tear. They see inflammation. There's no real way to know partially torn versus fully torn on an MRI.

#4 cmathewson

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Posted 13 March 2014 - 05:47 AM

When people review an MRI, they don't see level of tear. They see inflammation. There's no real way to know partially torn versus fully torn on an MRI.


Then why do they say "partial tear" and prescribe rest and rehab? Why do they sometimes say "complete tear" and prescribe surgery right away? I think it's because they see more than mere inflammation. MRIs would be worthless if they only see what you can feel from the outside.
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#5 Celebrity Weddings!

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Posted 13 March 2014 - 06:20 AM

http://www.startribu.../249982141.html

It appears that Andrews missed the call on this big time!


That article says that he probably tore it in his last intrasquad game. So, Dr. Andrews didn't actually miss anything unless he was using some sort of hybrid MRI/time machine to examine a future version of Miguel Sano's elbow.

And that seems like an exceedingly dull use of something with time travel capacity.

#6 nicksaviking

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Posted 13 March 2014 - 06:48 AM

The artical did make it seem like the Twins, Sano and Andrews knew it was a partial tear last fall. That's news to me, I don't recall hearing of any kind of tear, just that he had some elbow inflamation.

It's easy for me to say "Have the surgery right away," since it's not surgery on my elbow, but I don't think there are many partial tears that don't end up having TJ surgery anyway. I can think of Ervin Santana, who else is currently playing with a partially torn UCL?

Still, if he'd had the surgery in October, Sano may have been back in tme for August games, though they likely would have wanted him doing some rehab work at Ft. Myers first. He probably only missed a few weeks of AA/AAA games this year by putting it off. He would have never been a MLB call up.

Yet still, I think it's time these guys start getting opinions from the world's second best renowned orthopedic surgeon, Dr. Andrew James.

#7 cmathewson

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Posted 13 March 2014 - 07:10 AM

The artical did make it seem like the Twins, Sano and Andrews knew it was a partial tear last fall. That's news to me, I don't recall hearing of any kind of tear, just that he had some elbow inflamation.

It's easy for me to say "Have the surgery right away," since it's not surgery on my elbow, but I don't think there are many partial tears that don't end up having TJ surgery anyway. I can think of Ervin Santana, who else is currently playing with a partially torn UCL?

Still, if he'd had the surgery in October, Sano may have been back in tme for August games, though they likely would have wanted him doing some rehab work at Ft. Myers first. He probably only missed a few weeks of AA/AAA games this year by putting it off. He would have never been a MLB call up.

Yet still, I think it's time these guys start getting opinions from the world's second best renowned orthopedic surgeon, Dr. Andrew James.


We had a long thread about this. The upshot: It is relatively rare for partial tears to mend themselves. We found a half dozen cases out of the hundreds that ended in surgery. But the consensus of the thread was the guidance is different for position players than pitchers. Perhaps it is standard guidance to recommend rest and rehab for position players.
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#8 Willihammer

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Posted 13 March 2014 - 07:13 AM

It's easy for me to say "Have the surgery right away," since it's not surgery on my elbow, but I don't think there are many partial tears that don't end up having TJ surgery anyway. I can think of Ervin Santana, who else is currently playing with a partially torn UCL?


Greinke went through 2013 after showing "inflammation" on his MRI. He got the PRP injection and obviously was fine. Kepler has been playing through "inflammation" too I believe. Obviously its still plenty early for both players to still wind up getting TJ surgery.

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#9 JB_Iowa

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Posted 13 March 2014 - 07:23 AM

I don't think anybody necessarily missed anything. Although it may not have been communicated entirely in the media, it does sound like the Twins, Sano and his doctors believed it to be a partial tear.

Please keep in mind:

1. It is Sano's body and I believe he gets the ultimate decision on what is done to it (regardless of his contract with the Twins).

Phil Mackey ‏@PhilMackey 32m
[COLOR=#333333]Rob Plummer, agent for Miguel Sano, says his client was 100% opposed to surgery, which is the main reason why it didn't happen in November.



