UTK 7/31/20

Free Friday: Recap of Verlander, Mikolas, Kluber, and more

Welcome to Free Friday. This is for everyone out there and gives you both a taste of what you’ll get with a full subscription to Under The Knife. You’ve read this already if you’ve followed along this week, but I’ve also included some updates and clarifications in there, so maybe it’s worth reading again or just passing off to a friend who might be interested. Or, just jump down to Quick Cuts and all that is new with what’s going on around MLB now. This is a work in progress, so if you have suggestions, please reach out to me. For now, on to the injuries:

Justin Verlander SP HOU (strained forearm)

I went back and watched the Justin Verlander start again in context of knowing about his injury and I don’t see anything. He looked like the normal Verlander. He made his pitches, he was at his normal velocity, and didn’t seem to go up or down. It’s a first start so you’d expect some variation but it could have been any start as far as it went for Verlander. As much as I could, I tried to see what he did as he walked off. Did he go to the Athletic Trainer or to Brent Strom? Again, it seemed as normal as any other start I’ve watched from him.

Which leaves me feeling that there’s some missing piece of information here. The Astros are never the most forthcoming organization, but in light of early talk about this being season-ending, then Verlander’s quick, personal tweet contradicting the report, this isn’t normal for any of the involved parties. I’m not sure what it could be.

That all said, the difference between a flexor strain and a UCL sprain is not something that any doctor/radiologist is going to miss. If you want to dig in, here’s a presentation done that shows a lot of the different elbow MRIs. It’s pretty in depth, but isn’t going to trigger any queasy stomachs:

MRIs are distinct and with modern ones, the views are better and more distinct. Let’s suffice it to say that with access to the best doctors in the world, this isn’t an issue of misdiagnosis or lack of medical acumen. Verlander is going to be an interesting case, but making this into a general cry against the ability of baseball medical staffs is shortsighted and frankly wrong.

There’s also late word that Chris Devenski and Austin Pruitt are dealing with elbow soreness. This could be coincidence or it could be pattern, but if these turn out to be a workload issue or an issue of some change that was made in the summer, the Astros are going to have to turn things around quickly, which is difficult.

Miles Mikolas SP STL (strained forearm)

Houston, we have a problem. St. Louis too. All around the league, we’re seeing one injury more than others and well above the norm we would see at any point in a season. That flexor strains in all their varieties are outpacing Tommy John surgery is odd, to say the least. There’s simply no explanation for it and I’ve spoken with doctors, pitching coaches, and more over the last couple days. We didn’t see this in the spring, we didn’t even see it much in Summer Camp, but suddenly, flexor strains are everything.

First, let’s discuss what it is. The above video gives a bit on the anatomy and the causation. It doesn’t give any indication of why we’re seeing an outbreak - pardon the term - of these strains. There’s theories, but that’s all the are at this point, but to my mind, none are worth detailing because none feel correct.

Miles Mikolas’ strain is significant enough that he’ll need surgery. His season is done and the recovery and rehab could take him into next season, depending on how significant the surgery has to be. Players do come back from this kind of surgery well, including Tommy Hunter and David Robertson.

For surgery, it has to be a really significant strain, something that’s not going to heal on it’s own, so it remains a last resort kind of surgery and therefore somewhat rare. Once we get a better idea of how much work had to be done, we’ll have a better idea on when Mikolas should be back. For now, Daniel Ponce de Leon will take the slot in the very thin and very risky Cards rotation.

Corey Kluber P TEX (strained shoulder)
Jose Leclerc RP TEX

It might be a sign of the world we’re living in that Corey Kluber is leaving the Rangers to do his rehab where he does his offseason work. Eric Cressey is a top physical trainer and sports expert, so much so that the Yankees hired him to take care of his athletes. Yes, he can work with others, including his longtime trainee, Kluber. Kluber’s strained shoulder is going to take at least a month to heal up, but he’s going to be in Massachusetts working to make sure that time is used efficiently.

Is this just a preference or can Cressey do more for Kluber than a team can do? I don’t know, especially with all the great staff and tech additions the Rangers have made. What I know is that Cressey is more than qualified and that Kluber is comfortable there. That’s worth something. If he can rebalance and rework himself after this teres strain, Kluber can still be valuable for the Rangers and give them some more data to determine whether to bring him back next season.

