UTK Flash 5/16/26

Loose Bodies and Comebackers

Man, I leave to see one show and all this happens? “Loose Bodies and Comebackers” sounds like the start of a good country song, so here we go …

BLAKE SNELL, SP LAD (inflamed elbow)

Blake Snell finally made it back to the mound last week, which lasted exactly one start before the Dodgers were peering inside the elbow again. Imaging revealed loose bodies in the joint, a diagnosis that sounds alarming until you remember two things. First, this is not remotely new territory for Snell. Second, baseball suddenly has a very fresh example of what this procedure might look like in 2026 instead of 2019.

While Roberts is clear that surgery isn’t locked in yet, it’s the most likely path and one Snell’s been down. Chips are often recurrent. Snell underwent a similar cleanup procedure back in 2019 after his Cy Young season in Tampa Bay. He missed just under two months, returned effectively, and while the overall season looked disappointing compared to his absurd 2018 peak, the surgery itself worked. That matters because elbows often tell you how they behave historically. Loose bodies are annoying, painful, mechanically disruptive little pieces of calcium and chaos, but they’re also among the more straightforward problems modern sports medicine handles. Remove the fragment, calm the inflammation, restore motion, and pitchers frequently resume looking like themselves fairly quickly.

What changes the conversation now is Tarik Skubal.

Dr. Neal ElAttrache just performed the highly publicized nanoscopic cleanup on Skubal’s elbow, and the early returns have been aggressive enough to make the rest of baseball squint a little harder at what’s possible. Skubal is already throwing, reportedly well, and suddenly every pitcher with a loose body becomes a potential candidate for the same style of procedure. Potential, I said. Smaller instruments, smaller incisions, less fluid in the joint, less tissue disruption, and less inflammation afterward. Theoretically, exactly the kind of thing a pitcher like Snell could benefit from, or any pitcher that fits the profile.

Snell may qualify as the “perfect patient” profile ElAttrache reportedly referenced with Skubal. We know Skubal had a small number (one) of loose bodies that were small and easily accessed and removed. We don’t know that about Snell, yet. In addition, he’s lean, flexible, experienced with rehab, and already has a known successful history recovering from this exact issue. The Dodgers also have enormous incentive to optimize recovery without rushing recklessly because October, not June, is always the month circled on the planning calendar in Los Angeles.

The interesting thing is that the Dodgers almost don’t need this to become revolutionary. Even if Snell simply follows his 2019 path, he should return comfortably before the postseason. The problem is what happens in the meantime. Every Dodgers pitching injury becomes a stress test of depth and eventually even organizations built entirely around redundancy start running out of clean solutions.

Snell’s contract will naturally get some renewed side-eye because durability has never really been the sales pitch. Then again, if he returns by September, dominates for a month, and helps win another ring, nobody in Los Angeles is going to spend much time arguing about the invoice.

CLAY HOLMES, SP NYM (fractured fibula)

I’m not sure it helps to know the exact speed of the ball that flew back at Clay Holmes, hitting him in the leg and snapping his fibula like a dry branch. Granted, he didn’t go down, but I’m not sure if that really means as much as some are letting on. The coincidence of getting hit by an off-season workout partner is pretty wild too:

The number, for the record, was 111 mph, which sounds less like baseball and more like industrial equipment failure. Holmes took the comebacker flush in the lower leg and fractured his fibula, despite it being off the ground where being stable might have made things worse. Still, it absolutely could have been worse. The fibula is the smaller of the two lower leg bones and bears far less weight than the tibia. Had the ball hit slightly differently and fractured the tibia instead, the recovery becomes longer, more complicated, and potentially much more destabilizing mechanically. Or higher, which I’ll leave right there.

The interesting question is whether it matters more that this happened to Holmes’ push leg rather than his landing leg, and honestly, there’s no clean answer. Pitchers need both. The push leg generates force and direction. The landing leg absorbs violence and stabilizes rotation. Compromise either one and the delivery changes immediately.

One of the oldest and simplest UTK principles still applies here: bones heal. That part usually works. The bigger challenge is everything around the bone. Holmes can’t pitch while the fracture consolidates, obviously, but the Mets now have to decide how much of the rest of his workload ecosystem they can preserve. Can he throw lightly while protected? Can he use overload and underload tools? Can he sit and simulate workload on a Proteus Motion? Band work? Plyos? Modern workload management has evolved far beyond simply counting pitches.

That’s where Tim Gabbett’s ACWR framework still matters conceptually. Workload is not one thing. Pitching is workload, but throwing is different from pitching, and rotational training stresses the system differently than mound work. Smart organizations understand that maintaining adaptation matters almost as much as recovery itself.

The Mets absolutely have the resources and sports science infrastructure to attack this creatively. Whether they choose to depends partly on where they think the season is headed. If urgency fades, the easier path is simply waiting for the bone to heal while glancing nervously toward Triple-A Syracuse, where half the pitching staff already seems to be wearing a sling, brace, or ice wrap of some kind. Zach Thornton threw six scoreless for them on Friday so would line up, while Jonah Tong went on Thursday.

TY MADDEN, SP DET (bruised forearm)

108 isn’t 111, but I don’t think Ty Madden will be comparing the comebacker he took off his forearm to the one Clay Holmes took off his leg. Both hurt plenty, both looked ugly in real time, and both reinforce the increasingly uncomfortable reality that pitchers are standing awfully close to hitters producing triple-digit exit velocities with regularity. The exact number itself is descriptive more than predictive anyway. There isn’t one universal “bone-breaking velocity.” Force transfer depends on angle, timing, bracing, tissue position, and luck as much as raw speed. Physics can estimate energy transfer from the weight of the baseball and the exit velocity, but bodies are not crash-test dummies.

The good news for Madden is that initial X-rays reportedly showed no fracture. The less-good news is that taking 108 off the throwing forearm tends to create enough swelling and deep tissue trauma that teams almost always follow with more imaging to make sure a hairline crack or subtle bone injury wasn’t hidden initially. On replay, Madden’s arm had already come through the delivery and looked partially braced against his body when the ball struck, which may have dispersed enough force to spare the bone. He even reached down to grab the ball, but didn’t - or couldn’t - throw it to first.

The bigger issue here is context. Madden just returned from the rotator cuff strain that wiped out his 2025 season and Detroit was already handling him carefully in more of a bulk role than a traditional starter role. He wasn’t fully stretched out yet, which means the Tigers were already managing his workload carefully before this happened.

If the forearm avoided fracture completely, this becomes mostly a pain and function question. Can he grip? Can he pronate? Can he tolerate deceleration? If imaging finds even a small crack, then the old UTK rule applies again: bones heal, but on their own timeline.

Detroit’s rotation depth suddenly feels thin very quickly. Casey Mize is back Saturday, but in the spot that had already become a bullpen-game slot, while Skubal and Justin Verlander remain unavailable. Kyle Gipson-Long gave them two innings Thursday in Toledo and could factor in, though he’s not yet a full starter solution. The Tigers have enough arms to patch innings together for now. They just keep running out of certainty. If there’s one whispered question you’re hearing in Detroit, it’s “how fast did you say Skubal could be back again?”

If you read to the end, you get the prize. I’ll ask Dr. Neal ElAttrache that question next week, as I have him scheduled for Injury Territory. While you’re waiting, here’s the most recent episode, which features the 2025 PBATS Minor League Athletic Trainer of the Year, the Reds’ Manny Lopez: