Under The Knife 3/22/22
Year 21 Begins
Time flies when you’re having fun, so powered by the best readers, here we go on Season 21 of Under The Knife:
JACK FLAHERTY, P STL (inflamed shoulder)
ALEX REYES, P STL (labrum tear)
The news was not good over the weekend for the Cardinals. After 2021 was derailed by injuries to pitching, 2022 is starting off the same way with two possible starters on the shelf for at least the start of the season. The transition out of the Adam Wainwright era isn’t happening and with only Steven Matz brought in, the Cards appear to be heading towards a rotation at both ends of the age extremes.
Jack Flaherty has bursitis in his shoulder, but the bigger issue is a SLAP tear in his labrum of his pitching shoulder. The labrum has reportedly been there for years and has been asymptomatic until it was inflamed by the bursitis. A lot of people emailed to ask whether this makes sense and yes, it does. Very plausible. A lot of pitchers have small, asymptomatic issues in their shoulders, with multiple studies to show this is true at pretty much any level down to Little League.
It doesn’t make it better, since it’s clear that it can be irritated. If the injection to clear up the bursitis works, Flaherty should be able to get back to functional quickly, with only a small blip in his ramp-up. While the start of the season is reportedly out, this feels like the Cardinals being conservative with one of their more valuable pitchers. (If you wan’t more detail on this, I talked about it on 101ESPN yesterday afternoon and they usually have recordings up for a couple days.)
As for Reyes, things are bit more serious though they sound similar in ways. Yes, Reyes is having shoulder issues and had an injection, but it’s a symptomatic labrum tear (or “fray” as the Cards put it) that was hit with stem cells, which is more aggressive than PRP. Reyes has a long history, but going elbow to shoulder is seldom a good sign and a clear indication that something is up with the kinetic chain. Reyes is going to be out longer and I don’t feel great about even that timeline given his history.
FERNANDO TATIS JR, SS SDP (fractured wrist)
Start the Padres count. After missing better than two thousand days to the IL last year, Fernando Tatis Jr will start it with a cast on his wrist. Tatis injured himself during the lockout on a motorcycle, though the mechanism isn’t clear. He has a fractured scaphoid bone and had it pinned back together late last week. He’ll miss at least six weeks before really swinging a bat and how long he’s out past that depends on how the wrist responds.
This isn’t to say that the sequence of events is evidence of lockout issues or Tatis hiding something. He was working out and hitting during the period after, with minimal pain and swelling. Tatis, I am told, saw it as an annoyance rather than an injury. He disclosed it in his entrance physical and it wasn’t until there was evidence of a non-join on the bone that anyone thought something had to be done.
The issue is that the scaphoid heals poorly due to limited blood flow, the size, and the function. If it doesn’t heal right, it can not only cause inflammation, but can go necrotic (die) and make the wrist non-functional. That alone tells you why the Padres had no choice but to have the wrist double-checked and eventually pinned to make sure there was no issue there.
For Tatis, this is just waiting and then seeing how quickly he can come back. My guess is we’re looking at two months, which would put him back in the lineup in late May. If it’s June 1, I won’t be surprised - again, I think almost all organizations will be over-conservative in the first half of the season and more so if we see the number of injuries some expect (see below.)
In the long term, Tatis should be fine. Bones heal and while the scaphoid can be problematic, there’s also a very good record of healing when treated properly, as it has been.
DOMINGO GERMAN SP, NYY (strained shoulder)
The Yankees rotation is already down one, as Domingo German hits the 60-day IL with what the team is calling shoulder impingement. A source tells me German came into camp with the issue, with his problems starting almost as soon as he started throwing despite a rehab program. He’s had significant issues going back to last year in keeping the shoulder functional and that rest and strengthening program didn’t seem to work.
There’s some concern that German will need surgery and if the damage to his shoulder involves the rotator cuff, as it did last season, then he’s likely done for all of ‘22. That would push the Yanks to get one of the A’s available starters, though the cost could go up due to their known need.
I have hopes of getting an article done next month on some advances in shoulder surgery that could help in situations like this, but the Yankees medical staff is solid and has a number of advantages in treating situations like this. That will help German in the long term, but in the short term, Aaron Boone is down a starter for the foreseeable future, leaving Nestor Cortes, Michael King, and Luis Gil in the fight for the 5 slot.
CHRIS SALE, SP BOS (fractured rib)
A broken rib is an odd diagnosis for Chris Sale, but we should be used to those for Sale. The Sox have had a harder time keeping him healthy and it seems he’s at the rapid decline stage. There’s still clearly talent and stuff when healthy, but those are fewer and fewer, which remind us just how good the White Sox were at keeping him that way during his tenure there.
Without a mechanism of injury or even a location, it’s tough to say exactly what’s the key issue for Sale. The best case is that he’s just waiting on the bone to heal, with the downside that he can’t throw during that period. He’ll need a re-ramp, which has been problematic for him, but the Sox are both creative and have the talent to do some things like tandem him early, which would be smart. (The Sox are smart too.)