2. The following information from Heezy1323 posted in the "Ligaments are Stupid" thread:

[/COLOR][COLOR=#3E3E3E]Many times it is not necessarily that it takes so long to make a diagnosis of UCL injury- it is deciding how long to try to treat it non operatively before resorting to surgery. Most guys that have UCL reconstruction don't have a completely torn ligament on MRI. The vast majority (probably 80% or more) have a partial tear. Some can play with a partial tear... some can't. Many variables in play including mechanics, degree of partial tear, condition of shoulder/elbow musculature, etc. Many lay people (as well as many baseball people) assume the success rate of UCL reconstruction is 100%. Not true. It is a highly successful operation, but most literature puts success rate around 85-90%. So that means one out of ten is unable to return to the same level of play. This is the main reason for trying conservative treatment (rest, rehab, PRP) prior to proceeding with surgery. It is true some position players can play without an intact UCL, but these are usually not players at positions requiring hard throws (3B, RF). As far as the W and inverted W position, that is one of probably a dozen or more current theories about predisposition to UCL injury. The issue is far from understood.



[/COLOR]
[COLOR=#3E3E3E]Posted Image Originally Posted by ChiTownTwinsFan Posted Image
This is interesting info. Are you a doctor? Or did you just spend some time and do some proper research?


[/COLOR]Heezy1323:
[COLOR=#3E3E3E]I'm an orthopedist yes. I trained with Dr. Andrews recently so I have a fairly decent understanding of some of the thought processes in play for these guys. I certainly don't have all the answers but am happy to put my two cents in here and there if it helps. Was born and raised in MN and a lifelong twins fan so kind of a bummer to hear about Sano. Sure hoping things go well with his surgery and recovery.
[/COLOR]
[COLOR=#3E3E3E]
Can we please put all of the speculation to rest now about how Sano's injury was handled?[/COLOR]

#10 mike wants wins

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Posted 13 March 2014 - 07:26 AM

Art .... medicine is an art. Imagine how hard it is to figure this stuff out, when you cannot see what is actually happening. Even the machines can't yet get in there and see everything. I don't really begrudge any player for taking care of their body the way they want. It is their body.
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#11 spycake

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Posted 13 March 2014 - 07:37 AM

It appears that Andrews missed the call on this big time!


I suspect we've heard the last of this so-called "Doctor" Andrews! ;)

#12 cmathewson

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Posted 13 March 2014 - 07:38 AM

I don't think anybody necessarily missed anything. Although it may not have been communicated entirely in the media, it does sound like the Twins, Sano and his doctors believed it to be a partial tear.

Please keep in mind:

1. It is Sano's body and I believe he gets the ultimate decision on what is done to it (regardless of his contract with the Twins).

Phil Mackey ‏@PhilMackey 32m
[COLOR=#333333]Rob Plummer, agent for Miguel Sano, says his client was 100% opposed to surgery, which is the main reason why it didn't happen in November.



2. The following information from Heezy1323 posted in the "Ligaments are Stupid" thread:

[/COLOR][COLOR=#3E3E3E]Many times it is not necessarily that it takes so long to make a diagnosis of UCL injury- it is deciding how long to try to treat it non operatively before resorting to surgery. Most guys that have UCL reconstruction don't have a completely torn ligament on MRI. The vast majority (probably 80% or more) have a partial tear. Some can play with a partial tear... some can't. Many variables in play including mechanics, degree of partial tear, condition of shoulder/elbow musculature, etc. Many lay people (as well as many baseball people) assume the success rate of UCL reconstruction is 100%. Not true. It is a highly successful operation, but most literature puts success rate around 85-90%. So that means one out of ten is unable to return to the same level of play. This is the main reason for trying conservative treatment (rest, rehab, PRP) prior to proceeding with surgery. It is true some position players can play without an intact UCL, but these are usually not players at positions requiring hard throws (3B, RF). As far as the W and inverted W position, that is one of probably a dozen or more current theories about predisposition to UCL injury. The issue is far from understood.



[/COLOR]
[COLOR=#3E3E3E]Posted Image Originally Posted by ChiTownTwinsFan Posted Image
This is interesting info. Are you a doctor? Or did you just spend some time and do some proper research?


