Lewis Thorpe removed from game with elbow pain

[Halsey Hall]

I talked to Lewis this morning and asked if he was going to take it easy for a few days and then try to throw again.  He said no, it would be quite awhile. 

[Seth Stohs]

 

We aren't likely to agree on this......even for a pitcher, it is better for them as a human being to avoid surgery if they can.

 

I will certainly agree with this. 

[Squirrel]

 

I will certainly agree with this. 

Yup ... and what Heezy said ... after all ... I'll take a doctor's word, especially one in this specific field, over what others' perceptions may be.

[nicksaviking]

 

Mike, it is not, if you were a pro pitcher and your team wants you to spend the least time out of baseball as possible and return at the highest level as possible.   These are the most desirable outcomes for a pro pitcher and may different for anyone else.  For some people avoiding surgery (because of potential complications or whatnot) might be the most desirable outcome.

 

Well that's because you look at Thorpe's arm as an organizational asset while Thorpe looks at his arm as an actual appendage made up of his actual flesh and blood, which if cut open would impact his actual life. 

 

It's easy for any of us to say what would be better for the Twins and project those desires as also being the best move for Thorpe, since it's not our arm.

 

[Linus]

Two very underappreciated factors:

 

First, the teams go by what the doctors recommend.  I'm pretty sure they are not going to take on the liability of overriding the doctor's recommended course of action.

 

Second, TJ is no sure thing.  There are many success stories but we don't hear about the failures.  Joe Mays being a Twins example.

[diehardtwinsfan]

Well that's because you look at Thorpe's arm as an organizational asset while Thorpe looks at his arm as an actual appendage made up of his actual flesh and blood, which if cut open would impact his actual life. 

 

It's easy for any of us to say what would be better for the Twins and project those desires as also being the best move for Thorpe, since it's not our arm.

Yeah, it's quite a bit like this. As a fan, I just want him under the knife sooner than later. But he's a human being, and quite possibly this is his first surgery, as he's what, 19??? I have had my fair share of them, they all come with risks, some of which involve never waking up again, and while that's a rarity, it can happen. I understand wanting them to do the surgery, but if there's even a small chance that resting it fixes it, I can certainly empathize with him choosing to rest it for 4 months. Keep in mind, this affects their bottom line too. It forces things like 40 man decisions due to lost time, and if they cannot develop in time, it affects what they'll make in their first FA. It's not like they don't have anything on the line.

[kab21]

 

In a timely coincidence, The Hardball Times just published an article on the return rate of pitchers from TJ.

 

http://www.hardballtimes.com/tommy-john-surgery-success-rates-in-the-majors/

 

It goes into much more depth about the recovery rates - how long it took for recovery, how many games and innings pitched after surgery, etc.

 

We hear 80% recovery rate, but that means the pitcher comes back to pitch 1 inning. Here's one quote in summary:

 

"The most recent data suggest that one out of two major league pitchers who has Tommy John surgery will throw fewer than 100 innings the rest of his big league career."

 

So even if R&R has a low success rate, it may be better than guaranteeing missing 1-2 seasons and only having a coin flip chance to ever contribute meaningfully again.

The problem with that analysis is that a lot of the players that they mentioned as not coming back weren't very good or getting old in the first place.  It shouldn't be surprising that if they took 1-2 years off from baseball after a major arm injury (with or without surgery) that they would struggle to make it back to the majors.

 

It also doesn't address the point that there are very, very few examples of R&R working.  I'm waiting for more examples.

[Mike Frasier Law]

 

The problem with that analysis is that a lot of the players that they mentioned as not coming back weren't very good or getting old in the first place.  It shouldn't be surprising that if they took 1-2 years off from baseball after a major arm injury (with or without surgery) that they would struggle to make it back to the majors.

 

It also doesn't address the point that there are very, very few examples of R&R working.  I'm waiting for more examples.

 

That's not exactly right. In fact, they broke it down by age group. For pitchers who were 16-23 when getting TJ, they averaged 221 innings pitched after surgery. That's one good year. For 24-27, they averaged 137 innings after surgery. It is skewed somewhat by age, but even the youngest pitchers weren't likely to come back and have long careers.

 

You are right that it doesn't address the R&R rate, though.

[Brock Beauchamp]

 

The kid should had have the surgery already.  R&R does not work.  They never learn.  Repeating the same mistake pitcher after pitcher is beyond inane...

Yeah, it's always a good idea to cut open a teenager before exploring other options, especially when we have no idea whether Thorpe would have even agreed to surgery last fall.

 

How many times are we going to have this argument? In the past, it has been revealed that the Twins decided against surgery at the recommendation of the surgeon. I don't know about the rest of you but I'm a web developer. I can point to an elbow on an X-Ray. Past that point, I'm going to go with the opinion of the guy who went to school for a decade to learn about the human body.

[kab21]

 

That's not exactly right. In fact, they broke it down by age group. For pitchers who were 16-23 when getting TJ, they averaged 221 innings pitched after surgery. That's one good year. For 24-27, they averaged 137 innings after surgery. It is skewed somewhat by age, but even the youngest pitchers weren't likely to come back and have long careers.

 

You are right that it doesn't address the R&R rate, though.

They broke it down by age group but they didn't break it down by success before TJ. 

 

The names that they listed as not coming back after surgery - Ambiorix Burgos. Anthony Reyes. Macay McBride. Bill Simas. Bill Bray. B.J. Ryan. Taylor Buchholz. Victor Zambrano.  Additionally Twins fans list Joe Mays (200 awful innings post TJ)

 

Aside from Ryan (old) and Reyes (I liked him as a prospect) this is a who's who list of mediocrity.  Mays for example was dreadfully awful after TJ but it seems that Twins fans forget that he was dreadfully awful except for one great season before TJ.  I am not surprised that a bunch of mediocre pitchers didn't return to being mediocre pitchers after a major arm injury.

 

My argument isn't necessarily that R&R should completely be scrapped but I do question the benefits of it considering that very few ultimately end up avoiding TJ.

 

 

[ashbury]

 

 For pitchers who were 16-23 when getting TJ, they averaged 221 innings pitched after surgery. That's one good year.

What was the average for pitchers 16-23 who weren't injured and didn't get TJ?

[ashbury]

 

Past that point, I'm going to go with the opinion of the guy who went to school for a decade to learn about the human body.

Ah, the old "appeal to authority" logical fallacy.

[Brock Beauchamp]

 

Ah, the old "appeal to authority" logical fallacy.

Yeah, not really sure what I was thinking with that statement.

 

Grab the pitchforks, everybody!

[Dantes929]

 

As someone that had 3 major surgeries nearly 2 years ago.....it's always better to try not to have surgery.

 

And this is why having the number 1 farm system means nothing until the players are here.....and why betting your whole future on guys that have never made the majors is risky, imo.

Sometimes I think they should require surgery as soon as they sign a pitcher.   Kidding of course but doesn't Alex Meyer fit the profile of R and R working at least until this point?   I was sure after being shut down in 2013 he would have had the surgery already.   

Mike, I don't really care for the logic of your last paragraph.    Your position to not rely on a #1 farm system because it is betting on guys that have never made the majors may be a valid position though I am fine with that approach and consider it valid also.    However, using arm surgery to support that position is untenable to me.    Is Trevor May more likely to need arm surgery than Clayton Kershaw?   Relying on any group of pitchers is a risk due to arm surgery.   It is no more of a risk to rely on unproven pitchers due to the factor of arm surgery, imo.

[Mike Sixel]

 

Sometimes I think they should require surgery as soon as they sign a pitcher.   Kidding of course but doesn't Alex Meyer fit the profile of R and R working at least until this point?   I was sure after being shut down in 2013 he would have had the surgery already.   

Mike, I don't really care for the logic of your last paragraph.    Your position to not rely on a #1 farm system because it is betting on guys that have never made the majors may be a valid position though I am fine with that approach and consider it valid also.    However, using arm surgery to support that position is untenable to me.    Is Trevor May more likely to need arm surgery than Clayton Kershaw?   Relying on any group of pitchers is a risk due to arm surgery.   It is no more of a risk to rely on unproven pitchers due to the factor of arm surgery, imo.

 

Fair enough point on the last point. I actually have no idea if a pitcher who makes it to 25 or 26 w/o surgery is any more or less likely to need it eventually.

[Mike Frasier Law]

 

They broke it down by age group but they didn't break it down by success before TJ. 

