Under The Knife 2/20/23

And So It Begins

This is the first “real” Under The Knife of what will be my 22d year doing this. I don’t have a copy of the first couple of UTK emails I sent out, but the third looks remarkably like this. It’s six notes on player injuries, sourced from medical teams and doctors, plus a dot section I straight copied from Peter Gammons’ Diamond Notes. I recently asked Peter where he got the idea and he got it from Dick Young, who did dots and dashes. That’s not a bad lineage and twenty-two years at various stops isn’t bad either.

April of 2002? Tiger Woods won back-to-back Masters titles. David Carr was drafted first overall. The Diamondbacks were defending champs. American Idol had not debuted yet. This was the number one song:

Maybe UTK is like Ashanti, since neither has really changed since then:

Joe Sheehan was kind enough to let me run this at his place as well and while the Venn diagram of our readership is pretty close to a small circle inside his much bigger circle, his promotion of UTK has largely kept it afloat. If you like learning about the context of injuries and how they’ll affect your team, your fantasy team, or your bankroll, UTK is the place for you. I published the Team Health Reports last week, a risk-ranking of every significant player, and I do articles on other similar topics, from business to tech to just things that catch my eye. At five dollars a month, I think it’s one of the best values for the information you get and I hope you consider subscribing.

Literally powered by you, the reader, let’s get to it another season:

FRANKIE MONTAS, SP NYY (strained shoulder)

Frankie Montas will undergo labrum surgery this week, but there’s an open question about where and how damaged the labrum is. That means Dr. Neal ElAttrache won’t know what he’s going to do until he’s in there and what he does will determine how long Montas is out.

Even so, the prognosis is better than in the past. Labrum surgery has gone from a documented 1 in 39 in an article I did for Slate in 2004 to about 50 percent now. New techniques, especially a knotting technique developed by ElAttrache, have raised that rate even further, especially in the more involved cases.

That doesn’t mean it’s not serious or worrisome. If it’s not a death sentence for a pitcher’s career, it’s still a felony. There’s a chance Montas could come back this season, but it’s a long road with a lot of problem and failure. The high end for Montas might be an August return where he could work as depth for the rotation, but expecting any kind of bulk innings or more than a $1 return is unlikely. The hope is that the shoulder can be fixed and that something valuable can come in ‘24. At age-30, we have to hope that there’s something more Montas can do on what feels like a “what if” career. Montas has less than 100 starts and is one game over 500 and I bet you didn’t know either of those.

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JACOB DEGROM, SP TEX (strained oblique)

Risk, thy name is deGrom. However, I’m not worried at all by deGrom’s “sore side” and I think it points out one of the things that’s tougher to judge because of our human tendency to create mental divisions. DeGrom missed the first session of camp, something he had hoped to make as something of a point, but this was hardly his first throwing session with the Rangers. “First day of camp” is no different, especially with modern knowledge of ramp ups. Missing it is no different than missing a random Tuesday in February. It just has a better name.

DeGrom didn’t miss anything other than a high intensity session. He kept up with his other routines, threw on the side, and even had a ‘long toss’ session that wasn’t that long, but it was longer than a ‘catch’ session. (We need better or at least more precise names for these!) Speaking with several sources, deGrom had a very specific program designed for him by the Rangers, though deGrom has regularly used his own coaches and trainers to help him, even in-season.

One blip isn’t going to define deGrom and frankly, I’m curious why they’re ramping him up as a normal pitcher. He’s shown that he’s not normal in both positive and negative ways. Why not start him slow and bring him in later, especially when the Rangers have the depth, and more so now than what they’re likely to have by mid-season? There’s a lot of ways to manage the pitching load and maybe the Rangers are going to be able to squeeze 150 innings out of deGrom the old-fashioned way. If so, there’s going to be lots of Rangers development people getting hired around the league. In the meantime, I’m going to try to get used to putting TEX behind deGrom’s name instead of NYM.

JOHN MEANS, SP BAL (sprained elbow/rehab)

John Means had Tommy John surgery last April and the slow pace of rehabs has the Orioles aiming for a July/ASB return with him. He’s not yet throwing from a mound, which is in line with that goal, but is throwing from the slope. You’ll see this called many things, including “half mound” and there’s some variance from coach to coach and organization to organization. Regardless of the name, it’s progress and shows where Means is and should be, barring setback.

