Heezy1323

I certainly don't read every article out there, but with a brief search I couldn't find anything. If you'd told me Santana had surgery and asked me to guess the body part, I think the middle finger MCP joint capsule would've been about #12,342 on my list of guesses. I doubt there are any meaningful comps out there. That being said, it's certainly better than an elbow or shoulder issue. I'm guessing his likelihood of a full recovery is pretty good (though I'm not a hand surgeon).

It’s unlikely that anything could be tried that would replicate the stress of pitching. I’m sure they tried some things. It is unfortunate that the timing is what it is, but I’m not sure it was avoidable.

Again, this is because experts recommend 3-4 months off from throwing each year in pitchers. The risk of injury goes up 5x in those who fail to do so (in one study). So ramping him up earlier to 'see if the finger flares up' is not without risk. You are simply trading one risk for another.

Yes, that is the convention. I just don't use it in order to avoid any confusion. Less ambiguity is good, IMHO.

Some info that people may find helpful: 1) The MCP (metacarpophalangeal) joint is the joint at the base of the fingers. 2) I typically don't number the fingers (I use thumb, index, middle, ring and small), since it can be unclear if the thumb is considered the 'first finger' or the index finger is considered the 'first finger'. However, I am assuming that 'third finger' is the middle finger. 3) It makes sense to me that this could be a repetitive stress-type injury because the middle finger is finger that is typically in contact with the baseball the longest, and therefore sees the most stress. Over time, that could cause stress at the MCP joint that could lead to inflammation. 4) It is recommended by most throwing experts that pitchers should take off 3-4 months from pitching every year to reduce their chance of arm injury. This timeline with Santana seems about right to me. Of course it would have been nice to recognize this earlier and get it taken care of sooner, but beginning to throw earlier is also not without risk. You are simply trading one risk for another. 5) The timing is not ideal, but it also could be argued that taking care of this now may prevent a recurrence in the middle of the season, at which point all 10-12 weeks of recovery would be during the season. 6) Trying a cortisone injection in or around the joint to reduce inflammation last season seems like a very reasonable option to me. It's unfortunate that it didn't completely relieve the problem, but it was probably worth a try. Hopefully he will heal ahead of schedule and be back to his first-half 2017 self!

I appreciate the opinions voiced by everyone. I enjoy seeing topics such as this that don't have a clear 'right or wrong' answer discussed on TD. I agree that the up/down of the strike zone being changed from batter to batter could create a challenge for robo umpires. But the in/out of the strike zone should be the same for everyone, correct? What if there were a buzzer or something similar in the umpires hand, and if the ball caught the corner based on Pitchf/x, it 'buzzed'. If it didn't, no 'buzz'. We leave the up/down calls to the umpire, but give him/her some help on the corners. You could, alternately, structure it similar to tennis, where they use 'hawkeye' to see if balls are in or out. (As an aside, I believe I remember reading somewhere that this has some measure of inaccuracy as well, around 1/4" if I remember right). So the umpire could continue calling balls and strikes as we do now, and the batter or manager would have 1 challenge per inning or something similar, in which case we could use the robot. My basic point is, most of the discussion here seems to be centered around going completely to robots or not using them at all. I think there is room for discussion of some type of marriage of the two. IMHO, the objective should be the accurate calling of balls and strikes, regardless of method. Again, enjoy the discussion.

While this is true, NE finished 29th in yards/game allowed and 27th in third down conversion percentage allowed. The Vikings finished 10th in offensive yards per game and 3rd on third down conversions (on offense). Points can be skewed by a missed field goal, bad weather, etc more easily than yards. I'm not saying the Vikes would be a favorite vs. the Pats, but I like our chances as much as anyone's. Hoping Elflein can get healthy. As much as I hate getting sucked back in by the Vikes, they are going to be a tough out.

I would certainly be open to contributing in a more structured way, or more regularly if those in charge feel it would be worthwhile. It's not something I have ever done formally, but I enjoy contributing what I can. As for the compensation--- My student loans still look a lot like my phone number, but I'm working on it...

