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  • Mahle Diagnosed with Forearm Strain and Elbow Impingement


    Lucas Seehafer

    Expect Minnesota Twins pitcher Tyler Mahle to hit the disabled list in short order. A recent MRI revealed a flexor-pronator strain in addition to the posterior elbow impingement diagnosed earlier this past weekend according to multiple reporters including The Athletic’s Dan Hayes. The righty will be “shut down” for four weeks.

    Image courtesy of Wendell Cruz | 2023 Apr 15

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    Posterior impingement simply means that a soft tissue structure on the back side of the elbow is getting “pinched” repeatedly with each throw. Usually, the culprit is either the triceps tendon or the ligament-like capsule that helps hold the joint together. While uncomfortable and potentially nagging, it isn’t an overly concerning injury in the long run.

    What is of slightly more concern, though, is the other injury in Hayes’ tweet. The wrist flexors and pronators, two distinct muscle groups in the forearm, attach along the inner elbow near the ulnar collateral ligament, or UCL. These muscles flex the wrist and fingers (i.e. making a fist and bending the wrist down) and also pronate the forearm (i.e. placing the hand in a palm-down position). These muscles are important for gripping and imparting spin to the baseball. Their forceful contractions also provide dynamic stability to the inner elbow, attenuating a mild amount of force that is otherwise placed on the UCL. Basically, if the flexors and pronators are injured, the UCL is at an increased risk for injury.

    As Hayes mentioned in his article following Mahle’s recent start against the Kansas City Royals, Mahle’s fastball velocity dropped over five miles per hour between the third and fourth innings. He originally stated that his pain was located at the back of the elbow and was “sore”, which originally led to the impingement diagnosis. The MRI revealed the muscle strain. 

    According to Baseball Prospectus’ Recovery Dashboard, the median days missed due to elbow flexor strains is 40 days, with a minimum of 17 and a maximum of 84. However, flexor strains often precede a UCL sprain diagnosis, which may ultimately lead to Tommy John surgery. It should be noted, though, that frequently athletes are provided a flexor strain diagnosis prior to undergoing imaging; the MRI then reveals the UCL tear. 

    In Mahle’s case, there’s no reason to suspect UCL involvement at this time as it was not included in the team’s official diagnosis. There’s also no reason to suggest that surgery is imminent and his season is over. 

    The initial timeline provided by the Twins is suggestive of a Grade 1 or 2 strain, both of which can take weeks to months to heal. Mahle will likely resume a throwing program after the next four weeks conclude, at which point it will be determined if will be ramped back up or shut down further.

    This is a developing story, so stay tuned to Twins Daily for the latest information. 

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    Wow - out for 7 or 8 weeks minimum. Maybe done?

    Time to start paying attention to Paddack’s recovery/timeline.

    Scouting trade partners for July should ramp up soon…….who are we willing to part with in 3 months? This is probable due to Paddack probably not being ready for any real stress or workload & Maeda being unreliable as well, even if he comes back in 3-4 weeks.

    Ober looks more than capable but how long does he last with recent injury issues and never throwing more than 15-20 games worth of starts?

    Varland is firmly in the mix now.

    Hope Winder can get his act together so he and Headrick can support our rotation as the long guys!

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    Tough break for Mahle. I'll admit to being very concerned about this injury and whether he's able to recover from it with rest/therapy and avoid surgery. We've been through this dance before with pitchers where they try to shut it down for a while and get right and avoid the knife and eventually they end up having the surgery and get knocked out for the year, so I am afeared we're facing that again. (I'm not saying it's the wrong decision to try everything you can to avoid surgery; you should always try to avoid the need for surgery if you can. It's just that the odds seem poor.)

    Thank goodness we have the pitching depth for the rotation to deal with this. Thankfully, Sonny Gray got his regular program in and isn't already on the IL with a bum leg. Thankfully, Joe Ryan is a horse. Thankfully, there's been no problems with Pablo Lopez. 

    We knew Ober and Varland were going to get chances this season. their time is now.

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    Even if Maeda returns after the 15 day IL, they need to pay closer attention to his form. Clearly something was askance in his delivery to the plate in his last appearance. 

    I don't want Mahle to be indefinitely injured because then I'll start imagining that the Reds screwed us just like the Giants did with Dyson...

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    Isn't this why the Twins went out and got a guy like Pablo Lopez? They knew that Kenta Maeda had some question marks and that Mahle was coming back from a shoulder injury and had question marks too. They needed another arm that they knew could give them five or six innings a game once a week. I would say that the Twins probably have seven guys who could be counted on as solid starters when you include Ober and Varland. If you throw SWR into the mix, there is another arm that can probably get them a solid five or six innings of work. In a pinch, even Headrick could probably start a game and give them five innings. Who knows what Paddack is going to be like when he comes back. If they get really desperate, there is always Josh Winder hanging around (he looked awful this weekend so I would not give him a start unless I was absolutely forced to).

    The Twins have enough depth that they can weather this storm because they have learned from the last few years what happens when you lack that depth.

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    Well, I guess the Twins should've traded for Frankiie Montas instead, right?