The Orioles can be conservative here with their depth. Means gives them quality rather than just innings, though his best role would be as a 3-starter rather than the 1 he’s been forced into the last couple seasons. Tommy John shouldn’t change what he is or who he is, so while he’s not going to be able to throw a lot of innings this year, seeing 12 starts and perhaps a playoff game or two might be possible.

The O’s have long had a strong medical staff, even with transition the last couple years, and have a strong voice at the table, alongside AGM Sig Mejdal, who certainly knows that aspect of the game. The rehab of Means will be a step in the team’s plan, but keeping from having more of those, especially with the young pitchers, is much more important to their improvement.

AARON ASHBY, SP MIL (inflamed shoulder)

The stuff, the record, and the reputation don’t match up. Aaron Ashby came into the Brewers rotation as the latest from their pitching factory, with great stuff, including a slider than insiders touted as one of the best in the league. The downside is that he came into camp with shoulder fatigue, now diagnosed as inflammation inside the shoulder. He’s down a couple months, out of the rotation for now, and leaving the Brewers looking at their deep rotation possibles instead of having a virtually locked rotation.

Ashby’s inflamed shoulder is problematic, but the team has long had a very proactive medical staff. They were one of the earliest to adopt biomechanical testing and have been on the cutting edge with pitching tech like video and tracking, as well as having one of the best record of keeping the pitchers healthy. There have been changes, both in the medical staff and the front office, so we may see a bit of philosophy change as well, though that doesn’t change overnight given the long term commitments have become culture.

The Brewers have several options for the rotation, from Adrian Houser if he’s healthy to one of the younger pitching prospects the Brewers machine has stamped out. Ethan Small and Janson Junk (great pitching name!) will battle Eric Lauer and Hauser for that last slot, but keep your eye on Robert Gasser (another great pitching name) and Abner Uribe, who throws 104, as well. Both will likely start at Nashville (AAA) and could come quickly despite the depth. In fact, I’d expect Matt Arnold will be fielding calls from the multitude of teams that don’t have his pitching depth later this spring.

LANCE MCCULLERS JR, SP HOU (strained forearm)

Lance McCullers Jr has already been shut down, a bad sign for the Astros starter as he tries to get back to where he was prior to forearm surgery. Word is that he’s “just sore” and had some issues during the off-season, so he’s a bit behind schedule even before this shutdown. The problem is again in his forearm, but there’s some general soreness as well. I’m watching to see if this includes the shoulder, which would be a bad sign.

McCullers had a flexor tendon repair in ‘21, and looked healthy through the end of the season, so the fact that he’s having problems again and may have had some even earlier is problematic. The Astros have pitching depth, with Hunter Brown likely to be the next starter up, even as a rookie, so they can afford to be cautious and let McCullers start his season late again, if necessary. The worry is that there’s not a lot of ready depth behind Brown and pushing Brown deep into the season would be an issue.

The hope is that the Astros definition of “minor soreness” matches up with most and that McCullers is back throwing within a week. A longer shutdown would throw off his ramp up and raise even more questions about a pitcher with an extensive injury history. The Astros might have to look for depth on the waiver wire as that opens up during the spring, or we might see whether Forrest Whitley is really back.

MICHAEL BRANTLEY, DH HOU (torn labrum/rehab)

If the myth of “roll out of bed and hit” is true — and why hasn’t it been tested? — then Michael Brantley is likely one of those that can do it. That is, he can do it when he’s healthy and shoulders are almost as important for hitters as for pitchers. We’ve not only seen shoulder injuries negatively impact careers, but even on successful rehabs, they can take years to regain level. No one’s really sure why and I can’t find either a good scientific hypothesis or a good biomechanical study on this.

Brantley’s age-35 now — and Mickey’s age-61 if you can believe it — and coming off labrum surgery last August. Looking at past injuries isn’t always the most instructive. As I said above, there have been a lot of advances in the techniques, but recent examples like Clay Bellinger are very mixed, and we have yet to see how Fernando Tatis Jr comes back from his.

The Astros are bringing Brantly back slowly, so Opening Day is likely out. He’ll get some extra time in Florida, or in Sugar Land, but there’s every reason to think he’ll come back. How he’ll come back remains to be seen, but we’re getting some level of signal with his early work and hope to see him in games before the end of spring.

