Lewis Thorpe removed from game with elbow pain

[Seth Stohs]

I heard from Twins minor league director Brad Steil this morning that LHP Lewis Thorpe left his most recent spring start due to elbow pain.

No word at this point on what the next steps are, though certainly it is not good news.

[gunnarthor]

Damnit.

[Seth Stohs]

Yeah, this is not what anyone hoped for. 

[Thrylos]

The kid should had have the surgery already.  R&R does not work.  They never learn.  Repeating the same mistake pitcher after pitcher is beyond inane...

[kumm0012]

Except that it does work sometimes.  No surgery is without risks - if it was felt that there was a reasonable chance things get better with rest, then it's worth a shot.  Twins aren't the only team that employs this approach.  Feel bad for the kid - I'm sure he'd rather be pitching.  The rest of us - we get to go on with our lives, if we have them.

[curt1965]

The first kid I saw this happen to was Pat Neshak. He lost 2 years off his career with the Twins unwillingness to consider surgery. Just wondering, who has benefited from the decision to wait?

[kumm0012]

Wow, I don't pay enough attention to be able to list off names, but from a quick Google search it looks like Adam Wainwright avoided surgery for 7 years after diagnosis.  Ligaments are vascular structures, which means they have the ability to heal.  Large tears probably have little ability to do so, whereas smaller tears have a greater likelihood of responding to rest.  The bottom line is - they tried something, it didn't work.  It sucks for the kid, but we'll all be OK.

[Seth Stohs]

Ervin Santana had a partial UCL tear about 5-6 years ago. He never had the surgery. There are several other instances as well.

 

That said, it's always frustrating when it could have been done right away and they wait through an entire offseason.  

 

That said, guys like Andrews and other top UCL doctors make their recommendations and teams typically agree with them and their recommendations. The Twins have had several guys who they've had had surgery right away (Corey Williams, Randy Rosario, Tyler Stirewalt, Fernando Romero all last year)... 

[curt1965]

BTW- how cool is it to get messages from Twins minor league director Brad Steil?

[JB_Iowa]

http://blogs.twincities.com/twins/2015/03/22/twinsights-lewis-thorpe-to-undergo-mri-on-throwing-elbow/

 

Berardino after talking to Thorpe's mentor, James Beresford.

[diehardtwinsfan]

this sounded like a real possibility last fall.  Unfortunately, sounds like it will happen.

[Bob Sacamento]

Really sad, I just saw Thorpe throw last weekend and everything seemed well and he was in high spirits.  As a sports' Chiropractor, I've seen plently of high school/college arms and a few minor leaguers rehab successfully  from a sprained UCL with small tears with a proper incremental workout schedules without any issues. While others still need surgery after proper rehab.  Every snowflake is different.

 

As for ligaments being a vascular structure, yes it's true but on a pretty minimal standard, nowhere near like a muscle.  That is why having a muscle strain is a better prognosis than a ligament strain, by usually a few wee.  If there was a tear and it was minimal (10% or less) there is a nearly up to a 75% recovery rate depending on which ortho doctor  you believe.  Personally, if I 'm in charge of his care I'm doing an MRI every other week and once a week while he's throwing just to keep tabs

 

Wow, I don't pay enough attention to be able to list off names, but from a quick Google search it looks like Adam Wainwright avoided surgery for 7 years after diagnosis.  Ligaments are vascular structures, which means they have the ability to heal.  Large tears probably have little ability to do so, whereas smaller tears have a greater likelihood of responding to rest.  The bottom line is - they tried something, it didn't work.  It sucks for the kid, but we'll all be OK.

 

 

[nater79a]

If there is a silver lining it's that Thorpe is only 19. Even with 14 months off, he'd still be ahead of the development curve. Could be back pitching later next season at age 20.

[gunnarthor]

 

The kid should had have the surgery already.  R&R does not work.  They never learn.  Repeating the same mistake pitcher after pitcher is beyond inane...

Other than fans though, no one really thinks this.  Klaw, Callis, McDaniel have all defended teams that waited to see if R&R works first.

[ashbury]

 

If there is a silver lining it's that Thorpe is only 19. Even with 14 months off, he'd still be ahead of the development curve. Could be back pitching later next season at age 20.

Silver lining for the player, though not for the team who will have to make 40-man decisions on a fixed timetable.

[diehardtwinsfan]

yeah, I am curious when Thorpe needs to go on the 40 man.  He's not one of those extra option guys having pitched in Cedar Rapids last season.  If he's done, at best he's starting in Fort Meyers next year, and I think that's being a bit aggressive as I could see him in extended spring training to work out the kinks and then a month in CR before going to FTM.  He'd still have plenty of time from an options standpoint, but I think I'd rather him having some AA/AAA time in before those become a reality.

