Under The Knife 9/13/23

Hollywood Nights

I spent much of Tuesday getting a look at a product that I’ll be writing about soon. It’s a passive device that could change not just sports, but offices, homes, hospitals, and more. It’s created by the inventor of Bluetooth so there’s quite the pedigree. Several MLB teams are already using it, so I’m excited to bring you that, likely after the playoffs. I have a lot of projects for the off-season, let alone what should be one of the most watched free agent seasons, one now colored by injury. That’s all in the future, so for now, let’s get to the injuries:

FELIX BAUTISTA, RP BAL (sprained elbow)

Yes, Felix Bautista has a partial tear of his UCL. This much was known. A rupture - a complete, Grade III sprain - leaves no options, even in light of modern techniques. Tommy John is the answer, period. Anything less, especially in the low grades, is much more difficult now, because of the paradox of choice (and a playoff race.)

That’s what we know. What we don’t know is how much is torn. It doesn’t take much to necessitate a surgical option, reconstruction or repair, and even the smallest tears get PRP, stem cells, and other biologic options, along with rest and treatment. Even with Bautista throwing, we don’t know much. It’s a positive sign, or it’s a sign that it can’t get worse, but he’ll give it a go for the chance to help the Orioles win a hunk of metal.

One of the things Mike Elias said, calling the injury “acute on chronic” is correct (and suggests they’re doing Gabbett-style workload monitoring.) Bautista, and likely every pitcher, is doing slight damage to his elbow on every pitch, building over time and weakening the structure. Then, something happens. Either a freakish load or a “straw that broke the camel’s back” pitch and the ligament is damaged. There’s a theory by one leading doctor that most of those are scar breaking from the ligament under load. That’s interesting in that it could be visible in imaging ahead of that break.

Could Bautista put on a Kinetic Arm and go throw? Yes. That product, which I wrote about last year, offloads some of the dynamic stress on the arm, not just the UCL. More and more are using that device in rehab and after an acute injury. For a pitcher with an acute extremely low-grade sprain, it could be used to reduce load, allow a pitcher to do things like ramp up with less stress, and to get on the mound with less chance of over-stressing the ligament and the entire system.

As Bautista progresses, the biggest keys are going to be getting on a mound, which adds stress in known ways, and when he’s throwing at near-full intensity. Often, rehabs can look good until they hit that, so as positive as it is that Bautista is progressing, his return is a chance, not a certainty.

JOSE SIRI, OF TBR (fractured hand)

Jose Siri has had a weird season. He’s established himself in the Rays outfield after coming over from Houston, with the Rays able to use the things he does well while minimizing the things he doesn’t. His power surged, his contact didn’t, but if he hasn’t been valuable (2.7 WAR isn’t bad), he’s been very useful for the team that seems to squeeze the most juice out of the bump-and-dent aisle of the baseball player store.