Heezy1323

Agreed. In general, pitchers/teams are becoming more cautious and conservative in their return from TJ, not more aggressive. I think expecting a return before 12 months is likely unrealistic and would be the absolute best case scenario. I would be shocked if he was ready for ST.

Thanks for the note. Good discussion.

While true, Smoltz is probably not a good comp here. I have seen his shoulder MRI (Dr. Andrews keeps it around for teaching purposes). He had a cuff injury, which is different from the capsular issue Urias is dealing with. In addition, Smoltz was an incredible outlier in terms of what he was able to tolerate and still pitch at a high level. His MRI shows a ton of problems, and he was somehow able to overcome (and excel) at the MLB level. This is exceedingly uncommon and remarkable. Most of the shoulder surgery data we have is with respect to cuff injuries and/or SLAP tears- neither of which are what Urias is having issues with. I would agree with the numbers you quote as an overall statement, though for this problem specifically I am making an educated guess that the numbers are even lower than that. I am not aware of any large case series of this specific injury in the literature (though it's certainly possible it exists and I haven't seen it). Feel bad for the kid and wish him the best, but unfortunately the odds are probably stacked against him.

This is a fairly unusual injury. While it is essentially necessary, for everyone's sake, to publicly state the positive prognosis, I would be leery of his shoulder going forward. Some shoulders (and elbows) are built to pitch at the MLB level for a decade or more. Some, simply, are not. An injury such as this at a young age and with a fairly low overall level of use is concerning to me. I wouldn't be so bold as to see he can't make it back. But I know where I would put my money.

For those who are interested and may not have seen, Seth Maness, the former Cards pitcher who underwent UCL Repair surgery about 9 months ago, has returned to the majors with the Royals. He has 3 appearances with 3.0 IP, 6H, 2ER, 1BB, 1K, 2.33WHIP. There is a podcast that includes an interview with him (link below, 16:00 mark) https://soundcloud.com/ringermlbshow/mlbs-top-trio-a-returning-reliever-and-an-unbeaten-streak-ep-75 Certainly not tearing up the league or anything, but encouraging to see him back to pitching at a high level after just 9 months with no early elbow issues. We'll see how he progresses. Also, for what it's worth, Jordan Schafer of Twins 'fame' recently underwent the same UCL repair surgery while trying to make it as a reliever with the Cardinals.

I have seen a couple posters suggest a role for Joe with the team in some capacity, in lieu of playing next season (or sooner). Do we have any indication that Mauer has any desire to be a coach or other advisor-type person? What role would we like him to have? While I don't think this is necessarily in and of itself a bad idea, my take is that it is being suggested more as an "whatever it takes to get him off the field" option. Do we want him as a hitting coach? I suspect not. A veteran presence? Many have commented he seems ill-suited for this. A good clubhouse guy? Not necessarily his strength. Simply a fan ambassador? Maybe... Perhaps others have better ideas than me. Thoughts?

Can't argue with that one bit...

I can assure you that elbow impingement is an actual entity that is somewhat common in pitchers, though not commonly reported.

Here's to hoping I see: "Sano homers. Buxton and Kepler score." like 150 times over the next 5 years

Just a reminder- he was hitting .226... just NINE days ago. This is his fourth consecutive multi-hit game. Man it's fun to watch him hit the baseball.

How freakin' good is Sano... wow.

What are you seeing?

There has been a push in some circles for Dr. Andrews to be in the baseball HOF, which would be cool.

It would be nice if the MRI's just showed up with a big, blinking light that indicated surgery was necessary. Alas, as with many things, it just isn't that simple. The UCL of a major league pitcher almost never looks normal on MRI. A partial tear that completely prevents one player from pitching may not even by symptomatic in another player. The decision on when to proceed with surgery is, in many cases, difficult and there are many factors involved aside from simply the MRI findings. Hindsight is always 20/20, and of course there are trials of non-surgical treatment that are unsuccessful. That's part of medicine. Also, for what it's worth, the vast majority of professional teams don't pay their doctors (I can't speak specifically about the Twins, though I strongly suspect they do not). In most cases, the practice pays the team for the rights to 'cover' them.

What information do you have that supports this as a mis-diagnosis? There is a clear difference between a misdiagnosis and a trial of conservative treatment that fails before deciding to proceed with surgery.

I can see both sides of this argument (send him down vs. let him struggle through it no matter what). Certainly, everyone here realizes Buxton is extremely valuable in the field, and this offsets some of his shortcomings at the plate. But at some point, hitting around .100 with a K% approaching 50 has to get to you mentally, doesn't it? I want to see Buck succeed as much as anyone, but (honest question) does there come a point when, if things continue as they presently are going, you are almost forced to send him down, if nothing else for a change of scenery? June 1? All-Star break? He's coming to the plate as I type this. Lets rip a double and start the hot streak that breaks him out of this.

