Putz avoids elbow surgery for now

It isn't as bad as it could have been. At least not yet.

Arizona Diamondbacks closer J.J. Putz is not immediately headed for any operative procedure, and if things go well, he's hopeful surgery won't be necessary. That, however, remains to be seen.



According to the Arizona Republic, Putz is going to be shut down from throwing because of a sprained ulnar collateral ligament, a strained pronator and irritation of the ulnar nerve, as determined by MRI. The goal in the short term is to calm the elbow discomfort and control inflammation while maintaining his cardiovascular conditioning and shoulder strength to the extent possible. As manager Kirk Gibson said of the plan for Putz over the next two weeks, "He's certainly not going to be picking up a ball."

In 2009, Putz went on the disabled list in conjunction with surgery to remove loose bodies from the elbow. At the time, he received precisely the same diagnosis with regards to the UCL ligament, flexor muscle and ulnar nerve in the elbow. As the Republic noted, doctors compared Putz's most recent MRI with images taken four years ago and did not see significant enough change to warrant surgery at this time. Still, the decision for more aggressive and invasive treatment is often guided by the athlete's symptoms, not the picture alone. While the Diamondbacks hope Putz can return after some forced rest and rehabilitation, if the elbow doesn't respond, they will be forced to reconsider the options.

Putz's MRI findings are certainly not uncommon for a 36-year-old pitcher. But it's precisely because he is 36 -- combined with the fact that this is not his first experience with these symptoms -- that makes this episode more concerning. In fact, Putz was placed on the DL with ulnar neuritis (inflammation of the ulnar nerve, the same nerve currently giving him trouble) in 2008 and missed more than a month. Five years later, irritation of the nerve (manifested as tingling) is one of the symptoms that have flared up, forcing him off the mound.

In approximately two weeks, Putz will be re-evaluated, and a determination will be made whether he can pick up a ball or to continue the conservative route of treatment.

Even if the symptoms have subsided to the point where he can resume throwing, it will be a gradual process requiring additional time (likely weeks, not days) to return to the mound. When Putz experienced similar problems in 2011, he missed almost a month and sounds as if he anticipates a comparable timeframe, according to the Diamondbacks' official website. "It's pretty similar," Putz said. "Hopefully it won't be any [longer] than that."

Putz doesn't seem too concerned about the possibility of undertaking more drastic measures if his symptoms don't improve. At least not yet.