I would think they would not want him in a pool until the surgical wounds have completely healed (usually around 2 weeks somewhere), but the pool (or underwater treadmill) would be a large part of my rehab recommendations if I were involved. It offers resistance and also buoyancy (sp?) to reduce stress on the bone in the initial recovery. I would think elliptical and stationary biking would also be good options (lower impact than running). He would likely be limited in lower extremity lifting initially, but could do most seated or lying upper extremity lifts pretty quickly. If I were involved, I would suggest a personal chef or food preparation service of some sort to optimize nutrition/healing and calorie intake. I'm sure most of this is already being considered or implemented.

Thanks for sharing. Mad props for throwing in 'osteoblast/osteoclast'.

Many are. Stainless steel is also frequently used for many of the same reasons you list. The vast majority of hardware implants for fracture fixation are one of the two.

It's a little difficult for me to make sense of this with the information available, but I'll offer my $0.02. I'm guessing that he had an initial injury with the foul ball that caused a bone contusion/bone bruise which really is similar to a stress reaction, though at the beginning it occurred in this case all at once rather than due to repetitive stress over time. If the injury is on the anterior edge of the tibia (nearest to the front of the leg), that is what we refer to as the 'tension' side of the bone- meaning with each step, that part of the bone has a tension/distraction force place across it. This can slow the healing process. From a biomechanical perspective, his weight would also play a role. I can't remember if I've used the analogy here before, but I often discuss with patients who have this type of problem about the 'see-saw of bone metabolism.' On one side is 'bone build-up' and on the other is 'bone breakdown'. The body is always balancing these two for almost all of your bones (even if not injured). In cases of a stress fracture (or similar injury like this), the see-saw gets tipped in favor of 'bone breakdown' for any number of reasons. The things we can do to try to tip the see-saw back the other way include rest, vitamin D, smoking cessation, weight loss, activity modification, bone stimulators and others. I suspect all or most of these were tried with Sano (I am assuming he doesn't smoke). Most of the time, non-surgical treatment is successful. Sometimes, it is not. The titanium rod is something we refer to as an intramedullary nail. Meaning, it is a rod that goes down the hollow center of the bone. For the tibia, it is introduced just below the knee.The canal of the bone is opened with a reamer. You then pass a rod down the center of the bone and ream the canal of the bone in 1/2 mm increments until you reach the correct size. You then pass the titanium rod down the center of the bone and place 1-2 'locking screws' at each end to prevent rotation of the rod or bone. The idea is that the reaming process stimulates a stronger healing response at the site of the stress injury, and also that the added stiffness of the rod takes sufficient stress off the bone to allow the 'see-saw' to tip back to the 'build-up' side. Because the rod is sitting essentially directly adjacent to the bone where the injury is, any follow up MRI's are difficult to interpret because you are going to get some 'scatter' artifact from the rod. As such, I would expect that the return to play is going to be based on symptoms more than follow-up imaging. 6-8 weeks seems very reasonable to me. I would think that this has a very high chance of solving this problem, but I am also on record saying that I think it is unlikely he will require surgery, so what do I know. Once the rod is in place and this area has 'healed', I would think it is extremely unlikely for it to recur due to the presence of the rod. Sorry for the long post- it may have been more like $1.15...

This is very likely an ankle fracture/dislocation. It has been reported as a tibia fracture, which is probably a little misleading. The tibia is (of course) the larger of the two bones in the lower leg. The fibula (smaller bone) is almost always fractured in cases like this. The tibia sometimes has a fracture at the bump on the inside of the ankle (called the medial malleolus) and sometimes the injury occurs through the ligaments at the inside of the ankle (called the deltoid ligament). This is different from Paul George's injury, which was a fracture of the tibial shaft. He may also have some injury to the ligaments between the tibia and fibula (called the syndesmosis) which may require fixing as well. I'm sure he will undergo surgery in the next day or two to place a plate and screws on the fibula, some screws on the medial malleolus (if broken) or a ligament repair (if a ligament injury) and then have the syndesmosis evaluated and a fixation device placed there if it is injured. He will probably be non-weight bearing for around 6-8 weeks followed by a gradual return to walking without crutches. I would estimate 4-6 months before he is ready to return to significant athletic activity. I will be very surprised if he is able to play this season, but maybe around playoff time. I think it's unlikely that this is a career-ender, but of course everyone heals these things differently. I'm sure the mental side of his recovery will be just as difficult and arduous as the physical side. Really stinks to see anyone have an injury like this. I'm sure he had such high hopes for the season.