Here is a link to an article from the Pittsuburgh Post Gazette that discussed the use of PRP and stem cells as well as UCL repair in current major leaguers. Thought some may find it interesting. http://www.post-gazette.com/sports/pirates/2017/03/31/How-new-age-medicine-is-helping-Major-League-Baseball-pitchers-avoid-injury.html

Came across an article in the Boston Globe about stem cell injections in baseball players and thought some here may appreciate it: https://www.bostonglobe.com/sports/redsox/2017/03/20/stem-cell-procedure-could-next-wave-sports-medicine/carVS2aGYL6LqjjvMciKIL/story.html?p1=Article_Recirculation_Pos5

This was more of an academic review paper written by the surgeons out of Rush in Chicago (team doctors for the White Sox). It did not name any players who have undergone the repair procedure. I am not aware of any others aside from those you mention. I agree entirely that watching those pitchers will be interesting (whether May undergoes the procedure or not). Your take on the recovery is the same as mine- promising but lacking long-term data.

Here is a recent review of the current state of UCL repair. It is fairly technical, but thought I would post it for those who may be interested. http://journals.sagepub.com/doi/pdf/10.1177/2325967116682211

I enjoy participating in these discussions, and am happy to do my best to answer questions as they arise. I had considered starting an 'Injury' thread so that people could post there, since I may not always see posts in other threads. If people think that would be helpful, I'd be happy to do so.

Apologies for misunderstanding- now your question makes more sense. Since this procedure is fairly new (in this iteration), and obviously therefore doesn't have 10-15 years of research behind it, I don't think we know the answer to your very appropriate question. It is my belief that, carefully selected, these repair patients should do no differently from TJ patients. Now that begs the question, "how do you select?" Right now, especially at the ML level, I would say that this operation is likely only being considered for 'ideal' candidates. Meaning (possibly like Trevor) those players who have a fairly normal elbow and a then a sudden change with a UCL that looks good on MRI aside from the area of the injury at the bone. As more data is collected over time, it seems somewhat likely to me that the selection criteria will be loosened, and this operation will be done on 'less ideal' candidates. That is where we are really going to see how good this procedure is, IMHO. It's hard to know if the injured ligament is completely normal aside from the area of injury, or did the ligament get 'stretched out' a little before it tore and is therefore more likely to have recurrent trouble in the future. We can use the MRI and intra operative evaluation to help us decide, but at the end of the day there are always going to be some ligaments that fall into a gray area. Hard to know what to do with those right now. You would like to get players back to competition sooner. But you also don't want to have them undergo 6 months of rehab, only to find that the ligament was too injured to begin with, then have to resort to TJ and start the clock all over again (in effect, costing them 18 months or more).

I'm not sure how much detail you'd like me to go into (I sort of 'geek out' on this stuff), so I'll start with a little and can add more if people would like. 1) So everyone is on the same page, traditional TJ uses tissue from another source (usually either a small forearm tendon called the palmaris tendon or a hamstring tendon called gracilis) to 'reconstruct' a new ulnar collateral ligament (UCL). Repair is a similar operation, though instead of making a 'new' UCL out of other tissue, a surgeon simply repairs the injured tissue back to the bone (where it tore away from). 2) Only certain types of tears are amenable to the 'repair' surgery. The UCL can be injured at its attachment on the sublime tubercle (ulnar attachment), medial epicondyle (humeral attachment) or in-between (what we call mid-substance). Uncommonly the ligament can be injured at more than one of these locations, but usually just one. If the ligament is injured at one end, and the quality of the tissue is good, it can be considered for the 'repair' surgery, back to the bone where it tore away from. 3) The repair operation has really only gained popularity over the past 3-5 years, and has only been done a very few times on pitchers at the major league level. However, initial studies do appear promising. 4) For biologic reasons (that I can expand upon if people are interested, though it may put people asleep), a repair heals and becomes stronger more quickly than a reconstruction. Again, due to the small number of cases done at the ML level, the timeline is still somewhat unknown, but at lower levels, many players are back to pitching at around 6 months post-surgery, rather than 9-12 months as in TJ. 5) You asked about 'difference in effect', and I guess I'm not quite sure what you mean by that. The overall effect of the surgery is, of course, the same- to stabilize the elbow against the significant forces of throwing. It is only the manner in which it is done that varies. If that doesn't answer your question, please clarify and I'd be happy to try again. Hope this helps. Happy to entertain follow up questions. Too bad for May, I was certainly hoping for a bounce-back year from him (as we all were).

Sorry I'm late to the thread, at a family function presently. Will try to contribute more when I get a chance.

I can't say I'm aware of any data on switching between roles (SP/RP) but there is some fairly good data that discusses the effects of core injuries and that it can result in increased stress on the shoulder and elbow. So perhaps indirectly, if we believe his transition to the bullpen was a contributing factor to his back issues, we could say that switching may have been related to the current problem. A more interesting question to me is, since this was an acute injury, is he a candidate for a direct repair instead of TJ...