For all intents and purposes, it appears as if the mega-deal involving the Minnesota Twins, Boston Red Sox, and Los Angeles Dodgers is dead. At least as it was initially constructed.

To quickly recap: Los Angeles would have received outfielder Mookie Betts and pitcher David Price from the Red Sox, Boston would have received outfielder Alex Verdugo from the Dodgers and pitcher Brusdar Graterol from the Twins, and Minnesota would have received pitcher Kenta Maeda from the Dodgers.

But, again, the trade is reportedly holding on via life support as the Boston Red Sox - amongst blow back that they did not receive enough value in return for their All-World right fielder - balked after obtaining the medical records of Graterol from the Twins, according to the Star Tribune’s LaVelle E. Neal III.

What has been most confusing during this whole ordeal is deciphering why Boston became so concerned about Graterol’s health and how they justified that this meant they required more trade compensation in return, particularly from the Twins. After all, Graterol’s injury history isn’t exactly a secret; the 21-year-old underwent Tommy John surgery when he was a teen and missed a chunk of time during the 2019 season while recovering from impingement in his right shoulder.

According to Neal (via the Boston Globe), after the deal was agreed to in principle, the Red Sox were provided Graterol’s medical files, which “[included] magnetic resonance imaging exams and other images, trainer notes and virtually every detail about a player’s medical history since his entry into professional baseball.” It was apparently these images and notes that caused Boston’s knees to buckle.

So what could these images and notes have revealed that would cause such concern on the part of the Red Sox? This is where the landscape gets potentially foggy.

Advanced imaging techniques - such as magnetic resonance, radiographic pictures, CAT scans, etc. - provide great value in diagnosing athletic injuries. While athletic trainers, physical therapists, and orthopedic surgeons are trained to diagnose injuries by hands-on techniques, the severity and extent of the injury as well as the specific structures involved cannot be determined with 100% certainty - or at least near 100% certainty - without the use of imaging.

However, the use of advanced imaging often reveals silent “pathology” - or incidental findings; I use pathology with quotations as perhaps the more correct term would be anatomical variation. If anatomical variation is detected, but it is absent of pain and dysfunction - the characteristics used to define injury - is the athlete truly injured? Do these findings predict risk of future injury?

These questions are difficult to answer with any amount of certainty as the first is largely philosophical whereas the second has yet to be sufficiently researched. So, perhaps these questions should be reframed in this manner: Absent of imaging, would a team be hesitant to acquire a player of Graterol’s caliber knowing what they know about his injury history? The obvious answer is no as the Red Sox were willing to do just that as late as last week.

It would be one thing to conclude, as both the Twins and Red Sox apparently did, that Graterol would be best off as a reliever in the long-term based on his past injury history. It is entirely different to use his past medical history and images to demand further trade compensation - in such a public way, no less - after the deal has already been agreed upon.

As the linked clinical commentary from the Journal of Orthopedic and Sports Physical Therapy above states, it is common to find pain free, fully functional anatomical variation in the rotator cuff and glenohumeral labrum of the baseball pitcher’s throwing shoulder. Brusdar Graterol, an intriguing talent and 21-year-old kid, has had his health dragged through the mud based on past images and notes that may or may not have an impact on his future health and performance. That is what has been most disappointing about this entire process.