Arm injury for Bautista?

[Ridgway22]

37 minutes ago, Frobby said:

Got a report from a friend of mine who was doing a ballpark tour at Fenway this afternoon that Felix was doing long toss in the outfield from 120 feet under the surveillance of Brian Ebel.

Whoa, that is huge news. 

[Jim'sKid26]

8 minutes ago, jcaponio said:

I know nothing about UCL injuries. If it was torn, why would they have him doing long toss? Is it possible to pitch with a partial tear?

Here's a reasonably contemporary review in the medical literature:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825339/#:~:text=reviewed 10 National Football League,III UCL injuries [22].

"Historically, nonoperative management for UCL injuries in the throwing athlete has shown inferior outcomes when compared to the results following reconstruction. In 2001, Rettig et al. reported on 31 patients treated nonoperatively after UCL injury, including 20 pitchers, 9 infielders, and 2 javelin throwers. Their protocol included rest for 8 to 12 weeks while immobilized in a brace or splint until the patient was pain free. The athlete then began strengthening and throwing over the next 6 weeks. This protocol provided a 42% return to sport (RTS) rate at a mean follow-up of approximately 2 years." Not great results but that 2 out of 5 guys back throwing.

"In outcomes following UCL injury in 32 professional baseball pitchers. These injuries were evaluated via MRI for location, chronicity, and grade of UCL tear. High-grade UCL injuries (> 50% tear) were present in 14 patients, low grade (< 50% tear) in 18 patients, and distal tears in 13 patients. Athletes were treated with rest and ROM exercises for the first week, with graduated rotator cuff and forearm strengthening and plyometric exercises for 6 weeks after injury. At 6 weeks, a progressive throwing program was initiated until asymptomatic. This protocol resulted in a 66% (21/32 athletes) RTS at previous competitive level. Failures were found to be 12.4 times more likely with distal UCL tears. Additionally, UCL tears comprising > 50% of the ligament failed nonoperative management in 73% of professional throwers." So it does matter how severe and in which location the tear is found as far as if non-surgical treatment works.

Finally, someone asked about Platlet rich plasma (PRP) injection:

"The clinical use of PRP for treating UCL injuries was recently evaluated in 34 throwing athletes. In this study, all patients were diagnosed with partial thickness UCL tears on MRI and all failed 2 months of nonoperative management after attempting to return to competitive play. These athletes all received a single PRP injection performed under ultrasound guidance into the site of injury of the UCL followed by a guided physical therapy protocol. This protocol resulted in an 88% RTS at an average of 12 weeks." Also seems to work but not on full thickness tears.

The paper has a lot of data and summarizes the current standard of care.

Hope this helps.

[Malike]

They said Wed night that they were still waiting for the inflammation to subside before they could be sure what the issue is. Would doing a long toss decrease inflammation? Seems odd.

[Ridgway22]

26 minutes ago, Malike said:

They said Wed night that they were still waiting for the inflammation to subside before they could be sure what the issue is. Would doing a long toss decrease inflammation? Seems odd.

And it seems weird that they would have him throwing at 120' if they DIDN'T know the extent of the injury.

 

[yark14]

29 minutes ago, Malike said:

They said Wed night that they were still waiting for the inflammation to subside before they could be sure what the issue is. Would doing a long toss decrease inflammation? Seems odd.

The way they've treated this whole thing is odd.  If they want to try to avoid surgery and rehab over the offseason, why would he be doing long toss?

If they plan on going the surgery route, still why would they have him throw?  "You're UCL is 70% torn, lets go ahead and finish the last 30% before you go under the knife".

[FlaO'sFan]

34 minutes ago, Jim&#x27;sKid26 said:

"The clinical use of PRP for treating UCL injuries was recently evaluated in 34 throwing athletes. In this study, all patients were diagnosed with partial thickness UCL tears on MRI and all failed 2 months of nonoperative management after attempting to return to competitive play. These athletes all received a single PRP injection performed under ultrasound guidance into the site of injury of the UCL followed by a guided physical therapy protocol. This protocol resulted in an 88% RTS at an average of 12 weeks." Also seems to work but not on full thickness tears.

This vaguely reminded me of Dylan Bundy so I looked it up and he did indeed have this treatment before his surgery. I have been wondering if this might be tried for Felix.