 

The names that they listed as not coming back after surgery - Ambiorix Burgos. Anthony Reyes. Macay McBride. Bill Simas. Bill Bray. B.J. Ryan. Taylor Buchholz. Victor Zambrano.  Additionally Twins fans list Joe Mays (200 awful innings post TJ)

 

Aside from Ryan (old) and Reyes (I liked him as a prospect) this is a who's who list of mediocrity.  Mays for example was dreadfully awful after TJ but it seems that Twins fans forget that he was dreadfully awful except for one great season before TJ.  I am not surprised that a bunch of mediocre pitchers didn't return to being mediocre pitchers after a major arm injury.

 

My argument isn't necessarily that R&R should completely be scrapped but I do question the benefits of it considering that very few ultimately end up avoiding TJ.

 

Only approximately 30% of pitchers who had TJ pitched more than 200 innings after the surgery. It's closer to 20% that pitched more than 350 innings.

 

For the age group of 16-23, fewer than 50% pitched more than 250 innings after surgery.

 

That may somewhat reflect the mediocre pitchers not making it back, but I don't think you are going to argue that only 20% of pitchers who had TJ were bad to begin with.

 

I do think it would be interesting to see the overall return rate of pitchers, but I'm not smart enough to figure out how to do that.

 

 

[Dr. Evil]

I just read this entire thread and now my elbow hurts. Thanks a lot guys. I'm heading for the ice machine now!

[Dantes929]

 

Fair enough point on the last point. I actually have no idea if a pitcher who makes it to 25 or 26 w/o surgery is any more or less likely to need it eventually.

Intuition says the more they pitch and the harder they throw the more likely they are to need it but it seems like the more sturdy guys like Hughes and May are a little less likely to need it.

I don't know if it is supported by facts but it seems that those that have elbow or shoulder surgery don't require having it done again.    That is why I commented tongue in cheek that they should have the surgeries as soon as they are drafted and just be done with it.      It also seems the Twins have had their fair share of arm surgeries.    Liriano, Baker, Pavano, Nathan, Neshek, and Pelfrey come to mind. I am sure I have missed a few but if they have been in the past few years they probably fall under the "who gives a rats behind" category.   Is this worse luck than other teams experience, I wonder.

[Brock Beauchamp]

Last I read, the Twins were about middle of the pack in organizational TJ surgeries, though that was a year or two ago. They haven't had a rash of them in the past 24 months so that's still likely to be the case.

[kab21]

 

Only approximately 30% of pitchers who had TJ pitched more than 200 innings after the surgery. It's closer to 20% that pitched more than 350 innings.

 

For the age group of 16-23, fewer than 50% pitched more than 250 innings after surgery.

 

That may somewhat reflect the mediocre pitchers not making it back, but I don't think you are going to argue that only 20% of pitchers who had TJ were bad to begin with.

 

I do think it would be interesting to see the overall return rate of pitchers, but I'm not smart enough to figure out how to do that.

they definitely didn't pick a who's who list of guys that didn't make it back.  If they had picked a group of guys that didn't make it back that had also been relatively young and successful then it would make a better argument.  but my statement remains:  R&R hasn't been shown to be successful outside of a very limited number of examples and TJ for anyone good has been very successful (Ambroxis Burgos doesn't change that).

 

Sometimes I think they should require surgery as soon as they sign a pitcher.   Kidding of course but doesn't Alex Meyer fit the profile of R and R working at least until this point?   I was sure after being shut down in 2013 he would have had the surgery already.   

Mike, I don't really care for the logic of your last paragraph.    Your position to not rely on a #1 farm system because it is betting on guys that have never made the majors may be a valid position though I am fine with that approach and consider it valid also.    However, using arm surgery to support that position is untenable to me.    Is Trevor May more likely to need arm surgery than Clayton Kershaw?   Relying on any group of pitchers is a risk due to arm surgery.   It is no more of a risk to rely on unproven pitchers due to the factor of arm surgery, imo.

Alex Meyer has shoulder problems.  That is a completely different issue and perhaps one that is scarier since labrum surgery has a lower success rate than TJ.

[TRex]

 

...  but my statement remains:  R&R hasn't been shown to be successful outside of a very limited number of examples and TJ for anyone good has been very successful (Ambroxis Burgos doesn't change that).

