TBT: Masahiro Tanaka’s Partially Torn UCL & Why You Should Chill the F Out

 Throwback Thursday, Masahiro Tanaka and his partially torn ulnar collateral ligament in his right throwing elbow edition. Over two years ago I told everyone to "chill the F out" over it, how does it look two years later? Enjoy! 

ORIGINAL POST SEEN HERE

You know what Daniel Burch hasn’t done in a while? Rant (or talk in the third person while Daniel Burch is on the subject). He hasn’t ranted in a while, although he has come close, but that is all about to change. I have been hearing it for years, and I have argued against it for years, but for whatever reason this is not registering in some people’s heads. I am so sick and damn tired of hearing about Masahiro Tanaka’s partially torn ulnar collateral ligament and I am even more tired of hearing it used as an excuse for every time the guy throws a ball out of the zone, let alone struggles in a start. The partially torn UCL is not the reason for all his struggles and you are not smarter than a team of doctors that advised against him getting Tommy John surgery. Deal with it and get over yourselves people.

Let’s start at the beginning, the diagnosis.

Tanaka was diagnosed back in 2014 with a slight tear of his ulnar collateral ligament. Tanaka visited three different doctors including Yankees team doctor Christopher Ahmad and Tommy John surgery specialist and expert Dr. James Andrews and all three doctors came to the same conclusion, the need for Tommy John surgery and a new ulnar collateral ligament was not needed. While each doctor had their own plan for how to treat and how to rehab the elbow the consensus was the same, no surgery. The Yankees ultimately decided on a platelet-rich injection on the elbow and rest and rehab, a treatment that at least to date has worked for Tanaka’s particular case.

Despite this diagnosis there are still fans, not doctors, who say the most outrageous and off-base things about Tanaka, his elbow, and about Tommy John surgery in general.

“Tanaka cannot pitch at a high level with a partially torn UCL!”

WRONG! Now that this is out of the way let me tell you all a story. There once was a man named Adam Wainwright who not only pitched once with a small tear, like Tanaka’s, in his UCL, but he did it twice. Wainwright dominated Major League hitters for six seasons before needing the surgery which included 182 games, 99 of them as a starting pitcher, 874 total innings including 233 innings pitched in 2009 alone, and a second place (2010) and third place (2009) finish in the National League Cy Young Award vote. Wainwright was first diagnosed with the partial tear in his UCL as a High School pitcher where doctors advised against surgery. Wainwright tore his UCL partially again while in Triple-A and was once again advised against an ulnar collateral ligament replacement surgery. Both times Wainwright took the conservative route, like Tanaka, and came back throwing harder and stronger than ever. Wainwright pitched for six seasons with a partially torn UCL before completely blowing out his elbow and requiring the surgery.

“So, Tanaka will need the surgery eventually.”

No, not necessarily. Tanaka was never ridden like a horse like Wainwright was and has never approached 233 innings in a Major League season. Tanaka also sat out ten weeks after the diagnosis where Wainwright sat out only six weeks while Tanaka also received a platelet-rich plasma injection to promote healing in the elbow where Wainwright did not. Tanaka was closely monitored by a team of doctors and is still monitored closely to this day by the New York Yankees. Tanaka had multiple checkups after the diagnosis and every time he was told that there was no new damage to the elbow or the ligament.

“Why not just get the surgery done, sit out a year and come back strong in the final two seasons of his contract?”

If it were only that simple. While the success rate for Tommy John surgeries are as good as they ever were it doesn’t mean that they are 100%. Not yet, anyway. For every success story with a pitcher coming back in 15 months or so and coming back stronger and better than ever there are horror stories that contradict that line of thinking. It seemingly took Ryan Madson three-or-four years to fully recover from his Tommy John surgery, and he is just a reliever who isn’t relied upon every fifth day like Tanaka. Also, it is worth mentioning that there’s a ton of instances and stories of pitchers NEVER coming back or being the same after a torn UCL surgery. Why just go cutting on a ligament and take that chance when it has deemed unnecessary by a team, not just one, of doctors? Why take the risk? You don’t. Getting what is deemed as an unnecessary surgery like having your tonsils removed or a circumcision is one thing, having the ligament that essentially holds your elbow together ripped out and replaced for no good damn reason is another.

“But, but, but, Wainwright needed the surgery eventually. Tanaka will too!”

Wrong again, Yankees fans. Let me tell you another story. A story about a man many know as “King Felix” but a man I prefer to call Felix Hernandez. Hernandez has been pitching with a torn ulnar collateral ligament for God knows how long. Bob Nightengale of the USA Today has reported on it and Andy Van Slyke opened up about it in that interview about three years back where he claimed the Los Angeles Dodgers wanted to trade Yasiel Puig. It seems to be common knowledge around the league, yet Hernandez has yet to undergo the ulnar collateral ligament replacement surgery. And, FYI, Felix’s velocity did drop to around 92 MPH, yes. It was AFTER his velocity drop that he found his changeup and truly morphed into the “King” that he was nicknamed recently. The velocity drop did not coincide with the partially torn UCL, not even close.

“I know more than Daniel Burch.”

No, you don’t. Next.

Okay, so again on a serious, and less cocky, note you can sum up this entire article in just a few sentences. Every elbow is different, every person is different, and everyone’s body is different. Just because Adam Wainwright was able to pitch through the elbow injury and didn’t immediately require the surgery doesn’t mean Tanaka will, although he has thus far. Just because Felix Hernandez has reportedly a 25% tear in his UCL and has yet to require the surgery it doesn’t mean that Tanaka won’t require the surgery. No one knows. What the point of this post was is to show people that their opinions mean very little in the grand scheme of things. Doctors told Tanaka not to get the surgery, specialists in fact, and I trust them way more than I trust a casual fan. I trust the specialists more than I trust my own knowledge and opinion, so please stop acting like you know more about Tanaka, his elbow, UCL’s, and Tommy John surgery than someone who went to school for the better part of a decade just to learn the trade. You don’t, and neither do I. Thank you for listening to my rant while learning a little bit about Tanaka, ulnar collateral ligaments and the history of pitching with a tear in it.

Why I'm Not Afraid of Carlos Carrasco in Game Two Tonight

 The New York Yankees offense was not afraid of 2020's presumptive American League Cy Young Award winner, so should they be afraid of Carlos Carrasco tonight in Game Two? In a word, no. Here's why!

The New York Yankees generally struggle against pitchers that they are seeing for the first time, it doesn't make sense but it is definitely a thing for this team. The good news tonight is that the Bombers have seen Carrasco plenty, to the tune of the stats below provided by ESPN: 

New York Yankees Career Statistics Vs. Carlos Carrasco

PITCHER	AB	H	2B	3B	HR	RBI	BB	K	AVG	OBP	SLG	OPS
Clint Frazier	3	1	1	0	0	0	0	1	.333	.333	.667	1.000
Brett Gardner	22	6	1	1	0	3	5	6	.273	.407	.409	.816
Aaron Hicks	10	0	0	0	0	0	1	3	.000	.091	.000	.091
Aaron Judge	2	0	0	0	0	0	1	2	.000	.333	.000	.333
Erik Kratz	4	2	0	0	0	0	0	1	.500	.500	.500	1.000
Giancarlo Stanton	1	0	0	0	0	0	0	1	.000	.000	.000	.000
TOTALS	42	9	2	1	0	3	7	14	.184	.277	.263	.540

Is that a huge sample size? Unfortunately not, but it is better than nothing. With the above, do the Yankees start Clint tonight or do they start Gardner? Originally, my thought process was that Clint would get the start, but that was before Gardy's big game last night against Bieber and the Indians. 

Carrasco has made 12 appearances, nine of them starts, in his career against the Yankees and currently owns a 5-5 record with a 4.04 ERA. Carrasco has allowed eight home runs to the Bronx Bombers over that span with a 1.204 WHIP. Carrasco will get his strikeouts against this team, he has struck out Yankees batters 60 times in 55.2 innings pitched against them while drawing just 15 walks. That's not what you want to see, but ultimately I think the Yankees offense should be fine. 

