Heezy1323

If you had to choose, you would likely choose the non-throwing shoulder (obviously). But an injury to the front shoulder of a hitter is also not ideal, depending on the part of the labrum that has an injury. There is more flexibility required of the front shoulder when swinging and this type of surgery can sometimes alter the flexibility- hopefully temporarily until rehab is complete.

Im sure most here are aware that Royce Lewis strained his hamstring last night during the Twins vs. Reds game. It looked like he may have been a bit hobbled running to first earlier in the game, but returned to hit in the 8th inning. During the at bat, he appeared to aggravate the hamstring and had to leave the game. The Twins are calling this a day-to-day injury at this point. In 2018, Dr. Chris Camp (the Twins Head Team Physician) and others published the following report: This article and it's appendices give us great information about a wide range of different injuries to MLB and MiLB players over a period of several years. The injuries in this article span from 2011-2016 (as noted above), so there may be some changes over the past handful of seasons. But I believe the information is still relatively valuable. Here is what it has to say about Hamstring Strains (which happen to be the #1 most common injury during this time period): You can see the mean number of days missed is 14.5, with the median at 9. The majority of these occur while running (56%). Here is some additional context: Certainly unfortunate for Lewis and the Twins. The have 13 days until a likely playoff opener on 10/3. Let's cross our fingers and hope Royce is ready to go. (Cover photo credit Jeff Dean, Associated Press)

I agree with most everyone's thoughts on Paddack, Alcala, Stewart and Gordon. Not sure I have any meaningful insight there, from a medical standpoint. As far as Buxton… it's hard to know. It sort of depends on if we take the information at face value or if we 'read between the lines'. At face value, there can be an in-folding of the joint lining called a plica that can sometimes cause discomfort in the knee. It can rub along the edge of the femur and cause irritation and pain. In my experience, it is uncommon for this to be an issue of any significance, but it is possible. If we are reading between the lines, I am somewhat skeptical. If there had been a plica in Byron's knee, and it was anything of significance, I would think it would have been removed during his procedure last year. It is possible a new plica formed since surgery, I suppose. My speculation (emphasis on speculation) would be that the issue continues to be the surface cartilage issue that has been previously discussed. Cortisone injections can be used to treat both of these things (cartilage issue and plica). The idea being that the cortisone decreases inflammation within the knee, hopefully thereby helping swelling and pain. Other types of injections, such as platelet rich plasma (PRP) can also be used in a similar way (though there is less available data to support their use). I believe he has had PRP injections in the past as well. What I personally take away from this is that the Twins/BB are trying all possible avenues to get Buxton's knee settled down to something resembling normal in time to contribute for the playoffs. By all accounts, Byron has an exceptional determination to play, despite his injury ledger. However, given his history, I am skeptical his knee will suddenly 'turn the corner' to the point that he can withstand significant time in CF. That said, I will be the first to say that I have no first hand knowledge of his situation. There could absolutely be important details I am missing. I hope I'm wrong. There's nothing I'd love to see more than Byron running down a line drive in the gap or legging out a triple in October. But I have to say it will surprise me if I do. *insert sad face emoji*

I appreciate the kind words. I'm never quite sure when to 'chime in' vs not. Please feel free to tag me in future posts if you have questions, and I'll do my best to answer back. I don't read TD every day, but try to check here often. Between the Athletic and the Gleeman/Geek podcasts, there's so much great twins content.

I have heard rumblings (I have no specific information or anything like that) that the issue in his knee is as you say- damage to the surface cartilage. I have heard the area is in what's called the trochlea, which is the area in the front of the knee where the patella (kneecap) glides. You are mostly correct about the current technology. We do have some different methods to 'replace' the cartilage, but none of them make it 'good as new'. And there have not been too many instances where these procedures have been able to stand up to the rigors of professional sports for any considerable length of time. Some people, for reasons unclear, can tolerate even large cartilage lesions in their knee with minimal or no symptoms. Other people can have significant symptoms from even a small area of cartilage injury. It's highly variable. With the majority of these lesions in elite level athletes, we often attempt a 'clean-up' type procedure first, which is what I suspect Buxton had last year. This includes shaving some loose cartilage away and removing any floating pieces, etc. But this procedure does not 'fix' the root cause of the issue. The irregularity of the gliding cartilage remains. In many cases, people do well despite the irregularity (I don't always understand why it happens that way, it just does sometimes). In other cases, people continue to have trouble with the area, in which case the choices get more difficult. You can treat with rest/rehab/injections (as he has been). You can try to repeat the same surgery hoping for different results (always risky). Or you can try one of a handful of types of cartilage restoration surgeries. Without knowing the details on exact size, location, depth and several other factors, it's hard to say which of these would be best for someone like Byron. But they all require fairly lengthy recoveries. (A recent athlete with something like this is Lonzo Ball, who will miss the entire upcoming NBA season). From my perspective, it's also hard to know if this current issue he is having is actually patella tendinitis (totally possible from trying to ramp up activity) versus 'he is having pain in the front of the knee, and we are going to use the term 'patella tendinitis' to report it, but in reality he is having pain due to the cartilage damage area.' These two things will often result in similar symptoms, and it can be hard to differentiate which is the true cause of pain. In any case, a big bummer for Byron. I sure hope he can get things settled down and get back to roaming CF at 100mph like we all love to watch him do. As always, that's my $0.02. I am not a Twins team physician and have not examined Byron or seen any of his imaging or anything like that. This is purely speculative on my part.