Two quick points:

1) R&R doesn't preclude surgery later (nor does it decrease the success rate for surgery), and;

2) My feeling is that, short of a complete tear, the preferred timeline for TJ surgery and rehab is spring/early summer to spring/early summer.

 

More specifically (IMHO) if the recovery time is ~12-14 months, having the surgery ASAP (in August for Thorpe) doesn't help much. This is especially true for a MiLB pitcher whose season ends the first week in Sept. Not only would they make it back for only 3-4 starts, there would be tremendous pressure on them not have any setbacks as they see the season winding down. They may even end up hurting themselves by not being honest about how their arm feels.

 

Similarly, if the surgery is performed in winter, they may be able to make it back to start the following season, but how many innings are you going to let them throw? It seems to me that the concensus is 70-80 for MiLB pitchers. Is your plan to have them pitch in the cold of April and May, and then give them the rest of the season off (obviously with training, etc.)? Surgery in March/April still allows them to return the following July and get 8-12 starts, and then they can get a few more innings in during Instructional league to bump their total up to 80-90.

 

And since this is obviously a topic we can debate, I would imagine the Lucas Giolito scenario would be held up as a more 'aggressive' approach (and even he did the R&R thing). He had his surgey on  August 31, 2012, and made it back for 11 starts (36 innings) in 2013. That sounds great but, although healthy in 2014, the Nationals still kept his innings below 100. Yes 100>80, but Giolito said he "never had a setback", which isn't going to be true for everyone (or even most).

 

One final note is that the R&R periods for Randy Rosario and Fernando Romero last May/June were only a couple of weeks, and then they had their surgeries. I am not saying you have to like it, but I can definitely see the wisdom in it.

[Halsey Hall]

Lewis said he's having an MRI today. 

[Heezy1323]

Sure, but at some point one needs to do a cost-benefit risk-based analysis:

 

Three events (ranked in reduced time away from the game) :

A. someone to rest for X1 time and then pitch at Y1 percent of his previous level

B. someone to have surgery and have to recuperate for X2 time and then pitch at Y2 percent of his previous level/

C. Someone to rest for X1 time then try to pitch and finding out that he has to have surgery and has to recuperate for X2 time and then pitch at Y2 percent of his previous level.

 

Easily you don't want C because it is the worst outcome of the three.

Choice between A and B should be based on a. the probability that A does not turn to C (and empirically, someone should do the math, based on the PRO PITCHER cases of the last 10 years or so, it seems that 80% or A's go to C) and b. where is Y1 compared to Y2 (and empirically Y2 >= Y1.)

 

Logically, it is a no-brainer, unless there are some personal situations that would negate surgery because of potential complications, but for pro athletes, those are hard to find and likely more detrimental to their career than a UCL tear. Given those numbers, 85-90% of the cases TJ surgery is the best choice. And there is just too much of a risk to wait and find out whether someone is on the 10-15% of the cases that it isn't so...

Trust me, if this were as simple as plugging numbers into a mathematical equation, we would've solved this problem a long time ago. I can tell you with 100% certainty very few things about this issue, but one of them is this: no one knows exactly how well rest works for this problem. It is very difficult to study on a large scale. Several questions arise including

1) how do you define a 'qualifying' injury? Is a guy who has one elbow twinge and skips a bullpen session taking a 'rest'? Two? One start? Two starts?

2) how do you define 'rest'? 1 day? 5 days? 10?

3) how do you define success? Is it returning to normal pitching duties for 10 appearances? 20? If someone needs TJ two years later, is it success? Or failure? How about 5 years later?

4) how do you factor in those who receive PRP or stem cell injections versus those who don't?

5) do you count 'flexor strain' as a UCL injury? Triceps strain? Elbow 'inflammation'? Do all of these count the same?

 

Also realize this- surgeons like to do surgery. 'To cut is to cure' is something I have heard countless times in my career. If surgery was the answer, that's what we would do. Do you HONESTLY believe that despite the tremendous amount of research that has gone into this subject, that surgeons would continue to frequently recommend conservative treatment if it didn't work?

Finally, I can recall seeing at least a dozen pro pitchers during my time with Dr. Andrews with shoulder/elbow issues that had inaccurate information reported the press. Trust me, the public story is not always the 'real' story.

 

I'll get off my soapbox now.