Under The Knife 4/9/21
Free Friday: Paxton, Tatis, Rosenthal, and updates
It’s the first Free Friday of the season and if you aren’t a subscriber, you’ve missed out this week. Fernando Tatis was obviously the big news of the week, but James Paxton is now done for the season - see below - and there have been a bunch of injuries early. I appreciate all the subscribers, but I hope those of you that only get the free ones see the value for just five bucks a month. Begging done, let’s get to it.
Remember, Free Friday is mostly info that came out earlier in the week, so if you’re a paid subscriber, some of this will be familiar. I do add updates where necessary and there’s some new info as well, as on Paxton, so don’t just auto-delete your Free Fridays.
James Paxton SP SEA (sprained elbow/strained forearm)
James Paxton’s season lasted 24 pitches. Paxton was placed on the IL after leaving in the first inning of his first start in obvious pain, but the injury was called a forearm strain. That kind of flexor strain isn’t good, but it obviously wasn’t the whole story. A second opinion led to a recommendation of Tommy John surgery, which would indicate a significant sprain of the UCL.
What we don’t know is who did the second opinion and if the team - likely the first opinion - agrees with this. This kind of thing is common and while some teams have rules about this, such as requiring a third opinion for a “tiebreaker”, they’re always a bit fuzzy. It comes down to how much the second doctor is trusted — if it’s an Andrews or ElAttrache, that’s tough to argue — and how much the team doctor wants to hold to his opinion. In the end, the decision is always the player’s, as it is for any medical decision.
We’ll see where this goes, but this one doesn’t look like it’s headed for a happy ending. Paxton did look good, showing he was back to his mid-90’s fastball in those 24 pitches. Maybe there was more in there. With a one year deal, I wouldn’t be surprised if the Mariners - already on the hook for his rehab - don’t sign him to another deal for ‘22 that might allow them to get something out of him yet.
Fernando Tatis Jr SS SDP (strained shoulder)
There’s no new news on Fernando Tatis Jr, but there’s plenty of speculation about the injury, the outcome, and even some things surrounding it. Let’s start with the basics via Ben Higgins:
This is what I expected, definitely good news with the minimal tearing and the possible quick return. We know the team and Tatis are seeking second opinions, but even those might be delayed though it wouldn’t surprise me if he even visits one of the surgeons, which could hold him out for a while. The Padres are going to push Tatis to the IL, but even that seems a bit more positive.
The “light tearing” of the labrum could be interpreted a couple ways. There’s no definition for labrums in terms of grading so terms like tearing, fraying, and such can overlap and lack real information. That an MRI showed no significant tearing is obviously a positive, but we still have no real information on causation or severity. I’ll take the positives where they come, but inside, I have to think they’re focused on making sure this doesn’t happen again.
The rehab and strengthening is key. I went to Gary McCoy for what Tatis might be facing: “I'd be sure they have him kinesiotaped like a mummy on that shoulder. and I'm wondering if they'll ponder a capsule shrinkage with him at this end of the investment. (Left) Pec, (left) biceps tendon and long head would be natural discussion points in the weight room- along with isometric quadrant strategies.”
Let’s address a couple issues that came up on the net today. First, is this a “lingering” or “recurring” injury? In the strictest sense, yes. Tatis had a similar but lesser issue at the end of camp. It likely never fully healed and the hard swing pulled the head out more than it had before. He looked fine in his return, and happening twice in a week is hardly what I would normally call lingering or recurring. There’s no history of this injury in his past, let alone a severe injury that would have led this to be a risk.
Another issue is insurance. Many contracts are insured, but not all. My understanding is that Tatis’ contract is not insured. There’s a lot of reasons for that, mostly focused on cost. This is not some ‘name your own price tool’ thing. Specialized jumbo disability insurance is a small market and to offload some risk requires a big premium. Add in that the insured value would likely be only 50 or 60 percent of the value with a long elimination period and many owners look at the guaranteed deal as a sunk cost from day one. There’s often some catastrophic provision in the deal, forcing the player to walk away in a situation where there’s a career ending injury at a reduced value.
So what comes next? Tatis and the team will continue to seek opinions and expert recommendations, but the work likely has already begun to reduce the issue, to strengthen the area, and to figure out how to keep this from happening again. No pressure, Padres - it’s only your franchise on the line.
UPDATE - There’s not much new on Tatis and we likely won’t see much until the middle of next week at the earliest. We’ll probably get rumblings about batting practice or swings at that point. Tatis’ team has been checking into surgeons, just in case, but everyone seems focused on maintaining through this season and re-examining the situation at the end of the year.
Sixto Sanchez SP MIA (inflamed shoulder)
The Marlins looked like they were doing the Super Two/Extra Year dance with the guy who was likely their best starter when they sent Sixto Sanchez down to start the season. The excuse that he’s got soreness in the back of his pitching shoulder doesn’t make that better, but Sanchez isn’t making a big deal about not being on the MLB IL, which would give him days of service. More than a week after his MRI, we still don’t know much — shoulder inflammation could be a bunch of things, so there’s simply no way to give any sort of indication about when he might be back.