The worst case is that this is another in a long line of quirky injuries that hasten his age- and milage-based descent from ace to useful and from useful to costly. That’s the path all pitchers tread at some point, making Sale one of the riskiest of a risky bunch but one of few that can be a true ace as well. Managing Sale is as valuable and as hard a job as a medical and performance staff can do, but also one that can turn a season.
ADLEY RUTSCHMAN, C BAL (strained triceps)
New MLB rules make it more likely that a ready prospect like Adley Rutschman can make a team coming out of spring training than before. While service manipulation is still a real thing and a team like the Orioles, who isn’t going to win, again, still could see more value in the extra year of Rutschman which will presumably come during the late phase of a rebuild, there is at least some reward that pushes the best players towards the field.
However, Rutschman has a grade II strain of his tricep and even with the DH, the catching prospect can’t swing a bat for at least a couple weeks, let alone play behind the plate. That rules out Opening Day. Yes, he could start on the IL, but it’s more likely that the team will option him, let him get his swing going in Norfolk, and have him up sometime in May or June.
In the longer term, this muscle strain shouldn’t be any sort of issue, but Rutschman’s said to be a bit ‘tighter’ than many would like, according to sources. I’m told that while he doesn’t miss time often, some in the organization are less sure he can stay healthy at catcher full time and that he may need to shift, something he hasn’t worked on yet. It’s something to keep an eye on since at least some of his value is being at the very weak catcher slot.
NEW IL RULES
MLB hasn’t fully detailed it’s new IL rules but for the first time, they will be different for hitters and pitchers. It sounds as if the rule will stay the same for hitters (10 days), but will move to 15 days for pitchers. We’ll have to see where retro moves sit, how rehab stints will be handled, and some other technical details, but most of those will just affect those of us that watch these for a living. The medical side isn’t really affected, though as I said last week, I get the sense that we’re going to see a lot more use of the IL as the first choice rather than the “wait and see.”
BTW, Gary McCoy has an interesting take on the IL days as well. He thinks there’s going to be a “due by” date on this:
Knowing why he said this, I see his point. I wouldn’t count on him being wrong, especially if I’m an organization that’s doing no workload monitoring and has a significant injury history with pitchers.
Quick Cuts:
Justin Verlander is throwing free and easy (and high 90s) as he returns from Tommy John surgery almost 18 months ago. He has no limitations … Shane Baz had loose bodies removed in his elbow. It’s not bad and the fact that the Rays specifically said “loose bodies” rather than bone chips is interesting. He’ll be back throwing in a couple weeks and could be in the rotation shortly after … The Braves are still being conservative with Ronald Acuna Jr as he returns from his ACL reconstruction, but he’s hitting and running well. A source tells me that while he could play at DH right now, the team is likely to want him in more controlled situations. The quirk of the MiLB schedule is that he could DH for two weeks in Triple-A and still come up for Opening Day! … The Braves are also happy with where Mike Soroka is. He was placed on the 60-day as expected but is running and throwing. He’ll get back on a mound sometime in April and should be back ahead of the All Star break goal … Luis Urias has a Grade II quad strain and will be down a couple weeks. That puts his opening day in some doubt, though this will be determined more by his fielding range when he returns. The Brewers have some serious strikeout pitchers, so there’s a chance he could be back more quickly if they spot him in with either Jace Peterson or Keston Hiura. It could also mean one of their SS prospects might make the opening day roster, most likely Brice Turang … Mike Clevenger will pitch in a minor league game on Wednesday, his first action since Tommy John in late 2020. That it’s minor league is interesting - is that for confidence, control, or are the Padres worried he’ll start the year on the IL? … Chris Paddack had a small UCL sprain late last year, but is throwing well in camp. That’s a very good sign for a Padres team that needs to avoid arm injuries. If they can get Paddack back to his level from a couple seasons back, that’s a big win for them … Zac Gallen had an off-season shoulder issue, so it’s unclear if he’ll be able to ramp for Opening Day. Brent Strom has some challenges already in Arizona … News leaked that Chris Taylor had a minor elbow scope back in November, but he’s already throwing. He’s limited somewhat, but it’s more a confidence thing. While I couldn’t confirm what the surgery was, it sounds like a bone spur or chips … Jalen Beeks started on Monday and went an inning with two strikeouts in his first game action since August 2020 Tommy John. Solid return … Jose Barrero has a hamate issue and will see a specialist. Surgery would cost him six to eight weeks and put the Reds very short in the middle infield. Kyle Farmer is the only true SS on the roster right now … Carter Kieboom went to the 60-day IL with a significant forearm strain. He could miss a couple months, leaving Maikel Franco the starter at third for the Nats … Randy Dobnak had a “significant setback” with his middle finger and is out indefinitely. Twins have pitching, but most of it is young … Tyler Glasnow had minor ankle surgery, which will set his Tommy John rehab back slightly. He’ll miss a couple weeks but he’s not expected back until late in the season, if then.
Hope everyone is enjoying The Science of Baseball. The reception has been solid. Remember I have a way to get signed copies through Wild Geese Bookstore, if you’re interested in that or the upcoming event. I’m working to get Dan Symborski and a couple others to drive over - no promises, but I’ll keep you updated.