Under The Knife 6/5/26
All Rise (Ouch)
AARON JUDGE, OF NYY (fractured rib)
LATE NEWS: The Yankees are saying this is a stress fracture of the first rib, where the inflammation could mimic thoracic outlet syndrome. It’s not and appears more like his 2020 injury, which has more problems I’ll address below. For now, he’s out four to six weeks where he’ll be re-evaluated. Now, to what I wrote previous, much of which still holds true …
There’s a lot of people that have been looking back to try and find the play where Aaron Judge injured himself. Most are pointing at this one against the Orioles:
Is that the play? I don’t know. The Internet can often be wrong and one piece of info that came from Aaron Boone suggests this isn’t as old as we think. Boone said on MLB Network that the MRI was hard to read because of edema. Yes, injuries often have swelling, but it’s an aggressive and usually acute response. Perhaps Judge’s bruise is irritated by something, such as the swing, where his complaints of pain are? “It hurts when I swing” is a clue, not a diagnosis. Which begs another question - was there even a play?
The second new piece of info is that there’s a specialist involved in a bone injury. Dr. Chris Ahmad is not just the Yankees team ortho, he’s one of the top docs in sports. He’s by definition a specialist, but even the best often know there’s someone better than them at a specific condition or joint. (I think back to hearing Dr. James Andrews say “any time I get a complicated shoulder case, my first call is to [Dr.] Neal [ElAttrache.]” Just after that panel is when I first met Dr. ElAttrache. Good call, Jim.) Again, specialists are common and the Yankees know who, which would be a big clue as to what’s going on.
As I typed that, news that Judge is consulting with (or perhaps heading to see - it’s not clear) Dr. Gregory Pearl in Dallas. He’s not just one of the top thoracic surgeons in sports, but his practice brought in Dr. Robert Thompson, who is the other go-to guy and had been in St Louis. (Dr. Thompson is who I saw perform a TOS this offseason.) This is a big tell and the clearest sign that nothing is off the table yet. Honestly, I had discounted TOS as a possibility because this seemed more impact than impingement, but you don’t go see a vascular specialist for a bone bruise.
(As an aside here, I want to remind everyone that teams have long lists of doctors that they work with. There’s doctors at home, doctors at the complex, doctors at the affiliates, and then there’s pages of doctors for special cases. Dentists. Radiologists - lots of those. The first time I saw one of the lists, I wondered why the team had an OB/GYN on there. One of the team’s doctors laughed and said “because the players keep having wives and girlfriends!”)
One thing that keeps nagging at me: Judge’s 2020 rib stress fracture was also initially difficult to localize and presented in a way that didn’t make immediate sense clinically. Different location and different presentation, but giant humans generate giant forces. When Boone says this is in a “unique spot,” I suspect that’s shorthand for “we know where it hurts, but we’re still figuring out exactly why.” It would be nice if an actual medical professional were giving these updates, but Boone’s actually not bad at it. We don’t really know how Judge recovered from that injury because of the COVID gap happening over it. Was it weeks or months? Was it treated as a simple stress fracture, or were there other signs? We had more important things to worry about and no locker room access then.
What makes this difficult is that the possibilities range from relatively mundane to season-altering, and we’re missing the one piece of information that would narrow the field significantly: what exactly Dr. Pearl is looking at.
The problem is that the specialist consult suggested the Yankees think the bruise may be explaining less than it initially appeared to. Thoracic outlet syndrome suddenly jumps back onto the board because Pearl and Thompson are two of the names associated with exactly that condition. TOS can present in bizarre ways because nerves and blood vessels don’t always read anatomy textbooks. Pain can appear in the shoulder, neck, chest wall, arm, scapula, or even mimic muscular injuries elsewhere. If a rib abnormality, congenital issue, old injury, or inflammatory process is narrowing the thoracic outlet, a hitter might first notice it when generating the violent rotational forces required to swing. That doesn’t mean Judge has TOS. It does mean the Yankees are looking seriously enough to rule it out.
The comparables become messy because the outcomes vary so widely. Matt Harvey, Chris Carpenter, and Matt Harrison all dealt with TOS as pitchers, but overhead throwing creates a different set of symptoms than hitting. On the position-player side, the best-known example remains Josh Hamilton, whose 2012 surgery addressed neurogenic TOS and cost him months. More recently, position players have generally done better than pitchers after treatment, though the sample remains small.
What I keep coming back to is that no one seems to be talking about surgery yet. That’s important. If this were a clear-cut TOS diagnosis requiring first-rib resection, we’d likely have stronger signals already. For now, the range remains unusually wide: anything from an irritated bone bruise that’s masking the real source of pain to a thoracic outlet issue that nobody suspected a couple days ago. The truth will come out (and did.)
GIANCARLO STANTON, DH NYY (strained calf)
With Aaron Judge suddenly carrying a larger-than-expected medical question mark, the Yankees would very much like to have Giancarlo Stanton available. Unfortunately, Stanton’s calf strain continues to remind everyone that soft-tissue injuries don’t care about roster construction.
The easy explanation is that Stanton is a very large human(tm). That’s true, but it’s also incomplete. Big athletes do place larger loads through muscles and connective tissue, yet the bigger factor may be what Stanton asks that calf to do. People think of him as a stationary slugger now, but hitting is built on force transfer from the ground up. The calf is part of the chain that stabilizes, loads, and redirects force during the swing. Stanton doesn’t need to steal bases. He needs to generate exit velocities that occasionally resemble weather events.
That requires a stable foundation. Calf strains are also notorious for lingering because they’re difficult to stress-test safely. A player can jog without issue, run straight ahead comfortably, and still discover problems when explosive rotation, acceleration, or deceleration return. That’s particularly true for hitters. The first uncomfortable movement often isn’t running. It’s taking an aggressive swing and realizing the lower half doesn’t trust itself yet.
There’s also the reality of Stanton’s recent history. Once a player accumulates multiple lower-half injuries, teams become much more conservative. The Yankees aren’t trying to get Stanton through next Tuesday. They’re trying to avoid another cycle of activation, compensation, reinjury, and another trip back to the IL.
While individuality of healing always matters, there are practical reasons this recovery may land on the longer end. The calf has to be healed, certainly. More importantly, it has to convince both Stanton and the Yankees that it won’t become the next problem in a chain of problems. With Judge’s status uncertain, that timeline suddenly feels a lot more important. We could see the Yankees skip the rehab assignment now if he continues progressing with batting practice.
You know I’m talking about Tarik Skubal below the paywall. You know it. And there’s big news on Corbin Burnes, Ketel Marte, Cal Raleigh, and some Dodgers pitchers. (There’s always Dodgers pitchers.) Hit that subscribe now button and you get all of it, every time.