[/COLOR]Heezy1323:
[COLOR=#3E3E3E]I'm an orthopedist yes. I trained with Dr. Andrews recently so I have a fairly decent understanding of some of the thought processes in play for these guys. I certainly don't have all the answers but am happy to put my two cents in here and there if it helps. Was born and raised in MN and a lifelong twins fan so kind of a bummer to hear about Sano. Sure hoping things go well with his surgery and recovery.
[/COLOR]
[COLOR=#3E3E3E]
Can we please put all of the speculation to rest now about how Sano's injury was handled?[/COLOR]


Great synopsis. Repeating for emphasis.
"If you'da been thinkin' you wouldn't 'a thought that.."

#13 twinsfan34

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Posted 13 March 2014 - 07:57 AM

I don't think anybody necessarily missed anything. Although it may not have been communicated entirely in the media, it does sound like the Twins, Sano and his doctors believed it to be a partial tear.

Please keep in mind:

1. It is Sano's body and I believe he gets the ultimate decision on what is done to it (regardless of his contract with the Twins).

Phil Mackey ‏@PhilMackey 32m
[COLOR=#333333]Rob Plummer, agent for Miguel Sano, says his client was 100% opposed to surgery, which is the main reason why it didn't happen in November.



2. The following information from Heezy1323 posted in the "Ligaments are Stupid" thread:

[/COLOR][COLOR=#3E3E3E]Many times it is not necessarily that it takes so long to make a diagnosis of UCL injury- it is deciding how long to try to treat it non operatively before resorting to surgery. Most guys that have UCL reconstruction don't have a completely torn ligament on MRI. The vast majority (probably 80% or more) have a partial tear. Some can play with a partial tear... some can't. Many variables in play including mechanics, degree of partial tear, condition of shoulder/elbow musculature, etc. Many lay people (as well as many baseball people) assume the success rate of UCL reconstruction is 100%. Not true. It is a highly successful operation, but most literature puts success rate around 85-90%. So that means one out of ten is unable to return to the same level of play. This is the main reason for trying conservative treatment (rest, rehab, PRP) prior to proceeding with surgery. It is true some position players can play without an intact UCL, but these are usually not players at positions requiring hard throws (3B, RF). As far as the W and inverted W position, that is one of probably a dozen or more current theories about predisposition to UCL injury. The issue is far from understood.



[/COLOR]
[COLOR=#3E3E3E]Posted Image Originally Posted by ChiTownTwinsFan Posted Image
This is interesting info. Are you a doctor? Or did you just spend some time and do some proper research?


[/COLOR]Heezy1323:
[COLOR=#3E3E3E]I'm an orthopedist yes. I trained with Dr. Andrews recently so I have a fairly decent understanding of some of the thought processes in play for these guys. I certainly don't have all the answers but am happy to put my two cents in here and there if it helps. Was born and raised in MN and a lifelong twins fan so kind of a bummer to hear about Sano. Sure hoping things go well with his surgery and recovery.
[/COLOR]
[COLOR=#3E3E3E]
Can we please put all of the speculation to rest now about how Sano's injury was handled?[/COLOR]


Is there a link to where this 2 cents is?

I won't pocket it, but I'd like to read it. :)

#14 twinsfan34

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Posted 13 March 2014 - 08:00 AM

Knock on wood...

But "worst case" scenario...it's his right elbow, follow through part of the swing.

Worst case = he plays 1B. And I think his bat would still play plenty well there.

Joe Mauer, people don't give the guy enough credit for just how good an athlete he is. He was (and still is) the only player to be named Gatorade Player of the Year in TWO sports, baseball and football. He was a top 3 QB prospect in football and the top prospect in baseball.

He could arguably be working on his 4th or 5th 4,000 yard season as a NFL QB or looking for his 4th batting title.

That said, I'm sure he could play 3B pretty well in the bigs. Not sure if anyone was really doubting it.

#15 JB_Iowa

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Posted 13 March 2014 - 08:01 AM

Is there a link to where this 2 cents is?

I won't pocket it, but I'd like to read it. :)



Heezy1323's comments come from the Ligaments Are Stupid thread:
http://www.twinsdail...ents-Are-Stupid


There was also a long discussion of Sano's injury and treatment here:
http://www.twinsdail...my-John-Surgery

#16 notoriousgod71

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Posted 13 March 2014 - 09:39 AM

Knock on wood...