My $0.02: Burdi- TJ in late May: typically around a 12-18 month recovery. I suspect he will be ramping up before the AS break, hopefully if everything goes smoothly he would be available to MLB club 2nd half of season. Will be interesting to see if the TJ returners are put on an innings limit by Falvine. Kiriloff- TJ about March 9: Of course, it is less strenuous on a position player's elbow after TJ than a pitcher. Usually they can hit after around 4-5 months and I would be hopeful he would be ready to go next spring. Tyler Jay- surgery for TOS in early July?: TOS is always a difficult prognosis because of the relative rarity of the surgery (compared to TJ, for example) and the wide variability in previous cases. Hard to make prediction. Seems possible that he may be ready for ST, but I wouldn't be surprised if he needs a little more time than that. JT Chargois- 'out for season 9/5': had a hard time finding info- don't see anything that says he had surgery. Stress reaction of elbow is what I could find. Can be a very wide variation in timing depending on a number of factors. Hopefully a few months is enough time, but I have seen some cases take longer. Trevor May- TJ in late March: Same as Burdi, just with the timetable moved ahead a couple months. I think it will be asking a lot to have him in the rotation out of ST, but it's certainly possible.

That's a pretty fair point. In these situations I often advise swimming or doing work on an underwater treadmill apparatus. There are also anti-gravity treadmills available that allow people to work out at as little as 50% of their bodyweight. These could allow conditioning with less risk of worsening a stress reaction.

I truly appreciate the compliment- enjoy contributing where I can and glad some find it helpful. A big part of the reason I enjoy this site is that there are so many bright people with a broad range of backgrounds that all bring different perspectives.

If surgery is necessary for this (which I continue to believe is unlikely), the approximate healing time is likely around 6-10 weeks. As such, performing surgery Sept 1st or Oct 1st carries no additional benefit when compared to Nov 1st with respect to having him ready for ST in February. I suspect that is the reasoning. This is different from TJ or SLAP repair in a pitcher that requires a many months-long rehab. In addition, surgery has risks (obviously). This particular surgery has specific risks as well, depending on the specific surgery performed. If a rod is used to 'fix' this stress fracture, pain in the front of the knee is common after surgery (since the rod is inserted just below the knee). If a plate/screw construct is used, there can be pain or tenderness at this site of the plate. Both of these things are relatively common. In the vast majority of cases, conservative treatment is appropriate for stress reactions/fractures and results in successful healing. I have no doubt that these options have and are being carefully considered. If he continues to have symptoms without significant improvement for another month or two, I suspect a firm decision will need to be made.

Obviously I have no inside knowledge, so I'm going off purely what has been in the media. About the only thing that I can think of that would make any sense, would be if this is a stress reaction/fracture that is just not healing and it continues to not respond to conservative treatment (rest, medication, bone stimulator, etc.). Uncommonly, this can require an operation to 'fix' the fracture using either a metal rod or a plate/screw construct. This seems pretty unlikely to me for various reasons, but it's hard for me to understand what other type of surgery might be in play. Of course, what has been reported could be inaccurate or incomplete, in which case more options are possible. Hopefully tincture of time is the successful prescription... Or more cowbell.

He was likely allowed to play to see if he would be able to contribute in the wild card game. With the type of injury that has been reported, playing may or may not cause worsening of the problem- the crystal ball is a bit murky. And hindsight is 20/20, right? This doesn't change my opinion of the Twins medical staff. Certainly your right to have a differing opinion. He probably felt he was close to being able to contribute and all parties wanted to see if he could make it back in time for the playoff game. No real harm in letting him try- he either can play or he can't. It is extremely unlikely that playing a couple games at the end of this season has any effect on his ability to be ready for next year. FWIW, I would be really surprised if he needed surgery for something like this- I would postulate that Wolfson is just making an observation and not commenting on any specific information he was given.