Remember, Carrasco is not the same pitcher he was just two-or-three seasons ago, he is a shell of his former self. A lot of this gaudy strikeout numbers came while Carrasco was at his peak, and Carrasco has since fallen from that level due to injury. Carrasco's 3-4 record, 1.206 WHIP and 1.6 WAR, while good, are not what he was in 2017 and 2018. 2017 and 2018 were his Cy Young contending years, while he has stepped back each of the last two seasons. 

Bieber scared me a little last night, although I wasn't worried, but Carrasco really doesn't. I'm not looking past Carrasco by any means, but I am confident that the Yankees will close out this series with a victory tonight. See you in the ALDS. 

So Maybe I Was Wrong About Luke Voit

Insert foot in mouth, followed up by a healthy serving of crow. That’s what is on the agenda for me today as I make my not-so-triumphant return to the blog. I have to admit it, I was completely and utterly wrong, as of today anyway, about Luke Voit.

As we enter play on this last day of April, the Yankees first baseman is hitting .283/.397/.538/.935 with eight home runs, 25 RBI, 30 hits in 106 at-bats, and has a 0.8 WAR already. This came after I, Daniel Burch, was very much on-board with trading high on the current MLB Player of the Week. I made mention more than once this offseason that the Yankees should sell high on Voit and bring in another first baseman, and I was wrong.

Where would the Yankees be right now if it were not for Voit getting on base every day for nearly 40 straight games now? Where would the Yankees be if they relied heavily on Greg Bird once again and his ailing lower half in 2019? Where would the Yankees be if it were not for, another point of contention for me this winter, what seems to be Voit’s improved defense over at first base and knack for absolutely clobbering the crap out of the ball to the deepest part of almost every ballpark that he plays in?

Not where they are today.

Here is a better question for you. Where would the Yankees be, and I mean specifically this current crop of players, without Luke Voit’s leadership role that he has taken on and his warm embraces after a victory? You want to talk about leading a young group of guys and having fun while the team is winning? We haven’t seen that on this team, to this degree, since Nick Swisher was with the club back in 2009.

I’m not comparing the two teams, but you know what? Maybe I am comparing the two men. Clubhouse wise. Leadership wise. Personality wise. Yankee wise.

Luke, no one is happier than I am to gladly and fully admit that I was 100% wrong about you as a player. Keep proving me wrong, and I’ll keep appreciating it every step of the way.

photo credit: River Ave Blues

Also, a quick shout out to River Ave Blues on their final day. If it weren’t for publications and groups like you, I would likely not be here today, so I am forever grateful for Mike Axisa and his crew for all their hard work and generosity throughout the years. You will truly be missed.

Miguel Andujar, Michael Brantley and a Small History of Players Having and Attempting to Play Through Shoulder Labrum Surgery

Miguel Andujar will try to play through labrum tear, return this season https://t.co/QJ6t3bB2J5 @bykristieackert @Yankees pic.twitter.com/wWKGB9fGmb

— NY Daily News Sports (@NYDNSports) April 3, 2019

The New York Daily News reported today that Miguel Andujar, the third baseman of the New York Yankees, would attempt to play through a “small tear” in his right shoulder labrum that he suffered on a play earlier in the week. There are plenty of mixed emotions and opinions on this, but instead of jumping on one end of the spectrum or another, instead I decided to do some research. Honestly, I had no idea if it was a good idea that Andujar tried to play with the injury or not. I honestly had no idea if this could make the injury much worse, or if it would mean more time off if it did for the promising young Yankees star, so I did some research. I looked at some of the more recent and comparable torn labrum situations across MLB and found one such situation that fits that of Miguel Andujar’s situation more so than any other. But before we jump right into that, let’s take a look at some of the more recent labrum surgeries, their success rates, and how much rehab and “off” time it took to get these players back.

Let me preface this post by saying that I am focusing solely on torn labrums for positional players in this post, and torn labrums in their shoulders only. When I say “the most recent labrum surgery” I mean the most recent that fits the aforementioned criteria. Please do not litter the comments section with the fact that Michael Pineda came back from a labrum surgery or that Alex Rodriguez came back from labrum surgery in both hips, neither are really relevant with the Yankees third baseman.