BRAYAN BELLO, SP BOS (strained forearm)

“Shut down” is a scary term, especially for young pitchers and Republican governors. However, it doesn’t have a defined meaning. It can be a day, a week, a season. For Brayan Bello, who’s effectively the first in replacement starter for the Red Sox right now, shut down was barely a weekend and he’s scheduled to throw Monday from a mound. The forearm soreness, I’m told, was minor and the shut down was precautionary and really more a “take a day off.”

He’s scheduled to throw from flat ground on Monday and assuming that happens (update: it did), he’ll be likely to get a couple more sessions of that before a mound session. It’s common to have more issues there, due to both the higher intensity and the additional forces from the mound. The Sox medical and pitching staffs are likely to be careful with Bello considering his age and the fragility of the rest of the Sox rotation. With Chris Sale, Garrett Whitlock, and Nick Pivetta on the mend, Bello and likely more will be needed to get through the season.

Don’t expect to see Bello on a normal schedule, as due to his situation, he has to be both ramped up as a starter and maintained to fill in. Without the certainty and with his age and this early injury, he’s likely to be a short starter — four or five innings at most, paired with a multi-inning reliever like Kutter Crawford. Piecing together this staff is going to be key and a joint operation between the front office and medical staff. They’re both going to earn their money trying to find 800 innings from the starters they have on hand.

ROYCE LEWIS, CF MIN (sprained knee/rehab)

Royce Lewis is eight months post-ACL reconstruction and the Twins showed him running, including some hard sprints. However, they acknowledge that Lewis won’t be back on the Minneapolis side of town before the All-Star break. (I did later hear from a source that Lewis could be back before then, more like June, but much of that depends on how he adjusts to center field, his new position.) Lewis shouldn’t have much of a hard time with the rehab or the adjustment, as there’s no reason he shouldn’t regain both speed and stability.

DanHayesMLB @DanHayesMLB

Royce Lewis sprinting. #MNTwins

Those of you that have read about Fertilized ACL or followed the Audrey Biggs rehab might not be as impressed by Lewis at eight months. We have yet to see a high level athlete go through this, costing them time. Could Lewis be back now, ready to contribute for a Twins team that might have a fine margin between themselves and the Guardians for playoff position? Absolutely and things like this are where medical staffs can make a difference.

STEAMER has Lewis as a 1.6 win player on 200-something PAs. Pushing that to 300, even 400 could be a difference maker. The Dodgers had an advantage for years on medical due to the work of Dr. Frank Jobe. The Cubs and Yankees figured out Tommy John surgery was predictable and had the “Lieber contract” early. We’ll see whether teams adopting InternalBrace elbows and Fertilized ACLs will have a similar advantage.

Quick Cuts:

Just me, or are we seeing the development of “Classic hamstring”? A player slated to head to the WBC suddenly gets a minor hamstring strain and pulls out to stay in his team’s camp. Add in the move to pull some players who are healthy, like Clayton Kershaw, and I worry that teams or even insurance issues will take away from what could become a truly global event … Nick Pivetta’s rehab looked to be thrown off when he left his workout after just a few pitches, but reports are he’s physically ill rather than injured. We should see him back on field in a matter of days … Joey Votto will miss some early spring games as he continues to rehab his shoulder (rotator cuff) from August surgery. He’s still on track to DH on Opening Day per the team … Reports that Kenta Maeda was throwing upper 80’s isn’t that worrisome as the spring starts. He’s a 91 guy before his Tommy John and after missing all of ‘22, he should have had a normal off-season. The Twins say he’s fully cleared at this stage, as he should be 18 months post … DJ LaMahieu did not have surgery to fixate his fractured foot, but he says it has healed normally. He should be well past the healing time now … Daniel Hudson is coming off ACL surgery, so an ankle issue that’s hurting him early is a bit worrisome in terms of ramp up. I got a report that his motion this off-season looked “choppy” and the ankle could be a clear explanation … New Sox manager Pedro Grifol says Michael Kopech is healthy and locked in the rotation if he can stay that way. We’ll have to see if the Sox have overcome their injury issues from last season. Those started early and never stopped … Michael Soroka is a bit behind schedule due to a hamstring strain. It’s a bit worrisome given his Achilles issues, but it’s also early and teams are extra cautious … I’m seeing more “sinkers” that look like screwballs, with the hard pronation, in early looks around camps. I’m not there so I’m curious if people who are are seeing the same thing. I do believe the screwball is due for a comeback … Matt Manning (forearm) is looking pretty good in early camp, or at least making a plyo ball look bad:

Jason Beck @beckjason

Plyo ball go splat.