[Shane Wahl]

Surgery still before March is done. He can start pitching at Fort Myers in 2016 in June. That is the best case right now. Follow it and get it done Twins.

[Heezy1323]

Really sad, I just saw Thorpe throw last weekend and everything seemed well and he was in high spirits.  As a sports' Chiropractor, I've seen plently of high school/college arms and a few minor leaguers rehab successfully  from a sprained UCL with small tears with a proper incremental workout schedules without any issues. While others still need surgery after proper rehab.  Every snowflake is different.

 

As for ligaments being a vascular structure, yes it's true but on a pretty minimal standard, nowhere near like a muscle.  That is why having a muscle strain is a better prognosis than a ligament strain, by usually a few wee.  If there was a tear and it was minimal (10% or less) there is a nearly up to a 75% recovery rate depending on which ortho doctor  you believe.  Personally, if I 'm in charge of his care I'm doing an MRI every other week and once a week while he's throwing just to keep tabs

As far as the MRI's go, their utility is overestimated for this injury. The same MRI findings in two different players may mean two widely disparate things. Serial MRI's, particularly a week apart almost never add anything to the discussion unless there has been an increase in symptoms or a new 'pop' or something of the like. The 10% or less is not definable. There is no classification system for UCL tears that measures them this way. Coincidentally, the annual meeting of the American academy of orthopedic surgeons is this upcoming week and there is a paper being presented (that I worked on- shameless plug) that proposes a classification system, but it's utility is far from clear.

 

Bottom line, the decision for when to proceed to surgery is often difficult and approached individually on a case by case basis. Some guys can pitch at a high level with a partial tear- others can't. Only way to find out is to let them try.

[jokin]

 

As far as the MRI's go, their utility is overestimated for this injury. The same MRI findings in two different players may mean two widely disparate things. Serial MRI's, particularly a week apart almost never add anything to the discussion unless there has been an increase in symptoms or a new 'pop' or something of the like. The 10% or less is not definable. There is no classification system for UCL tears that measures them this way. Coincidentally, the annual meeting of the American academy of orthopedic surgeons is this upcoming week and there is a paper being presented (that I worked on- shameless plug) that proposes a classification system, but it's utility is far from clear.

Bottom line, the decision for when to proceed to surgery is often difficult and approached individually on a case by case basis. Some guys can pitch at a high level with a partial tear- others can't. Only way to find out is to let them try.

 

Thanks for the professional opinion.  Please, don't be a stranger around these parts, particularly as the inevitable medical issues arise.

[nicksaviking]

Aside from Ervin Santana, R&R does not show much success.

 

Still, it's easy for us to say he should have had surgery, we aren't the ones getting knocked out, sawed open and incapacitated for months. Last I checked Thorpe is still an adult privileged with making his own choices with his body. I'm guessing even if the Twins tried to force Thorpe to have surgery, they would find a stiff rebuke from our legal system.

 

Hey, perhaps a team could start looking into setting up their training facilities in Cuba now if they were interested forcing medical procedures upon teenagers.

[h2oface]

 

Ervin Santana had a partial UCL tear about 5-6 years ago. He never had the surgery. There are several other instances as well. That said, it's always frustrating when it could have been done right away and they wait through an entire offseason.  

And there is the rub for signing Santana. Will the Twins get to pay for him to have the surgery and rehab for years, finally? Are we jinxing him to even bring it up, again? That was my main problem with his signing. Wainwright lasted 7 years..... which puts Santana .... stop......... I can't think about it.

[Shane Wahl]

 

As far as the MRI's go, their utility is overestimated for this injury. The same MRI findings in two different players may mean two widely disparate things. Serial MRI's, particularly a week apart almost never add anything to the discussion unless there has been an increase in symptoms or a new 'pop' or something of the like. The 10% or less is not definable. There is no classification system for UCL tears that measures them this way. Coincidentally, the annual meeting of the American academy of orthopedic surgeons is this upcoming week and there is a paper being presented (that I worked on- shameless plug) that proposes a classification system, but it's utility is far from clear.

Bottom line, the decision for when to proceed to surgery is often difficult and approached individually on a case by case basis. Some guys can pitch at a high level with a partial tear- others can't. Only way to find out is to let them try.

 

Ok, that makes me feel better at bit.

[kab21]

I think it is quite obvious that the R&R method works so few times that at this point it almost shouldn't be considered an option.  In the last decade I can only come up with three names where it worked.  Wainwright, Santana and Brett Anderson (delayed his 2nd surgery by one year).  If you are going to say that something works then you need to have a better success rate than this list.

