Carl Crawford wants surgery

NEW YORK -- According to two people with close ties to Carl Crawford, the left fielder is reluctant to tell the Boston Red Sox he would like to shut down playing and have surgery to repair the torn ulnar collateral ligament in his left elbow because he is afraid of how that will be perceived -- by his teammates, by management, and not least, by Red Sox fans, who already were underwhelmed by his performance in 2011, his first season in Boston after signing a seven-year, $142 million contract.

Crawford spoke with Red Sox general manager Ben Cherington on Saturday -- before a Boston Globe report surfaced that he plans to tell them in the next couple of days of his wish to have surgery -- and according to the GM made no mention of wanting to proceed with an operation. Cherington said he has not spoken with Crawford since the report, and Crawford was not in the visitors clubhouse when reporters were allowed entry after Boston's 4-1 win over the Yankees.

But Cherington made two things clear Saturday night: "This is a real injury," he said.

The other? "He knows if he ever feels that way, there is an open door to come in," Cherington said. "The last thing we would ask him to do is anything he's not comfortable with. It's up to him.

"The focus understandably has been the timing of it (surgery). But we have to protect him first. Whether we are 10 games up or 10 games behind, that doesn't have anything to do with whether he has to shut it down. We have to put him first."

In an email to the Boston Herald on Saturday night, Crawford's agent said the left fielder will follow the advice of the Red Sox medical staff.

"Carl intends to follow the course recommended by the medical professionals who have been treating him, in whom he has full confidence," agent Brian Peters said. "Whether and when he has surgery wil be determined by them. The Red Sox have been and remain 100 percent supportive of Carl throughout the process."

Crawford underwent wrist surgery in January, causing him to open the season on the disabled list. While rehabbing at the team's training facility in Fort Myers, Fla., he subsequently hurt his elbow, an injury the team announced on April 27 as a sprained ulnar collateral ligament. He missed the team's first 89 games before returning on July 17, but days before his activation, he acknowledged he had thoughts about having Tommy John reconstructive ligament surgery.

"I thought about it," he said at the time, "but at this point if I can play, I think they want me on the field, so I'm just trying to do everything I can to get back on the field."

As to whether it is best for him to play now, he said: "Right now, I feel if I couldn't help the team, I wouldn't get out there. I think helping the team right now is best for me."

Crawford has maintained that Dr. James Andrews, the orthopedist who examined him in April, told him that he ultimately would require Tommy John surgery, a position repeatedly challenged publicly by both Cherington and manager Bobby Valentine, who said that surgery was not necessarily required.

On Saturday, when Valentine was asked about the report that Crawford wanted to proceed with surgery, the manager cracked: "Slow news day, was it? OK, I might have to have surgery, too -- a frontal lobotomy.

"He's playing very well. He threw the ball from left-field (wall) to second base. That's why it may be hurting him. But he's a tough guy. He's given us everything he has."

Crawford had a single in five at-bats Saturday and stole a base. He has posted a .283/.308/.487 batting line in 30 games since his return, and his 10 doubles and 13 extra-base hits in August led the major leagues at the start of play Saturday and also matched his career high for doubles in a month. He has confided in at least one friend that as long as the Red Sox were in contention, he would continue to try playing.

Even with Saturday's win, the Red Sox are 12½ games behind the Yankees in the AL East and trail five teams in the wild-card standings.

Cherington on Saturday night softened his public position on surgery, at no time suggesting the operation might not be necessary.

"The decision was made over three months ago -- he elected to give it a shot, and we decided to treat it conservatively," Cherington said. "It's a situation we continue to monitor. We're talking to Carl every day -- I'm not talking to Carl every day, but someone on the staff is and I check in with him every few days. He's got an injury he's playing with, giving it a shot. He wanted to do it.

"But if at some point he comes to grips with symptoms that he feel he can't play with, we have to figure out what's right for him and the team."

After the initial diagnosis, Crawford received a platelet rich plasma (PRP) injection and subsequently began rehabilitation.

PRP therapy for tissue injuries is a fairly recent development for professional athletes, and its effectiveness is still debated. Golfer Tiger Woods and pro football players Hines Ward and Troy Polamalu are among the athletes who have undergone the treatment. Kobe Bryant also had the treatment done on his knee.

"Some physicians are finding better success with PRP injections on partial UCL tears, depending on the location of the tear within the ligament," said ESPN.com sports medicine expert Stephania Bell, who has not treated Crawford.

But Crawford has said the discomfort in the elbow has remained, and he's been consistent in his position that surgery will ultimately be required. Cherington said Saturday night that Crawford has not yet indicated that time is now, but it is clear that the GM would not be surprised if the 31-year-old decides to shut it down. Estimates for recovery for position players who have had the procedure usually run from six to nine months, which means Crawford likely would not be ready for the start of spring training even if he has the procedure soon.