    Though the prospect haul by the Reds was substantial, at least the Twins do have some depth and could afford to lose guys. But overall, thgis hurt. The front office gets credit for trying to bring competitive talent into the fold for a playoff run, which didn't happen.

    I was at least hoping that Mahle (and Madea) would prove adequate for flipping for at least some prospect return, albeit at a lower level.

    The joy is that opportunities exist for Varland and Ober. If I was the Twins, I would bring back Headrick and let Winder work into rotation speed at St. Paul. If push comes to shove, the Twins still have DeLeon, Sanchez and Rodriguez down on the farm. And Dobnak, now is your time to start shining!

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    1 hour ago, Rosterman said:

    Well, I guess the Twins should've traded for Frankiie Montas instead, right?

    Though the prospect haul by the Reds was substantial, at least the Twins do have some depth and could afford to lose guys. But overall, thgis hurt. The front office gets credit for trying to bring competitive talent into the fold for a playoff run, which didn't happen.

    I was at least hoping that Mahle (and Madea) would prove adequate for flipping for at least some prospect return, albeit at a lower level.

    The joy is that opportunities exist for Varland and Ober. If I was the Twins, I would bring back Headrick and let Winder work into rotation speed at St. Paul. If push comes to shove, the Twins still have DeLeon, Sanchez and Rodriguez down on the farm. And Dobnak, now is your time to start shining!

    I hope that was sarcasm, as Montas is out the whole year with injury, and was never 'right' from the jump.  Risks abound with these arms.....On the other hand (given unexpected injury to high stress pitching), perhaps we just shouldn't 'chase' pitchers at all with high mileage and just develop our own (if we were good at it)...

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    Horrible result of the trade. He was damaged goods when they traded for him. His arm problems were in progress. To me, the only smart thing about the trade with the Reds was that Mahle’s wildness couldn’t break Buxton’s wrist again if he was on the same team. I guess the do nothing plan for rehab since he shut down last August 17 (except for 2 innings on September 3) was as ineffective as it seemed it would be. Free agent at the end of the season. Please stop trading for damaged arms.

    And to think we let Tyler Wells go unprotected in rule 5 december of 2020 to have slots open on the 40 man for pretty horrible 2021 roster additions. He was "damaged" at the time though, out all of 2020 recovering from May 2019 TJ surgery, and we needed slots in the bullpen for guys like Alex Colomé, Hansel Robles, and Randy Dobnak on the active roster and guys like Nick Vincent, Brandon Waddell, Derek Law, Ian Gibaut, Andrew Albers, Shaun Anderson, Charlie Barnes, Kyle Barraclough, Beau Burrows, Luke Farrell, John Gant, Edgar Garcia, and Ralph Garza Jr to have space on the 40 man througout the year. The Orioles were building and saw the talent that had made the 6'8" Tyler Wells the TD Minor League Starting Pitcher of the Year in 2018. Pitcher identification is not easy. 

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    4 hours ago, Shaitan said:

    I wonder if one injury is causing the other (overcompensation).

    Fingers crossed that it's that it's relatively short-term.

    Those were my thought too. Hoping for recovery on the shorter end of the timeline.

    wondering if compensating for the previous injury caused some new injury. Likely we’ll never know

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    Thank you, yet again, for a marvelous breakdown. 

    From an outside looking in position, assimilating everything known, and unknown, Mahle had a sore shoulder and "tired arm" in 2022 after a good start. He rested, looked good, and the Twins made the trade move. Mahle looked just fine his first couple of starts before the "tired arm" came up again and pretty much finished his season. It bears repeating yet again, doctor exams and MRI's showed no structural damage. Mahle had a good start to the season, and even looked good in his first 4IP before being pulled.

    NOW we get this unfortunate news. I don't have to be any sort of doctor or biologist to know there is a difference between a shoulder and an elbow. I do wonder if there was, indeed, hard work in the offseason to get ready for 2023 and if any sort of compensation might have happened to either lead to this latest injury, OR, aggravate a previously unknown possibility of elbow, potential UCL, injury. And maybe Lucas can add more to that point. Could there be a coralation between his shoulder and "tired arm" last year and this elbow/forearm injury that might lead to TJ?

    I have a hard time believing the Twins would have made the trade for Mahle last year if they felt there was a serious TJ risk. And in truth, isn't just about every pitcher at risk at some point? 

    MEDICALLY speaking, maybe he worked too hard? Maybe his arm is still adjusting to his new repertoire? No...I'm not quite buying in to that either. But pitching arms are fragile things. From what Lucas has stated, and given the general wear and tear on a ML arm, it does seem possible that rest and rehab will strengthen the forearm muscles and the elbow inflammation will settle down. And Mahle will be OK to finish the second half. That would be excellent.

    From a personal point, I feel bad for Mahle, as I'm pretty sure his arm is just giving out right before the possibility of growing as a pitcher and ready for a new deal, or FA.

    From the Twins perspective, this couldn't have happened at a worse possible time based on his talent and projection. 

    I hope for the best for Mahle, and his career. And maybe we'll all be surprised and rest and rehab will have great results. I just have to expect the worst at this point.

    Baseball wise, how many teams had the likes of Ober and Varland waiting in the wings, and deserving of being on the opening day roster, just waiting to fill the last 2 spots in the rotation?

     

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