The next clue will be when Sanchez gets back to throwing. How long he’s down will determine how long he’ll need, assuming the shoulder is back to full health. However, the alt site appears to be almost a black box if the team wants it that way, so we may or may not get much information on the way. No news is good news does not always hold true in situations like this.
George Springer OF JAY (strained oblique)
George Springer is very close to making his Blue Jays debut. After just 17 swings in a live batting practice, Springer looks as if he has passed every test and the strained oblique should be a thing of the past. Assuming he’s activated in the next couple days, he should play normally, though it wouldn’t surprise me if the Jays rested him a day or had him DH as they manage his initial workload.
Oblique injuries used to be one of the worst for recurrences, but all the practice in the last twenty years means that it’s now pretty standard treatment and recurrences are uncommon. It’s not zero, but Springer looks to be a safe bet to play, play well, and stay out there on the field. I also don’t think we can read much into the fact that his first Opening Day with his new team was missed. Injuries happen and the timing of most of them is seldom anything other than random.
UPDATE - that one last test thing? It didn’t go well for Springer, feeling tightness in his quad, which I’m told was completely new and out of the blue for the medical staff. Essentially, they’re starting over with a new injury, one that’s said to be minor, but enough to push his Jay debut back for at least a few days.
Trevor Rosenthal RP OAK (inflamed shoulder)
Sometimes, who someone sees tells you almost everything. If someone goes to Bill Meyers near Philadelphia, it’s because he’s the best with core muscle/sports hernias. A trip to Greg Pearl in Dallas? Thoracic outlet syndrome. That’s where Trevor Rosenthal went, so the A’s have to be thinking this is what’s going on with his pitching arm.
Thoracic outlet syndrome is an interesting thing in that the doctors that ‘discovered’ it in baseball were in Dallas. We see it in many teams, but because it’s difficult to diagnose it, it’s been seen more in Texas Rangers’ pitchers than any other team. The injury happens in other repetitive stress professions, most notably among carpenters. The motion and force of hammering while above the head, with roofers and framers, sees it more than any other professions.
If Rosenthal does have TOS, he’ll likely need surgery and will miss the bulk of 2021.
UPDATE - He did, sort of. The surgery was for “severe vascular decompression”, which is essentially the “core muscle injury/sports hernia” kind of nomenclature change that makes me stare at the wall and debate exactly where I should put my head. The surgery to remove a section of the first rib and a bit more cleanup should relieve the problem, but the three month recovery time seems a bit aggressive. We’ll see when Rosenthal can get back on any sort of throwing program for a better gauge of when he could return.
Tim Anderson SS CWS (strained hamstring)
It looked like a hamstring strain as Tim Anderson, the speedy heart of the White Sox offense, pulled up after a run down the first base line. It’s certainly not a good thing, but the Sox will wait to see how the hamstring responds over the next 24 hours before they make any decisions (Early morning word is positive). A significant strain would necessitate an IL stint, but a Grade I might be something that could cost only a few days. It’s unclear how Tony La Russa and the Sox will consider playing a man down with the expanded roster and a taxi squad.
The roster implications are interesting, since Leury Garcia is the simple replacement. However, most expected Garcia to be pushed to left when Eloy Jimenez went down. Instead, the team has put together a rotation out there, with Andrew Vaughn and Billy Hamilton taking turns, with Yermin Mercedes stunningly hot at DH. I’m not willing to say this isn’t just luck, but La Russa has shown some interesting flexibility. Let’s just hope he doesn’t have to find a long term replacement for Anderson.
UPDATE - Anderson told the media he’s “85 percent recovered” from the hamstring strain. Oddly specific, but go for it, Tim. That should mean his IL stay is the 10-day minimum. The downside is that Leury Garcia is experiencing a leg issue of his own, so they’re down to Danny Mendick.
Quick Cuts:
Paul Goldschmidt was held out of Thursday’s game with back spasms and will be re-evaluated on Friday. Comments from the Cardinals after their game made it sound as if they expect Goldschmidt to miss some time, maybe even hit the IL … Nate Pearson was shown throwing on field while wearing a Catapult device during Thursday’s broadcast. He then went in and threw a pen, with all reports positive … Josh Donaldson is expected to test his leg with batting practice and some “situational running”. If that goes well, he could be back shortly after that … Jake Odorizzi is getting close to his Astros debut. He needed time to build up his workload and the word is that the Astros had a “very specific plan” for that, despite the fact Odorizzi felt he was near ready at the time he signed … AJ Puk hits the IL with a strained biceps. Depending on which end of the muscle and how severe the strain is, there’s a broad range for this type of injuries, so it’s one to keep an eye on … Luke Bard tried to pitch through it, but couldn’t and will now have surgery on his hip labrum. It has a high degree of success but it will be tough to come back from it in season … Max Kepler left after beating out an infield single, but no official word from the Twins as of Thursday night.