Under The Knife 5/22/26
Carb Day
Let’s start off with this interview I did yesterday with Dr. Neal ElAttrache:
TARIK SKUBAL, SP DET (inflamed elbow)
BLAKE SNELL, SP LAD (inflamed elbow)
EDWIN DIAZ, RP LAD (inflamed elbow)
As Tarik Skubal gets better and better faster and faster, there’s bound to be some discussion about what’s next. The answer is increasingly clear:
Does this align Skubal’s hope to show that he’s healthy and have a good second half of the season, shaking off what could have put him out for the season and instead potentially competing for a ring, a Cy, or both, alongside the hope that doing good on field will get him signed to a big dollar deal? Well, yes, of course. It should go without saying, but the complicating factor of a media and fan base that’s been inculcated against Scott Boras clients and into rooting for billionaire owners over millionaire players exists.
So let me make this a medical discussion rather than a philosophical or financial one. Tarik Skubal is currently a one of one case, with Blake Snell coming behind him as an addition proof of concept. With Skubal throwing another bullpen session on Thursday, this time a “high intent” session that went 36 pitches - 35 planned, plus that “one more” that can be good or bad - Skubal is pushing the timeline and pressing to skip a rehab assignment. The idea that he could be back, in the rotation, before the calendar flips is a gamechanger, which is what the NanoNeedle might be.
Jon Heyman had some interesting speculation about Skubal pushing to get back so he could be traded. I’m not sure everything lines up that perfectly or that players really think that way. Heyman is as wired in as anyone, but I think this is less chess move than convergence. Skubal wants to pitch because pitchers want to pitch, especially pitchers staring at a Cy Young window and free agency simultaneously. The Tigers want him back because contenders with healthy aces tend to stay contenders longer. Dr. Neal ElAttrache wants the procedure to succeed because surgeons, despite what fans think, are often every bit as competitive as the athletes.
What’s become impossible to ignore is the timeline itself. Skubal is moving through checkpoints faster than almost anyone expected even after the initial optimism. The elbow reportedly continues responding cleanly without inflammation spikes, range-of-motion setbacks, or the kind of recovery hiccups teams usually hide behind vague language like “day-to-day soreness.” Detroit is now gifted a situation where lots of options open up, all because the timing was right and Skubal was open to being “first.” We’re at a stage where it’s clear this is taking months off the timeline rather than weeks.
That’s where Blake Snell enters this story in a very important way. Snell underwent the same NanoNeedle procedure Tuesday, also with ElAttrache, and his situation may actually accelerate acceptance of this approach across baseball more than Skubal’s did. One case can be dismissed as unusually favorable anatomy or timing. Two Cy Young winners in rapid succession starts looking like process. The easy comparison to Edwin Diaz, who had arthroscopic surgery about a month before for a similar issue, will be back about the same time as Snell and maybe after!
Snell is not some mystery box here. He already underwent arthroscopic loose body removal back in 2019 and returned in just over two months. We’ll call that the best previous case and we’ll now see just how much things change. The difference now is procedural scale. Nanoscopic visualization means less fluid, less tissue disruption, less inflammation, and faster functional recovery. Dr. ElAttrache confirmed my thinking on this. The path forward is going to be a branching pathway: start with the NanoNeedle, fix the issue if possible, and only enlarge to standard arthroscopy if necessary.
That’s why this matters beyond these three pitchers. Baseball is watching two experiments in real time, worth hundreds of millions of dollars, alongside a control group of another great pitcher and seeing just how successful this is.
Seriously, how good was that interview? It shows that things don’t have to be hidden. Imagine every team letting their Athletic Trainer explain injuries once a week on TV. Explain, educate, build trust - it’s a winning combo and good for ball. Anyway, subscribe to read the rest.