So there are some subtle differences here which are potentially worth discussing. I admittedly don't know the details of Harper's injury, but a 'stress reaction' is different from a 'bone bruise' or 'bone contusion'. Typically, a stress reaction is the bone's response to a repetitive stress when bone metabolism becomes unbalanced in favor of bone 'breakdown' and away from bone 'buildup'. This can happen for a number of reasons that range from simple to extremely complex (and way over my head). Some factors include bone location, amount and type of stress, shoe-wear (these are commonly in the foot area), alignment of the limb, injuries to the opposite leg that cause more stress on the area, vitamin D status, and many others. A bone 'contusion' or bone 'bruise' is really a different animal. These typically occur when either two bones bang into each other (commonly in the knee) or when something external bangs into the bone (like a foul ball, for example). It may seem like a small difference, but it is an important distinction. If it is a repetitive stress injury, we need to do our best to identify the cause or causes and eliminate or improve them. In a bone bruise, most commonly it was a single event (rather than a repetitive stress) and identifying the cause is usually easy. Just like a bruise in any other location of your body, there is a huge range in severity. As an example, bumping into the table with your thigh might give you a small bruise that take a week or so to improve. Being hit by a line drive softball in the thigh might cause massive bruising and take several weeks to improve. In both instances, there is a 'thigh bruise', but the difference is severity can't be known without more specific information. Also, for several reasons, bone bruises typically take longer to heal than soft tissue bruises. They are a fairly difficult thing to treat.

I completely agree. What benefit is it to anyone for Sano to be out longer than he needs to be? There is no one in the equation that has any reason to hold up his return other than 'he just isn't ready'

Absolutely true. But my response would be that it is impossible for a layperson to make that judgement from the information available to them via the media. I know these doctors personally. I also know a number of other MLB doctors and speak with Dr. Andrews fairly regularly. I can't tell you how 'talented' the Twins doctors are in comparison to other teams'. No one can.

With respect to the concerns about the Twins medical staff- I can tell you that they are professional, well-respected doctors. I know it is common sentiment (here and many other places) to believe that every injury should be diagnosed correctly within hours and that the timetable for return should be set minutes later- and no deviation should ever be needed (exaggerating... a little). I am telling you--- it just ain't that simple. It is quite frequent that the specific diagnosis or the extent of an injury is unclear initially, and only becomes apparent over time. It is also quite frequent that the response to a proposed treatment doesn't occur exactly as expected. Each of these things requires vigilance, communication, careful thought and appropriate medical knowledge. But the human body is an incredibly complex machine that can be strikingly different from person to person. The fact that the stakes are higher in these athletes than in the average 'working Joe' can make it even more challenging. Should the newest, unproven treatment be tried? Should we let them return to play? To practice? To partial practice? To fielding only? To hitting only? To throwing only? Some combination of the above? Do we need to do surgery? As with every job, the devil is in the details. I understand the frustration of those who want to see Sano back in the lineup (you can include me in that group), but there are too many variables in play to make any significant conclusions from the information available. Sometimes injuries heal quickly. Sometimes they take longer. There are (quite literally) dozens of variables.

I agree with you 100%. Certainly the big hits are more eye-catching, but the sum of the constant smaller collisions certainly isn't zero. I'm sure there is some threshold, below which the hits don't accumulate. But it's hard for me to believe that many hits that we would consider 'routine' don't somehow add up over time. There have been some college conferences that have put significant restrictions on contact in practice for that very reason (without doing some research I don't recall the exact details). I do think it is discussed less than it should be, for sure. In the same way that it's probably the cumulative effect of many punches that give boxers problems, rather than the 'knockout blows', it's likely similar for football players.

As a physician who has been on the sidelines for probably 12-15 games per year across the HS, college and professional levels for the past 10 years or so, I probably have a slightly different outlook on this than most. I agree with many posters that my enthusiasm for watching football on television has waned over the past few seasons, but that is difficult for me to tell if it is because I watch so much football already, or if my overall interest has decreased. I enjoy being around the game and appreciate how hard these athletes work. I am constantly amazed at what people their size can do. I enjoy being able to help them when my services are needed. But I cringe every time a big collision happens. I dread that brief instant after a big hit when you aren't sure if the player is going to get up or not. I say a quick prayer before every game that no player will lose their life that night (which is crazy, right?). And when the clock hits 0:00, and no one has been hurt, I feel a huge sense of relief. Inevitably, every fall when the stories about players dying from heat illness or traumatic injuries (and there are always a few, every year), I wonder if THIS is the year things really start to change. But damned if I know how to change things to make them safer. These are large, strong human beings running into each other at top speed. I don't know how you make that 'safe', by any definition. I'm torn on this issue. I do think eventually, football as we know it will be no longer. How long? No idea, that's for people much smarter than me to figure out. But I can tell you: I have a young son. I hope like heck he picks up golf.