On the other side, Rangers performance and medical staffs have to be looking around and wondering how they have two of the three teres major injuries. The news that Jose Leclerc, the team’s closer, has a very similar tear, both in location and grade, is worrisome. One injury can be a fluke, but two is a worry. There’s going to be a lot of speculation, but the Rangers are a data-driven team, so I’m curious to see what adjustments they make to figure out what if any issues are bringing this plague down on them.

As with Kluber, Leclerc will be out a month while they see whether rest and modalities, including PRP, help the tear heal and get him back out on the field. Leclerc won’t need to build up stamina, but he does have a sharp motion, so he’ll need full strength throughout his shoulder before a return.

Clayton Kershaw SP LAD (strained back)

#KershawDay didn’t last into the night. Clayton Kershaw was scratched from his Opening Day start, placed on the IL, and Dustin May was called over to take his spot. This wasn’t a secret and having May on the same schedule as Kershaw makes it sound like this was anticipated for longer than just Tuesday, when reports said Kershaw felt the tightness. So of course I picked him to win the Cy Young yesterday.

Kershaw’s back is becoming Sandy Koufax’s elbow, a weak spot that he pitches through brilliantly, but is likely to take years off his career. The Dodgers and Kershaw have never been specific about the issue, but we know from the chronic nature and the way they’ve treated him what it likely is. The team has consistently called the injury a strain, which would indicate it’s muscular, but that’s very unlikely to recur over and over without some major weakness. What they’re likely dealing with is spasm and pain from some underlying issue. A flareup causes spasm, pain, and a reduction in function, though each time it’s happened, Kershaw’s been able to come back and pitch effectively.

The downside of this is that it keeps happening. Kershaw has tried to avoid surgery, though it has been discussed as early as 2015. That again points to some kind of nerve issue or impingement rather than a purely muscular injury. There are lots of rumors that Kershaw injured himself in the weight room. Loading up Kershaw’s back doesn’t seem like a good idea, but balance that with the knowledge that the Dodgers have one of the top medical staffs out there. Could this be a JJ Watt situation, where he was just doing too much? It’s certainly possible.

The risk/reward of Kershaw is about as high on both sides as it comes, which makes having that great medical staff pretty key. We’ll have to see how they minimize any absence of Kershaw, though they do replace him with Dustin May, the kid who throws 99 on the black. Yes, depth is going to count this season.

On the plus side, Kershaw made it through several throwing sessions later in the week without issue and should be back in the rotation sometime next week. The question now is going to be maintenance - how is the Dodgers medical staff going to keep this from recurring in a situation that we know is chronic?

Quick Cuts:

If you’re a Rangers fan - or a Reds fan, obviously - the return of Anthony DeSclafani this week bears watching. DeSclafani had a teres major strain, though a minor one, and has come back quickly and well … Gleyber Torres took a pitch off the point of his elbow. X-rays came back clean and the Yankees think he could be back as early as today, depending on how he feels … Ken Giles took a PRP injection in his elbow per reports, but his injury is, like so many, a forearm strain. Let’s assume the reports meant flexor and see how Giles is after two weeks of rest … Eduardo Rodriguez is recovering well from his COVID-related heart issues. The Red Sox would love to get him back, likely in a relief role, but there’s no rush. His health comes first … The Angels don’t think Andrelton Simmons has a chronic ankle issue. A solid team source told me that while the injury that put him on the IL this week is very similar to one he had last season, “it’s just that he’s so quick. He rolled it the same way, but it’s not because it’s weak. It’s the same motion, not the same problem.” … Mike Trout is out on paternity leave and as he returns, the Angels expect him to miss a couple more days here and there, and wouldn’t be surprised if he took more than the normal three days. This isn’t a complication with the child or delivery, but an acknowledgement of the complications of COVID in the world … “PCL laxity” is the latest diagnosis for Jed Lowrie and huh? That’s the response I got from several sources. “You’d get that day one with manual tests,” said one NL Athletic Trainer. Most think this is a chronic issue that can’t be corrected, so Lowrie and the Mets are likely at a crossroads.

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