Under The Knife 6/26/24
Mise en Place
As I was writing about Max Scherzer’s start and how the Rangers might have to consider how to best use age-39 Scherzer in order to maximize what they can get from him, I realized that the Rangers have put as much time and effort into the question of pitcher development as anyone in the game. They’ve done this for years, with varying results, but like the other 29 teams, they’ve ended up in roughly the same place in how they deploy pitchers. There’s changes in other areas, but again, there’s not a ton of variation.
Part of this is baseball’s ingrained resistance to change. Even necessary changes come at a glacial pace. Even smart changes see resistance from multiple areas. So my question was simple and focused - was the deployment and usage of pitchers so homogenized because it’s smart or because change is hard? I went to about fifteen people around the league in various positions, from GM to minor league pitching coach, and asked the same question without much prompt.
What I’d expected would be a simple intro ramble like normal turned into something about 3,000 words so far. I’m hoping to have it ready next week, but may hold it for All Star week, which isn’t far off. In the meantime, think about what questions you might have, because I’m going to follow up with this bunch some more. Believe me, this one’s going to be worth the wait. For now, some injuries:
PATRICK SANDOVAL, SP LAA (strained/sprained elbow)
Sometimes, it is one pitch. We don’t know the condition of Patrick Sandoval’s elbow before that near-last pitch he made - but the Angels do - but when both the flexor and the UCL are gone, it’s more likely a catastrophic failure of the system. There’s very little in the way of signs, absent looking at the elbow with ultrasound regularly, which is possible, unobtrusive, and inexpensive, and the result is catastrophic.
Having both the ligament reconstructed and the tendon repaired isn’t better or worse. The healing and rehab overlap and the surgery itself is simply longer, but done through the same portal. There’s no indication that this will be augmented in any way, but we don’t know one way or the other and likely won’t until after the surgery.
The local boy made good should return in mid to late 2025, with the team context being a big factor in his return. There’s not a huge sample of these double injury/surgeries, but most do come back well. This is a first elbow reconstruction for Sandoval rather than a revision, though the return and revision rates are very similar for non-augmented surgeries despite the count.
FERNANDO TATIS JR, OF SDP (fractured leg)-ish
I won’t knock Mike Shildt for coming out and saying that Fernando Tatis Jr had a “bit of a stress reaction in his quad.” He’s a baseball coach, not a medical professional. Someone told him something, a while later he repeated it, and he got it wrong. That’s on the system, not so much Shildt, though he should maybe take notes when it’s something this important. Did Tatis have a stress reaction in his femur, or was it some sort of muscular issue? The initial statement told us very little, almost nothing.
The answer - much clearer in the press release - is unusual: a stress reaction in the femur is almost unheard of, given the femurs location and size. It’s the largest bone in the body and one of the strongest. That this comes after being hit by a pitch on his arm - which we can safely ignore by now - and reports that Tatis has been limping makes it doubly odd.
The press release noted that Tatis has been dealing with quad tightness for several weeks. That sounds muscular, but there’s no indication that the Pads medical staff thought a bone problem until recently. Sources are vague and conflicting, but the benefit of the doubt here always goes to the medical staff. They likely treated for symptoms and only when it didn’t get better did they investigate. Occam’s razor applies in the training room.
In the classic sense, a stress fracture doesn’t have a trauma. Most times someone breaks their leg it’s a collision, a fall, some clearly notable event. A stress reaction is a stress fracture caught early, so there’s no trauma, usually, but the term is a bit amorphous and has some overlap as imaging technologies and the doctors using them have gone better.
The injury itself is so odd that I don’t want to generalize at all. Normally, this takes less healing time than a “classic” fracture since it’s not actually a fracture. With a fracture, we’d know more and it’d be easier to pin down both a cause and a timeframe. With this, we have neither.