Under The Knife 5/6/26

Pronation Principle

A reminder: A reader asked why the annual subscription costs so much more than monthly. Because of the impending strike next season, I want to have the option to pause taking payments while that goes on. I can’t pause annuals - time keeps on ticking, as the song says - so I made it prohibitive to do it. I would take it off, but Substack doesn’t have that option.

TARIK SKUBAL, SP DET (inflamed elbow)

Tarik Skubal’s arc since 2022 has been almost too clean. Elbow surgery, the long road back, and then a version of himself that didn’t just return, but arrived. Velocity intact, command sharper, and the full mix suddenly playing at a level that put him in the very top tier of the game. Tarik Skubal didn’t just survive a second major elbow surgery, but came out of it looking like one of the best pitchers in baseball. Odd development path aside, no one can argue that Skubal hasn’t been one of the best pitchers in baseball over the past three seasons.

Detroit treated him like it. They managed the workload, avoided the high pitch counts, kept him away from the kind of accumulation that quietly breaks pitchers down. His career high of 107 pitches came in a playoff game, not a random June outing, which tells you how tightly they controlled the rest of it. The WBC exposure was minimal - one start, against Great Britain - just enough to participate without letting it become an excuse for anyone. Add in the support structure of Scott Boras, the Boras Institute, a full suite of medical and performance resources, and it’s hard to argue that anything was left to chance.

And yet, here we are.

That’s the part that matters. This isn’t a failure of process so much as a reminder of the limits of it. Pitching at this level, with this kind of velocity and intent, carries inherent risk that doesn’t fully yield to management. Skubal throws hard, not just in radar gun terms, but in how much force each pitch carries. Tommy John surgery doesn’t reduce that. In many cases, it sharpens it. The arm comes back strong, the mechanics get refined, and the pitcher learns to trust it again. The ceiling rises, and often with it, the load.

The comparables are instructive, though none are perfect. Gerrit Cole came back from his early-career elbow concerns and built into a durable ace, but even he has dealt with periods of management and adjustment and, yes, Tommy John in 2024. Stephen Strasburg followed a similar post–Tommy John rise before injuries reasserted themselves in a way that ultimately defined the back half of his career. More recently, Spencer Strider showed how dominant a post-surgery arm can look before the stress profile catches back up. Rinse, repeat.

What makes Skubal’s case stand out is how little was left to chance. If there’s a blueprint for keeping a pitcher healthy, Detroit followed it. That doesn’t guarantee anything, and it never has. That’s the tension heading into any long-term deal. You’re not just buying performance. You’re buying into the idea that this version of the pitcher can hold, even knowing how rarely that happens without interruption.

What we don’t know, yet, is when the surgery will happen and who will do it. That will tell us a good bit and it will also add a piece of information for those who are thinking about that next contract. Looking inside the elbow for loose bodies will give a perfect look at his reconstructed UCL and flexor - and it was that flexor that was repaired in 2022, not his UCL. His Tommy John was during college in 2017. Making those a known takes some of the guesswork out of the pre-signing physicals.

There is still the unknown of when he’ll have the surgery and by whom. That should come soon, perhaps as soon as Wednesday for both.

Skubal has shown what the upside looks like. The question now is how much of it you can count on and for how long. There’s a lot of zeroes in the answer to that question, and how much we really know about keeping pitchers healthy.

Lots more below for paid subscribers. You know the drill.