The American Orthopedic Society of Sports Medicine (AOSSM) picked an inopportune time to gather for its annual meeting. Or so it would seem for those who depend on the nation’s elite orthopedists for their services, given the rash of baseball injuries since the conference started Wednesday in Seattle. The AOSSM meeting is the annual congregation of sports medicine practitioners who come together to share their research and clinical perspectives in the interest of advancing the field. With all the injury news of the past 48 hours, some of them may be commiserating over what awaits them when they return.
Masahiro Tanaka, SP, New York Yankees (elbow): So what does a baseball player do when his team physician is attending the conference? He travels to him, of course. At least that’s what Tanaka did, traversing the country for a visit with Yankees team doctor Chris Ahmad. One could even make the case that Tanaka, who has been placed on the DL with a partial tear of his ulnar collateral ligament, benefited from the timing of the conference. With all the experts gathered in one location, Tanaka could seek multiple opinions without making another trip.
And now the plan for Tanaka has been shared with all of us. Yankees general manager Brian Cashman told reporters Thursday that Tanaka will receive a PRP (platelet-rich-plasma) injection and undergo a rehab process in the hopes that he will be able to return in approximately six weeks. Cashman did note that if the conservative treatment fails, Tanaka could be a candidate for Tommy John surgery.
The rehab course is not unusual as an initial intervention. After all, if it is successful, Tanaka will have avoided an invasive surgery and a 12-18 month recovery process. Considering the calendar, there is nothing to lose. If Tanaka were to have surgery immediately, there is no guarantee that he would be able to pitch in 2015, so why not opt for a conservative measure that might be sufficient to allow him to resume? It is true, however, that many pitchers still have lingering issues following the injection and rehab effort, thus leading them to eventual surgery. In those cases, they at least have the peace of mind of knowing that surgery was not just an option, but the option.
Although Tanaka did not complain of elbow soreness prior to his last outing, there were signs that things were not right for him of late, most notably his yielding nine runs in his past two starts. What was not known was whether an injury was responsible for his decline or whether he was contending with adjustments to the American system. Perhaps it is a little of both. Elbow injuries are rarely single-episode events. More often they are the result of cumulative wear and tear, ultimately leading to failure.
Despite his young age of 25, Tanaka has accumulated a large workload. Among all active MLB pitchers, Tanaka ranks fourth overall in total innings pitched through their age-25 season (which includes minor leagues and Japan). Given the young age by which Tanaka had acquired so much mileage on his arm, a fair portion of work presumably occurred when his throwing arm was still adapting to the stress of pitching. Research is beginning to connect the dots between early workload as a youth pitcher and elbow ligament failure. Sports Illustrated’s Tom Verducci outlined the potential risks associated with Tanaka based on his youth workload, portending future complications.
Coincidentally enough, at the very AOSSM meeting where Tanaka is traveling for evaluation, a paper was presented Thursday reporting 60 percent of MLB pitchers who have undergone Tommy John surgery did so within their first five years in the league. This would hint at earlier and more strenuous workloads resulting in earlier ligament failure in professional pitchers than what was seen even a decade ago.
There’s no denying that Tanaka is now pitching under different conditions. Four days' rest is the average for American starting pitchers, whereas Tanaka came from a system that afforded him six or seven days off between starts. As ESPN.com’s Wallace Matthews notes, the Yankees did give Tanaka an extra day off every other start as a means of helping him physically adapt to the new regimen.
The test will come when Tanaka resumes a throwing program. Will the soreness be gone? Can he effectively locate his pitches? Will he maintain his velocity? And we all know what the next step will be if the answer to those questions is no.
Carlos Beltran, New York Yankees (head): Tanaka isn’t the only Yankee to suffer an injury this week. Beltran was hit by a tipped ball during batting practice, resulting in a concussion and a broken nose. The concussion allowed the Yankees to place Beltran on the seven-day DL, and he will gain up to four additional days because of the All-Star break. Manager Joe Girardi said he did not anticipate surgery for Beltran but he was scheduled for further evaluation. The rest can only help the inflammation in his other joints, namely his knee and elbow.
Even if no facial surgery is in order, Beltran will have to pass all concussion tests in order to receive clearance to return, something the Yankees hope will happen when the team returns to action Friday following the All-Star break.