Bundy, shut down in Spring Training, received a PRP (platelet-rich plasma) injection to promote healing on April 29 from Wilckens and was prescribed six weeks of rest. He was cleared to begin a throwing program on June 3 but reported feeling discomfort after throwing from 120 feet on June 24.

https://www.milb.com/news/gcs-51848268

[Pickles]

3 minutes ago, yark14 said:

The way they've treated this whole thing is odd.  If they want to try to avoid surgery and rehab over the offseason, why would he be doing long toss?

If they plan on going the surgery route, still why would they have him throw?  "You're UCL is 70% torn, lets go ahead and finish the last 30% before you go under the knife".

I actually think that might be the thought process. No matter what he does, he's going to eventually need surgery on that ligament. Might as well try to squeeze every last drop out of the arm before he goes under the knife.

Reminds me of Jimmy Smith with the Ravens from a few years ago. He had a partially torn Achilles and it was only a matter of time before he tore it completely and had to go under the knife. So he kept playing on it until it finally gave out on him.

[Malike]

10 minutes ago, Pickles said:

I actually think that might be the thought process. No matter what he does, he's going to eventually need surgery on that ligament. Might as well try to squeeze every last drop out of the arm before he goes under the knife.

Reminds me of Jimmy Smith with the Ravens from a few years ago. He had a partially torn Achilles and it was only a matter of time before he tore it completely and had to go under the knife. So he kept playing on it until it finally gave out on him.

The real issue is, when they pulled him from the game it was because his arm hurt after he threw the ball. I'm not sure how they are going to say let's burn up the last 30% before surgery when he's not comfortable after throwing a fastball. It's definitely odd how they've handled this whole thing.

[Sanfran327]

Personally, I think the time of year / where we are in the season is playing a big role in this. If the team can get a few effective innings out of his arm during the playoffs before it blows up, that's great. I'm sure they'd test him out in a very low-leverage situation for 2-3 appearances to see if he can handle any live action at all, then put him back in the closer role or shut him down based on results. Either way, if he needs TJ surgery, 2024 is completely out the window whether he gets it done now, or in October or November. After that, I'd assume that ST 2025 should be a normal spring for him. Just a hunch on my part.

[baltfan]

At this point it seems pretty obvious they think there is a possibility they can get him back this year.  otherwise, they would just shut him down and either start rehab for next year or have a surgery.  Obviously, they think there is a chance or they just would have ruled him out. 

[OsFanSinceThe80s]

3 minutes ago, baltfan said:

At this point it seems pretty obvious they think there is a possibility they can get him back this year.  otherwise, they would just shut him down and either start rehab for next year or have a surgery.  Obviously, they think there is a chance or they just would have ruled him out. 

That’s what I think too if there’s a chance Bautista can pitch they’re going to give it a shot with the playoffs coming. Bautista gets the surgery now or in November/December he’s not going to be back until spring training 2025.

So there’s no rush to get the surgery this minute. 

[yark14]

22 minutes ago, Malike said:

The real issue is, when they pulled him from the game it was because his arm hurt after he threw the ball. I'm not sure how they are going to say let's burn up the last 30% before surgery when he's not comfortable after throwing a fastball. It's definitely odd how they've handled this whole thing.

Exactly. Plus, what if he changes his throwing mechanics to reduce the load on the UCL and thus injures something else, like his shoulder?  Great way to end a promising career...

[Malike]

1 minute ago, yark14 said:

Exactly. Plus, what if he changes his throwing mechanics to reduce the load on the UCL and thus injures something else, like his shoulder?  Great way to end a promising career...

I doubt they would risk further injury this season. I just think they are playing dumb and know more than they are telling anyone.

[Pickles]

49 minutes ago, Malike said:

The real issue is, when they pulled him from the game it was because his arm hurt after he threw the ball. I'm not sure how they are going to say let's burn up the last 30% before surgery when he's not comfortable after throwing a fastball. It's definitely odd how they've handled this whole thing.

Well that will be the question: Can he still perform?

[dbmillertime]

This is so puzzling.  What kind of benefit would there be of using a playoff roster spot the first series just to mess with the other team?  Maybe have him come in in a Willis Reed type moment?  
 

Seems extremely unlikely but I can’t see him pitching.