Dylan Bundy setback a definite concern

As I noted April 5, Dylan Bundy was shut down from throwing for precautionary reasons after experiencing stiffness in his right (throwing) elbow. Now Bundy has been shut down for six more weeks, and the undertone of concern is evident within the organization.

Bundy tried to resume a throwing program after the forced rest in early April, but even throwing from a short distance on flat ground was enough to resurrect his symptoms. He was seen earlier this week for a second opinion by Dr. James Andrews, who administered a platelet-rich-plasma injection and recommended the six-week hiatus.

So what are we to make of this latest setback?

It's hard to draw any definitive conclusions other than the obvious one: Pain, stiffness or tightness in a thrower's elbow combined with a lack of velocity is enough to provoke legitimate concern. It's worth remembering that the initial MRI on Bundy's elbow revealed no significant structural damage. That said, the MRI isn't always perfect; some issues do not manifest themselves on imaging. Many pitchers will experience intermittent episodes of something abnormal in the throwing elbow or forearm area yet will go on to recover and return to throwing without incident.

It's also worth noting when evaluating the phrase "no significant structural damage" that the presence of tissue changes is more common than not in pitchers as a result of the wear and tear they subject their arm to by performing their craft. Recent studies have shown up to two-thirds of professional pitchers may have demonstrable changes in the ulnar collateral ligament on imaging yet have no symptoms whatsoever. Translation: Many throwers are out there on a daily basis, doing their job, with elbows that are not altogether "healthy." It is only when the picture and the symptoms combine to tell a common story that medicine has something definitive to address.

Furthermore, while the PRP injection may be of help to Bundy, it is also possible that his symptoms will persist. The jury is still out on the sum total of the effects of PRP, but it is seen by many as a treatment option with virtually no downside since it involves using the patient's own blood components -- and nothing synthetic -- as a means of trying to facilitate healing. There is much more to be learned about what the optimal treatment parameters and ultimate benefits of PRP injections are.

In the meantime, the Orioles have to hope that the combination of PRP and extended rest will allow Bundy's elbow to hit the reset button on the start of the season. After the rest period, the team will attempt to move him through a throwing progression, which will continue until he either returns to the mound or the symptoms recur. If Bundy's elbow continues to be problematic, the next course of action will be determined at that time. Until then, a concerned Orioles organization will hold out hope that this episode will be in the rearview mirror soon enough.