The first question that came to mind when the news broke, at least in my mind, was if Andujar was able to play through the surgery, how would it affect the Yankees 2020 season? Would the team be without Andujar for a long stretch in 2020 as well? And would that be worth it, given the Yankees “window” with this team? My research brought me to San Francisco and the most recent torn labrum surgery that I could find aside from Andujar’s

Steven Duggar of the San Francisco Giants announced on August 31, 2018 that he would have to undergo surgery on his torn labrum in his left shoulder. Duggar had successful labrum surgery during the month of September last year and was back for spring training and Opening Day. Duggar’s production did not seem to slip after the surgery, which was evident when he was named the Giants starting center fielder here in 2019 (well, until the team acquired Kevin Pillar, but that had nothing to do with his rehab from shoulder surgery in my opinion).

Does that extra month that Duggar had help him in his rehab? I was unsure, so I went and looked for an example of a player that waited until the regular season was over to get the surgery and I ran across the story of outfielder Matt Kemp.

Matt Kemp waited until the offseason after the 2012 season before having his torn labrum surgery and was back on Opening Day in 2013. Granted, his spring training was cut a little short and, granted again, the start to his 2013 campaign left much to be desired, but whether that was because of the surgery or not, while assumed, cannot be confirmed with 100% certainty. Then again, every shoulder is different. Just because Kemp struggled after coming back from the surgery it doesn’t mean that Andujar will. The point of it all is to say that conceivably the Yankees could wait until the end of the regular season to have the surgery and still have Andujar back on Opening Day, or very shortly after, if all goes according to plan.

Here are Kemp's before and after stats from the torn labrum surgery for your reference: 

Standard Batting

Year	Age	Tm	G	PA	R	H	2B	3B	HR	RBI	BB	SO	BA	OBP	SLG	OPS	OPS+
2012	27	LAD	106	449	74	122	22	2	23	69	40	103	.303	.367	.538	.906	147
2013	28	LAD	73	290	35	71	15	0	6	33	22	76	.270	.328	.395	.723	104
2014	29	LAD	150	599	77	155	38	3	25	89	52	145	.287	.346	.506	.852	140

Provided by Baseball-Reference.com: View Original Table

My next question was whether or not Andujar could even play through such an injury. In my research, I learned that not many players had even attempted to play through it, nor did I find many examples of a player successfully playing through the injury. Luckily enough, I did find at least one example of both instances, although there are a few more of each.

Devin Mesoraco, at that time a member of the Cincinnati Reds, at least considered playing through his torn labrum in his left shoulder in 2016. Ultimately, Mesoraco was limited to just 16 games that season and opted for the surgery, but the initial report on MLB Trade Rumors on May 2, 2016 stated that Devin at least considered trying to play through the injury. For what it’s worth, Mesoraco is right-handed and the labrum tear was in his left shoulder. While that did not hinder him much in the throwing department, through the research I am gathering it DOES affect hitters more in their lead shoulder (for a right-handed batter it would be their left shoulder) than their back shoulder, the right shoulder on a right-handed hitter like Miguel Andujar.

In our research of an instance where a player did play through a torn labrum, we go to J.J. Hardy of the Baltimore Orioles in 2015. On October 1, 2015 it was announced that Hardy, who opened the season on the disabled list with a “left shoulder sprain” at the time, had been knowingly playing through the year on a torn labrum in his left shoulder. Hardy is a right-handed throwing and batting shortstop, FYI, so it was not on his throwing shoulder, but it was on his lead shoulder while at the plate. Hardy’s final stat line in 2015 with the torn labrum can be seen below. I put his 2014 season, 2016 season, and his career numbers as well just for your reference.

Standard Batting

Year	Age	G	PA	AB	R	H	2B	3B	HR	RBI	BB	SO	BA	OBP	SLG	OPS	OPS+
2014	31	141	569	529	56	142	28	0	9	52	29	104	.268	.309	.372	.682	90
2015	32	114	437	411	45	90	14	0	8	37	20	88	.219	.253	.311	.564	54
2016	33	115	438	405	43	109	29	0	9	48	26	68	.269	.309	.407	.716	90
162	162	162	655	602	75	154	30	1	20	71	43	100	.256	.305	.408	.714	90

Provided by Baseball-Reference.com: View Original Table

FYI, through my research I have read that it is much harder to play through a torn labrum on your lead shoulder while at the plate, which means your left shoulder if you are a right-handed batter and vice versa.

