Under The Knife 4/9/25
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Terrible news from the Dominican Republic:
Tons of baseball connections in this tragedy, but the game goes on. To the injuries:
BLAKE SNELL, SP LAD (inflamed shoulder)
Blake Snell told the media that he’d been dealing with shoulder inflammation for three weeks or so now and that he “hoped it’d go away.” That’s minimizing the work of the medical staff, but I’ll hope he didn’t mean the slight. The Dodgers are likely to be conservative with their investment even if the imaging showed minimal internal issue and “no structural damage.” Dave Roberts says Snell won’t even be getting treatment, though I find that a bit surprising and unlikely. He’ll throw again on Monday and the Dodgers are hoping he’s at or near minimum for his return.
The no treatment statement is, I believe, Roberts simply being unclear, a misspeak more than a misdirect. If he had said “no additional treatment” or “no special treatment”, I’d have nodded and moved on, but none? Modern pitchers simply don’t get out of their routine, even when they’re not between starts, and the non-use of all the tools that could help Snell to heal up wouldn’t make sense in any context.
When a team says a pitcher has "shoulder inflammation," it’s usually a polite way of saying there’s rotator cuff irritation, most often in the supraspinatus tendon. It’s the muscle that holds the shoulder stable at the top of the throwing motion and it takes a beating with every pitch. Sometimes there’s bursitis mixed in, sometimes just general soreness, but the worry is always the same: inflammation is a warning flare. Left alone, it can settle down. Pushed too hard, it turns into a strain.
Right now, everything is leading to a Monday throwing session that will make or break the current plan. More pain or inflammation after the session is the key, so just making it through isn’t going to tell us much, though I guarantee that will be the focus. The Dodgers can deal with a short term loss of Snell, but the piecing together of their extended group depends on at least some of them making it through rather than just finding the numbers at any given time. Almost everyone thought that would be Snell and instead, we’re going to see the team lean again on some of its young arms like Landon Knack and Justin Wrobleski.
FRANCISCO ALVAREZ, C NYM (fractured wrist)
Francisco Alvarez is close. Like “objects in the mirror are closer than they appear” close and while this is interesting, some of what I’m picking up from behind the scenes is even more interesting. First, Alvarez has been cleared for live hitting. He’s been doing it for a while, but interestingly, the Trajekt has been off limits since it can be functionally the same as a pitcher rather than the control of a standard pitching machine, soft toss, and batting practice fastballs.
Players often lose some power in the first six weeks back from hamate surgery, but that’s trended down both in loss and length with some new techniques. Alvarez came back well from his UCL surgery, so it’s reasonable to think the kid just heals well and handles rehab.
Where it gets interesting is that the Mets aren’t just spending money, they’re listening to the smart people they’re hiring. Bones and surgeries like this have long been an area where it’s simply time. “Bones heal” is a catch phrase here because there’s honestly not much a team, doctor, or player can do. Yes, there’s still the occasional use of things like Forteo, but we’re talking a day accelerated, not weeks.
On the very near horizon are things like direct injection stem cells into the fracture site and a drug called Evenity that is showing some promise. Add in some things in Phase 2 and 3 trials - which always seem to get out early or off-label - and there’s reason to think healing times could change. Evenity has some issues like cardiovascular risk, but the anabolic changes are pretty positive. (Anabolic in this sense means building tissue, not anything steroidal.)
Legal? Yes. Also, unlike Forteo, none of these are a daily injection, which makes things easier. I couldn’t get confirmation that Alvarez did any of these, but there’s more than a little suggestion that a company like Point72 that’s invested in biotechs like Hinge and Adonis might just have some insight that would benefit the Mets.
You like stuff like future therapies that won’t just help a catcher’s wrist but might help your grandmother when she breaks her hips? Me too. Support my work in tracking the best in sports medicine and sports science by subscribing.