 

I am sure that somebody else has recovered but I have been asking baseball forums for the last 2-3 years for more examples and nobody has mentioned anyone yet.

[nicksaviking]

 

I am sure that somebody else has recovered but I have been asking baseball forums for the last 2-3 years for more examples and nobody has mentioned anyone yet.

I agree, and as a fan I would like to speed up the process and get it done with at first tear, but we too often see these guys as 2D characters. If I was faced with 100% certainty of delaying my career AND the loss of my dominant arm for months, I'd probably try for the lotto ticket too.

[kab21]

Just because it almost never happens doesn't necessarily mean that rest and rehab should be completely scrapped.  I am merely pointing out that there are almost no examples of it working and nobody has actually been able to name more I can count on one hand in the last decade.

 

I also am not sure athletes would agree.  Surgery is scary but the most likely option now is that Thorpe loses two years of development instead of one and his lotto ticket (the MLB) is delayed another season.

 

Nolasco's case is a better example of when R&R should be used since he came back and was able to pitch at the end of the season.  If R&R had failed on his initial return (in the first month) then he could have had TJ and still only missed one season.  I'm not optimistic that he can avoid TJ but there is a better chance since he has thrown at normal velocity for an extended period of time since the R&R.

[Mike Sixel]

As someone that had 3 major surgeries nearly 2 years ago.....it's always better to try not to have surgery.

 

And this is why having the number 1 farm system means nothing until the players are here.....and why betting your whole future on guys that have never made the majors is risky, imo.

[Thrylos]

 

Bottom line, the decision for when to proceed to surgery is often difficult and approached individually on a case by case basis. Some guys can pitch at a high level with a partial tear- others can't. Only way to find out is to let them try.

 

Sure, but at some point one needs to do a cost-benefit risk-based analysis:

 

Three events (ranked in reduced time away from the game) :

A. someone to rest for X1 time and then pitch at Y1 percent of his previous level

B. someone to have surgery and have to recuperate for X2 time and then pitch at Y2 percent of his previous level/

C. Someone to rest for X1 time then try to pitch and finding out that he has to have surgery and has to recuperate for X2 time and then pitch at Y2 percent of his previous level.

 

Easily you don't want C because it is the worst outcome of the three.

Choice between A and B should be based on a. the probability that A does not turn to C (and empirically, someone should do the math, based on the PRO PITCHER cases of the last 10 years or so, it seems that 80% or A's go to C) and b. where is Y1 compared to Y2 (and empirically Y2 >= Y1.)

 

Logically, it is a no-brainer, unless there are some personal situations that would negate surgery because of potential complications, but for pro athletes, those are hard to find and likely more detrimental to their career than a UCL tear.   Given those numbers, 85-90% of the cases TJ surgery is the best choice.  And there is just too much of a risk to wait and find out whether someone is on the 10-15% of the cases that it isn't so...

[Thrylos]

 

As someone that had 3 major surgeries nearly 2 years ago.....it's always better to try not to have surgery.

 

And this is why having the number 1 farm system means nothing until the players are here.....and why betting your whole future on guys that have never made the majors is risky, imo.

 

Mike, it is not, if you were a pro pitcher and your team wants you to spend the least time out of baseball as possible and return at the highest level as possible.   These are the most desirable outcomes for a pro pitcher and may different for anyone else.  For some people avoiding surgery (because of potential complications or whatnot) might be the most desirable outcome.

[Mike Sixel]

 

Mike, it is not, if you were a pro pitcher and your team wants you to spend the least time out of baseball as possible and return at the highest level as possible.   These are the most desirable outcomes for a pro pitcher and may different for anyone else.  For some people avoiding surgery (because of potential complications or whatnot) might be the most desirable outcome.

 

We aren't likely to agree on this......even for a pitcher, it is better for them as a human being to avoid surgery if they can.

[Mike Frasier Law]

In a timely coincidence, The Hardball Times just published an article on the return rate of pitchers from TJ.

 

http://www.hardballtimes.com/tommy-john-surgery-success-rates-in-the-majors/

 

It goes into much more depth about the recovery rates - how long it took for recovery, how many games and innings pitched after surgery, etc.

 

We hear 80% recovery rate, but that means the pitcher comes back to pitch 1 inning. Here's one quote in summary:

 

"The most recent data suggest that one out of two major league pitchers who has Tommy John surgery will throw fewer than 100 innings the rest of his big league career."

 

So even if R&R has a low success rate, it may be better than guaranteeing missing 1-2 seasons and only having a coin flip chance to ever contribute meaningfully again.