I largely agree with you @Lucas Seehafer PT. Allow me to play devil's advocate to some degree. What do you think is the SPECIFIC question being asked of the consulting doctors (Dr. Anderson et al.)? I think it is most likely something along the lines of "Do you see anything on this imaging study (xray/MRI) that would indicate that there is the chance of Carlos developing an ankle problem that limits his function in the next 10-12 years?" I don't believe that is a question you can answer using the 'functional model' you are describing. The MD isn't being asked about how he is currently performing or how he has performed in the past. Everyone involved knows the CC of today is an incredible player. If the MD says, "Well, I see some arthritis on this MRI, but he is currently functioning fine," the response is going to be- "OK great. What does that mean for his future?" As such, the MD is essentially forced to make a prediction. Are predictions always correct? Absolutely not. But I don't think that the argument that "He is functioning just fine today" satisfies the question being asked. Also, the MRI here is not 'predicting future injury' to use a term you used. It is, more precisely, 'documenting the current state of the ankle'. This may seem like semantics, but I don't believe it is. The injury isn't being predicted- it is already there (presuming my assumption of some ankle arthritis is accurate). What is being predicted is how this ankle will hold up over time given the amount of arthritis currently present. Now, is there some room for subjectivity as to how an ankle with some arthritis will hold up over time? One hundred percent yes. This is likely (IMHO) where the MDs differed in their opinions. Or, perhaps the MDs said similar things, but team officials chose to utilize that information differently. I don't think we can say for sure. In any event, I thought your article was a very good synopsis. I agree entirely with the last 2/3 of it. Well done.

How do they know exactly what he said? All they know is that the Giants deal seemed to hinge on his feedback about the MRI. Not exactly what the feedback was. Allow me to phrase another way. Why NOT ask him? What is to lose by collecting all available information? You can always choose to disregard it. For $300 million, I am of the opinion that a 15 minute phone call is reasonable.

I think this is a great read of the situation. I agree entirely.

You don't believe the Mets spoke (at minimum) with any of their own physicians? I think this is tremendously unlikely.

Why is it that you find this weird? He is the preeminent foot/ankle physician for professional athletes in the world. The "Dr. James Andrews" of foot and ankle. Essentially every high level athlete seeks his opinion after an injury. I don't think it's weird at all. I would want to know what his concerns were. I may or may not choose to abide by his recommendations, but I sure as hell would want to know what he had to say. He didn't get to his level by accident.

IMO, this is VERY unlikely to be the case. These plates/screws just don’t suddenly come loose after 8 years. If something happened at the slide, the most likely disaster is fracture of the bone directly above the plate (which obviously didn’t happen here). I still like my theory of low-grade arthritis stemming from his original injury. Other possibilities exist, for sure.

I didn't intend my reply to come across as snarky. I certainly didn't take your response disrespectfully. Mine was simply an honest take (as I see it): This was, for all practical purposes, a one year deal. I'm guessing the team reviewed his medicals at hand, but did not require repeat imaging of *all* prior injured areas (again, due to this being effectively a 1 year deal). IMO, this is because anything that is not recently/currently bothering Carlos is unlikely to become important over the course of one year. To be clear, I'm not endorsing this approach as foolproof or the most ideal approach. I'm only giving my thoughts on what may have happened. I don't think I'm able to comment intelligently on what threshold exists for *standard* due diligence and *extreme* due diligence. I think most people would agree that a different level of scrutiny is necessary for a 10-year and what is effectively a 1-year deal.

IMO, this wasn’t a 3 year deal. It was a “3 year deal” in which essentially everyone involved knew it was a one year deal absent extraordinarily unusual circumstances. You’re welcome to disagree with my reasoning. I have no idea if I’m correct or not. It’s just the most plausible explanation to me given what we know.

Here's my $0.02: (I have no insider info) I think the most likely scenario is that Correa fell into the Twins lap quickly last year, and everyone recognized it was most likely a 1 year arrangement. So the level of due diligence required by the medical staff is lower. Imaging of all prior nicks/bruises isn't necessary in that case. This time around given the commitment of 10+ years, teams were being more diligent and likely getting new imaging of any body part that had ever been treated for an injury (surgically or not). My guess is that the imaging of his ankle shows some early arthritis related to the ankle fracture that was fixed 8 years ago. This is something that is essentially impossible to "fix" in the traditional sense. And it may be mild enough at this point in time that it isn't causing him any significant symptoms (hence no issue made of it last offseason). But imaging can still show some early signs of arthritis, even before a person has symptoms. My guess is that the Giants docs saw this, and said something to the effect of, "This ankle has some early arthritis. This is something that generally is going to get worse over time, at a rate that is impossible to know. As it worsens, it is likely to affect Correa's ability to perform quick movements and may require a position change. Worst case scenario, it could be progress more rapidly and be a significant hindrance to him playing at an effective level." There are certainly other possible explanations. This is the one that seems to fit the circumstances best as I think about it. Merry Christmas/Happy Holidays all.

I appreciate your further explanation. My response was perhaps a bit unfair, in that there were a few posts that questioned the aptitude of the medical staff, and I just chose yours to quote. My response was probably a more generally directed response to that notion, rather than a specific retort to your post. IMO your concerns are valid, and also highlight the incredibly complex nature of this type of decision-making. These are tough problems to solve. I would argue that they are even tough problems to 'measure' in any consistent or meaningful way, much less 'solve'. Thanks for your response.