Less than a month into the 2016 season and two of the Yankees "Scranton Shuttle" relievers have been shut down with torn ulnar collateral ligaments (UCLs): Branden Pinder and Nick Rumbelow. UCL tears can be corrected through baseball's most infamous medical procedure, the Tommy John surgery, which is the path that Rumbelow opted for after suffering the tear in an appearance for Triple-A Scranton/Wilkes-Barre on April 10. Yankees team physician Dr. Christopher Ahmad was scheduled to perform Rumbelow's operation on April 15, and Rumbelow is expected to be available to return at some point early in the 2017 season.
Pinder suffered his injury last week, with the team announcing the diagnosis of a partial tear of the UCL shortly thereafter. Sunday it was reported that Pinder was scheduled to visit famed orthopedic surgeon Dr. James Andrews sometime this week for a second opinion on how to proceed, and on Monday the Yankees announced that Pinder would undergo Tommy John surgery and miss the remainder of the 2016 season. Tommy John surgery has become so ubiquitous throughout the baseball establishment that some may wonder why Pinder would even bother seeking a second opinion, rather than immediately opting for surgery so that he can quickly began the extensive post-operative rehabilitation process.
Jeff Passan's compelling new read, The Arm, dispels the notion that there is anything routine about Tommy John surgery, and makes clear that the procedure does not represent a silver bullet solution to injuries to pitchers' elbows. Pinder's decision recalls the choice that Masahiro Tanaka was forced to make when he suffered a partially torn UCL in July 2014. Tanaka opted for platelet-rich plasma therapy and rehabilitation, which enabled him to return to the mound for two starts in September 2014, and begin the 2015 season on the active roster.
The Arm presents readers with the puzzle of how the nature of elbow injuries, and how to best prevent and correct them, can be so poorly understood given the vast sums that Major League teams invest in pitching. While organizations, pitchers, and doctors find themselves mired in what Passan calls a "swamp of possible solutions," research cited by Passan has demonstrated that the biggest risk factor for arm injury is prior injury. Previously injured arms are powder kegs waiting to explode, and will remain so until a therapy emerges that reduces arm injury risk to a level comparable with that of pre-injury levels. Given that Tommy John surgery is not that therapy, pitchers are wise to be ambivalent about immediately electing to have the surgery performed in situations where rehabilitation is an option.
Beyond the uncertainty surrounding repaired arms, the rehabilitation process that follows Tommy John surgery is a grueling one. As a fan, I was generally aware of the difficulty of Tommy John rehab, but The Arm demonstrates just how tough it is in captivating fashion. Following the recoveries of Daniel Hudson of the Arizona Diamondbacks, and Todd Coffey, who currently is listed as a pitcher for the Long Island Ducks of the independent Atlantic League, Passan documents the physical and even more significant emotional toll that the rehab process has on pitchers post-surgery. As Passan describes:
"To the world, Tommy John surgery consists of only two days that matter: the date of the procedure and date of the return. In reality, the days in between matter far more than either. Healing a broken elbow takes at least a year, time that limps along with loneliness and quiet desperation, monotony and boredom."
The success of the youth movement that the Yankees are currently undergoing hinges critically on the continued health of young starters including Tanaka, Michael Pineda (who suffered an anterior labral tear in his right shoulder in 2012), Nathan Eovaldi (who had Tommy John surgery as a high school pitcher in Texas), Luis Severino, and top prospect James Kaprielian, who was shut down indefinitely earlier this week with inflammation in his right elbow. The Yankees will be exceedingly cautious with Kaprielian, who will lose important development time with this setback, but who was not being counted on to contribute at the Major League level this year.
Given the importance of young arms to the future of the club, it is no surprise that Passan identifies the Yankees as one of five teams that will participate in a project to study all of their pitchers from the 2014 draft class. Pitchers from this class will undergo biomechanical analysis, share detailed information pertaining to their participation in youth baseball, and serve as a pilot group for future studies. Data collection efforts such as this one are necessary and important, but it will take years before they lead to any actionable recommendations. In the meantime, the Yankees will have to hope that their current crop of talented, young arms do not face the same decision that Pinder and Tanaka did.