Article: MRI Reveals Torn UCL For Trevor May

[jud6312]

 

My thoughts exactly. The problem is I can see this as a realistic scenario....

I've been predicting it since they signed him. I'm guessing he has an opt-out, and no matter how below average the veteran is, the Twins seem to fear losing that veteran more than anything else.

 

I can't imagine a worse scenario than going a rotation featuring Hughes, Santiago, Vogelsong and every other start Gibson.

 

Yikes.

[Vanimal46]

This is really unfortunate for May.... Guy hasn't been able to catch a break the last 2 years. Wishing him a quick and successful recovery.

 

As we move on, let's win a job in the rotation Berrios or Mejia!

[mikelink45]

 

Was it the Twins who told us that, or was it pundits on forums such as this who were assuming that it's easier to split the atom than to move a pitcher to the bullpen?

It's the third time May has missed time with a back injury this season, as he also missed 23 games in June with back spasms. He saw a specialist at the Mayo Clinic before his return and thought he had found the root of his problem, but will seek another opinion and will see specialist Dr. Robert Watkins in California.
"It's been tremendously frustrating [for him]," Molitor said. "At some point you even wonder when you can't find the exact source of the problem, you start thinking worst-case scenario. I think he's going to be OK over time, but we need to start putting together a program where his focus this winter will be on being healthy."

May's back issues have only flared up when pitching in relief, so Twins interim general manager Rob Antony said he's hopeful May will start next year.
"He'll be told as he was last year to go home and prepare to be a starter and hopefully he comes in and wins a spot in the rotation next spring," Antony said. "He didn't earn one this spring and he had success as a reliever so it was easy enough to put him back in the pen. But I'd like to see him earn a job as a starter next year."

By Rhett Bollinger / MLB.com | @RhettBollinger | September 13th, 2016

Edited March 11, 2017 by mikelink45

[Heezy1323]

 

Can you elaborate on that specifically please?  Difference in effect, and recovery time to be included.

I'm not sure how much detail you'd like me to go into (I sort of 'geek out' on this stuff), so I'll start with a little  and can add more if people would like.

 

1) So everyone is on the same page, traditional TJ uses tissue from another source (usually either a small forearm tendon called the palmaris tendon or a hamstring tendon called gracilis) to 'reconstruct' a new ulnar collateral ligament (UCL). Repair is a similar operation, though instead of making a 'new' UCL out of other tissue, a surgeon simply repairs the injured tissue back to the bone (where it tore away from). 

 

2) Only certain types of tears are amenable to the 'repair' surgery. The UCL can be injured at its attachment on the sublime tubercle (ulnar attachment), medial epicondyle (humeral attachment) or in-between (what we call mid-substance). Uncommonly the ligament can be injured at more than one of these locations, but usually just one. If the ligament is injured at one end, and the quality of the tissue is good, it can be considered for the 'repair' surgery, back to the bone where it tore away from.

 

3) The repair operation has really only gained popularity over the past 3-5 years, and has only been done a very few times on pitchers at the major league level. However, initial studies do appear promising.

 

4) For biologic reasons (that I can expand upon if people are interested, though it may put people asleep), a repair heals and becomes stronger more quickly than a reconstruction. Again, due to the small number of cases done at the ML level, the timeline is still somewhat unknown, but at lower levels, many players are back to pitching at around 6 months post-surgery, rather than 9-12 months as in TJ.

 

5) You asked about 'difference in effect', and I guess I'm not quite sure what you mean by that. The overall effect of the surgery is, of course, the same- to stabilize the elbow against the significant forces of throwing. It is only the manner in which it is done that varies. If that doesn't answer your question, please clarify and I'd be happy to try again.

 

Hope this helps. Happy to entertain follow up questions. Too bad for May, I was certainly hoping for a bounce-back year from him (as we all were).

 

 

Edited March 11, 2017 by Heezy1323

[Dantes929]

 

I'm not sure how much detail you'd like me to go into (I sort of 'geek out' on this stuff), so I'll start with a little  and can add more if people would like.

 

1) So everyone is on the same page, traditional TJ uses tissue from another source (usually either a small forearm tendon called the palmaris tendon or a hamstring tendon called gracilis) to 'reconstruct' a new ulnar collateral ligament (UCL). Repair is a similar operation, though instead of making a 'new' UCL out of other tissue, a surgeon simply repairs the injured tissue back to the bone (where it tore away from). 

 

2) Only certain types of tears are amenable to the 'repair' surgery. The UCL can be injured at its attachment on the sublime tubercle (ulnar attachment), medial epicondyle (humeral attachment) or in-between (what we call mid-substance). Uncommonly the ligament can be injured at more than one of these locations, but usually just one. If the ligament is injured at one end, and the quality of the tissue is good, it can be considered for the 'repair' surgery, back to the bone where it tore away from.

 

3) The repair operation has really only gained popularity over the past 3-5 years, and has only been done a very few times on pitchers at the major league level. However, initial studies do appear promising.

 

4) For biologic reasons (that I can expand upon if people are interested, though it may put people asleep), a repair heals and becomes stronger more quickly than a reconstruction. Again, due to the small number of cases done at the ML level, the timeline is still somewhat unknown, but at lower levels, many players are back to pitching at around 6 months post-surgery, rather than 9-12 months as in TJ.