But "worst case" scenario...it's his right elbow, follow through part of the swing.

Worst case = he plays 1B. And I think his bat would still play plenty well there.

Joe Mauer, people don't give the guy enough credit for just how good an athlete he is. He was (and still is) the only player to be named Gatorade Player of the Year in TWO sports, baseball and football. He was a top 3 QB prospect in football and the top prospect in baseball.

He could arguably be working on his 4th or 5th 4,000 yard season as a NFL QB or looking for his 4th batting title.

That said, I'm sure he could play 3B pretty well in the bigs. Not sure if anyone was really doubting it.


With Mauer's injury history I can't imagine him making it through one scrimmage at Florida State, let alone a decade in the NFL.

#17 SpiritofVodkaDave

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Posted 13 March 2014 - 10:00 AM

Is it just me, or has Minnesota teams as a whole been super unlucky with really bad injuries over the years:

Liriano, Mauer, Josh Harding, Sano, Peterson etc
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#18 Steve Lein

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Posted 13 March 2014 - 10:16 AM

I don't know exactly how they determine "partial" or "full" tear diagnoses from the MRI, but when I tore my ACL I basically remember them coming to this conclusion because there we're markings (technically I believe this would be "inflammation") on bone or muscle tissue where the ligament connected everything together that weren't normal, and would only be there as a result of a catastrophic and sudden disruption of all the connections (like a "whip-crack" or "ripping-off" of the ligament against that tissue, if that makes sense).

I don't think mine was completely torn in half (like a knife cut it), but it was completely shredded into frayed strands. The before and after surgery pictures of my knee are pretty cool...

But I knew it was torn well-before the MRI, your knee doesn't make that sound and be okay... q;)

Scouting Report: Power: 30, Hitting: 50, Arm: 60, Defense: 40, Speed: 40. "Line drive swing and shows good contact and on-base abilities. Double's power at his peak. Strong arm from 2B or the OF, stiff hands. Not a fast runner, but above average instincts on the bases. Skinny body doesn't look the part, but can sneak up on you. ACL surgery sapped much of his athleticism." (Probably)


#19 nicksaviking

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Posted 13 March 2014 - 11:06 AM

Is it just me, or has Minnesota teams as a whole been super unlucky with really bad injuries over the years:

Liriano, Mauer, Josh Harding, Sano, Peterson etc


I'm guessing other cities feel the same thing. And Peterson really only missed like 4 games.

#20 ashburyjohn

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Posted 13 March 2014 - 11:16 AM

I don't think there are many partial tears that don't end up having TJ surgery anyway. I can think of Ervin Santana, who else is currently playing with a partially torn UCL?


Albert Pujols's name has come up in this context, dating back many seasons apparently.

#21 JB_Iowa

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Posted 13 March 2014 - 11:20 AM


#22 Marta Shearing

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Posted 13 March 2014 - 02:24 PM

Is it just me, or has Minnesota teams as a whole been super unlucky with really bad injuries over the years:

Liriano, Mauer, Josh Harding, Sano, Peterson etc


Once the Metrodome is completely torn down, I firmly believe the curse will be lifted.

#23 mike wants wins

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Posted 13 March 2014 - 02:30 PM

Not until the trees are back in CF, Marta....
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#24 Jim Crikket

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Posted 13 March 2014 - 02:59 PM

It's not likely even possible to keep Sano in Ft Myers all offseason, but if I ran the Twins, I'd securely duct tape his right arm to his body before letting him get on a plane to the DR.
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#25 ashburyjohn

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Posted 13 March 2014 - 03:27 PM

It's not likely even possible to keep Sano in Ft Myers all offseason, but if I ran the Twins, I'd securely duct tape his right arm to his body before letting him get on a plane to the DR.


I didn't even like seeing him lean on the arm during his video. :)

#26 drbob524

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Posted 14 March 2014 - 08:18 AM

I feel like we had a similar discussion a few years ago regarding Baker's elbow and TJ surgery. MRIs arent 100% sensitive and are reliant on the radiologist reading them.