I think the most compelling case, and maybe the closest case that matches that of Andujar, is the torn labrum that Cleveland Indians outfielder Michael Brantley suffered in 2015. Brantley, a left-handed hitting and throwing outfielder currently in the Houston Astros organization, was diagnosed with the same “small” tear of his right shoulder labrum in 2015 after attempting to rob then Twins center fielder Aaron Hicks of a triple in a September 22nd game. Brantley would take his next plate appearance after injuring the shoulder but would be removed following the inning. Brantley would appear in two more games that season before the Indians season ended without a trip to the postseason. Initially, both Brantley and the club thought that they could avoid the surgery following the season, but the discomfort in his shoulder lingered for two weeks into his rehabilitation program, prompting the surgical procedure. Brantley was told that he could not pick up a bat for the four months after the surgery. Brantley was also told that he could not begin getting rehab games for at least another month after that, leaving him out for at least six months after the surgery.

Here are Brantley's before and after stats from the surgery. I included Brantley's 2017 stats as well because he was limited to just 11 games in 2016. Brantley had other shoulder issues as well as biceps tendinitis that limited his season that required a secondary shoulder surgery that also cut into his 2017 season as well:

Standard Batting

Year	Age	Tm	G	PA	R	H	2B	3B	HR	RBI	BB	SO	BA	OBP	SLG	OPS	OPS+
2015	28	CLE	137	596	68	164	45	0	15	84	60	51	.310	.379	.480	.859	129
2016	29	CLE	11	43	5	9	2	0	0	7	3	6	.231	.279	.282	.561	48
2017	30	CLE	90	375	47	101	20	1	9	52	31	50	.299	.357	.444	.801	108

Provided by Baseball-Reference.com: View Original Table

So, how does it compare? Both tears are considered to be “small” and both tears are small enough that the team and the player thought that they could play through the pain. Brantley ultimately couldn’t as pain continued to linger in the shoulder, while Andujar is saying that the shoulder still feels healthy and strong. If pain persists, obviously Andujar will shut it down and face the same time period as Brantley did before the 2016 season, but if he doesn’t experience that same pain are the Yankees essentially robbing Peter of time in 2019 to pay Paul by Andujar missing more time in 2020 because the surgery will need to be completed eventually anyway?

The 2019 season ends on September 29, 2019. If the Yankees do not make the postseason that gives Andujar four months of surgery and rehab (October – January) and a return in February, or whenever spring training begins. If the Yankees make the postseason as a Wild Card you can push that back about a week and get the same result. But if the Yankees make a deep postseason run that stretched until basically the end of October (Game 7 of the World Series would be projected to be played on October 22, 2019) then the Yankees may have a bit of a problem. If the World Series ends somewhere around the last week in October, you have to expect Andujar to not get the surgery until at least the beginning of November. Four months of rehab, November through February, and then another month of rehab games, puts Andujar’s readiness into March, and that’s if everything goes exactly according to plan.

Would the Yankees be better off with Andujar even missing the first month of the 2020 season if it means they have a chance at the World Series here in 2019? The more I research, and the more I think about it, the more I am inclined to say yes. It’s really, for lack of a better term, a no-lose situation here for both Andujar and the Yankees. Andujar needs the surgery regardless. If Andujar attempts to play through it and can’t, he gets the surgery early and is 100% ready for the 2020 season. It’s a huge blow, but the window for this Yankees team stretches far beyond just the 2019 season in my opinion. If he plays through it and does more damage, he is going to need the surgery regardless and can clean it up whenever it occurs, or after the season. A labrum surgery is a labrum surgery. A small tear and a larger tear require the same surgery and the same rehab time, give or take very little. It’s still a very serious and intrusive surgery, so I’m not saying that a smaller tear and a larger tear are exactly the same, but I am saying that with either one it’s likely a five-to-six-month process regardless before being game ready.

I won’t sit here and say I am 100% on-board with Andujar trying to play through this injury, but I can’t say that I am 100% against him trying to play through it either. History suggests that he can and that the Yankees, nor Andujar, would be any worse for the wear if he was to attempt to play through the injury, but I’d be lying if it still didn’t scare me just a bit.