Revisiting the decision not to send Masahiro Tanaka under the knife

Tanaka's health was high atop the preseason fear list, and now the concern has become reality. The Yankee ace has found the disabled list before the calendar shifts to May. The response, immediate and predictable, second guessing the choice of rehab over surgery.

In all fairness to many of the voices calling out variations of "I told you so", in large part they did in fact tell us so. All through the initial decision to opt for platelet-rich plasma therapy over Tommy John surgery last season, when Masahiro Tanaka hit a blip on his return to the rotation, right through the offseason, continuing through spring training and the early days of the 2015 season. Points for consistency on this issue, certainly, to the various reporters, baseball players, and fans all over the internet who felt surgery was the way to go all along.

The success rate with Tommy John surgery has been covered in depth, notably here by Jon Roegele, where he does demonstrate that the commonly accepted wisdom, that Tommy John is more a one year pitstop as opposed to an actual surgical procedure with risks, may not hold true quite as much as one might expect. Still, we've seen many successful cases of the surgery, and for a lot of people associated with baseball, it appears taking the known loss of a year on a player's career is an easier concept to reconcile, than running with the uncertainty that comes with the rehab approach.

In this case though, as well we know now, Tanaka and the Yankees didn't opt to take the pseudo-certainty of the 12-18 months on the sidelines, opting to follow medical advice instead of the common-held wisdom within baseball. Yankee beat reporter Bryan Hoch sheds more light on the process here, and the names involved from a medical perspective, and they certainly are brand names.

Following that injury, Tanaka was examined by Yankees team physician Christopher Ahmad, Los Angeles Dodgers team doctor Neal elAttrache and Mets team physician David Altchek. His results were also sent to noted specialist James Andrews for consultation, and all four doctors recommended the Yankees should rehabilitate Tanaka’s injury using platelet-rich plasma injections rather than rush into surgery.

We've heard what a pitching legend like Pedro Martinez and a potential future Hall of Famer Curt Schilling think about the decision not to send Tanaka under the knife, but with this sometimes, a little knowledge can be a dangerous thing. Any medical knowledge Martinez, Schilling, the host of reporters covering this, or us fans have when it comes to Tommy John surgery is surely largely anecdotal. Of course, I do not speak for those of you with extensive medical training, but should the rest of us really be second-guessing the real experts here? Reading about the procedure on Wikipedia doesn't give me the confidence to question Ahmad, elAttrache, Altcheck or certainly Andrews; not any more than reading a how-to on throwing a circle-change will lead me to think I can go be the next Pedro Martinez.

Luckily, in my opinion anyway, Joe Girardi has chosen to put his faith in the medical experts here, again as-per the Hoch article.

"I am a manager. I am not a doctor, so I don’t understand the mechanics of all that," Girardi said. "As I said yesterday, there’s going to be speculation. Are they related? I can’t tell you that. I don’t know; could be, it may not be. It could just be something came up from his bullpen. Who knows? The thing is, we’ve got to deal with it, and we will."

Crucially, after hearing about Brian Cashman not rule out Tommy John surgery in response to Tanaka having a strained forearm, along with his sore wrist, we also have a little more context into where the Yankee organisation currently  stands on the issue.

For the moment, the Yankees believe that Tanaka’s current injury does not represent a precursor to Tommy John surgery, but they recognize that possibility. Tanaka will refrain from throwing for seven to 10 days and is not expected to travel with the team.

Again, not ruling anything out, as well they shouldn't of course, but no suggestion of an imminent season-ender. The one thing we can say is again the Yankees are making no knee-jerk reactions. Giving Tanaka at least a week to rest and hopefully heal from soreness, when that week is the first one in May, seems a very prudent course. Allowing him to then rebuild some arm strength before returning, while likely monitoring him closely for setbacks, is again hard to argue with. If that drives Cashman's conservative timeline of a month before Tanaka returns, it's probably the best decision for the long term.

Certainly, we cannot say now that Tanaka won't ultimately go under the knife, or when that might happen. What we do seem to see here, is that the Yankees are consulting the real experts in the field, procuring multiple opinions, and following the judgement of the people who are likely as qualified as any group of individuals on the planet in making a recommendation for this very specific medical question. They did so then, and now that Tanaka will miss time again, the Yankees aren't making a reactionary decision, but once again following a process of trusting the experts.

When a decision is driven by that logic, it's probably the right call, however it turns out. The Yankees are making the best of a bad situation here, by doing the best they can to keep Tanaka healthy and performing at a high level.

Get well soon, Masahiro.