 

5) You asked about 'difference in effect', and I guess I'm not quite sure what you mean by that. The overall effect of the surgery is, of course, the same- to stabilize the elbow against the significant forces of throwing. It is only the manner in which it is done that varies. If that doesn't answer your question, please clarify and I'd be happy to try again.

 

Hope this helps. Happy to entertain follow up questions. Too bad for May, I was certainly hoping for a bounce-back year from him (as we all were).

Thank you for the info.    I meant is the result stronger from one type or the other.    Is there more likely a reoccurance from one or the other?   

[TheLeviathan]

I don't think you can prove or have data on whether yanking guys back and forth from the pen to the rotation can cause injury.  And the Twins are far from the only ones doing this.

 

That said, athletes train their bodies to do certain things, in a certain way, many times.  I have to imagine for some players a change like that can be a precursor for injury.  Whether it was for May or not is hard to tell, but I think he's said publicly that the bullpen role caused the back injuries and our resident medical expert has acknowledged there could be a connection there.

 

Either way, devastating news.  Trevor can't catch a break in his goal of being a major league starter.  

[FormerMinnasotan]

That's too bad for May, I expected him to take the 5th spot in the rotation over Berrios. With that said I believe Berrios should get the 5th spot over Mejia and Duffey. Berrios has shown improvement from last year and seems much more prepared to start in the Bigs this year. Mejia can come up once either another injury happens to any of the other starters get hurt. Duffey? No thanks, with being a two pitch pitcher he won't be any better of a starter than he was last year.

[Heezy1323]

 

Thank you for the info.    I meant is the result stronger from one type or the other.    Is there more likely a reoccurance from one or the other?   

Apologies for misunderstanding- now your question makes more sense. 

 

Since this procedure is fairly new (in this iteration), and obviously therefore doesn't have 10-15 years of research behind it, I don't think we know the answer to your very appropriate question. It is my belief that, carefully selected, these repair patients should do no differently from TJ patients.

 Now that begs the question, "how do you select?" Right now, especially at the ML level, I would say that this operation is likely only being considered for 'ideal' candidates. Meaning (possibly like Trevor) those players who have a fairly normal elbow and a then a sudden change with a UCL that looks good on MRI aside from the area of the injury at the bone. As more data is collected over time, it seems somewhat likely to me that the selection criteria will be loosened, and this operation will be done on 'less ideal' candidates. That is where we are really going to see how good this procedure is, IMHO. 

 It's hard to know if the injured ligament is completely normal aside from the area of injury, or did the ligament get 'stretched out' a little before it tore and is therefore more likely to have recurrent trouble in the future. We can use the MRI and intra operative evaluation to help us decide, but at the end of the day there are always going to be some ligaments that fall into a gray area. Hard to know what to do with those right now. You would like to get players back to competition sooner. But you also don't want to have them undergo 6 months of rehab, only to find that the ligament was too injured to begin with, then have to resort to TJ and start the clock all over again (in effect, costing them 18 months or more).

Edited March 11, 2017 by Heezy1323

[djvang]

It could be Berrios, Mejia AND Duffey. Not impressed with Santiago and Hughes is coming off surgery.

[Darius]

...and the Twins screw up another career.

 

Unlimited resources. Profits rolling in that they refuse to spend. All that cash laying around, and they haven't thought to put any of it to a medical and training staff that has a clue on how to get players in shape and keep them healthy.

 

Pitching is one thing. But, when you're top hitting prospects are also dropping like flies and getting TJ, something is wrong. Sample size is way too big to keep claiming "bad luck."

 

The ineptitude of this organization knows no bounds.

Edited March 11, 2017 by Darius

[Darius]

I've been predicting it since they signed him. I'm guessing he has an opt-out, and no matter how below average the veteran is, the Twins seem to fear losing that veteran more than anything else.

 

I can't imagine a worse scenario than going a rotation featuring Hughes, Santiago, Vogelsong and every other start Gibson.

 

Yikes.

It's the Twins. You really can't imagine a worse scenario? Andrew Albers? Scott Diamond? I could go on all afternoon.

 

By Twins standards, Santana, Gibson, Hughes, Voglesong, and Mejia is a Starting rotation version of Murderer's Row. There is a chance they're all actual MLB rotation caliber pitchers, even if nothing more than a collection of #5s. They're normally rolling out a couple a guys that wouldn't sniff a 40-man slot on any other club, let alone a rotation spot.

[DocBauer]

Feel awful for May. I think he was poised for a really solid year.

 

Not be sparky, but about Berrios AND Mejia as someone else will invariably get hurt or not be ready?

[Mike Sixel]

Well. This just sucks. Good luck in your recovery sir.

[ken]

At his best May was one of the better 8th inning guys in baseball and looking to be a good bet to be a solid #3 as a starter. Not to mention he very likely would have been the Twins second best SP this year.

 

Hardly mediocre.

Upside of a #3 starter and maybe the second best pitcher on the worst staff in the majors sounds like the definition of mediocre.

[ScrapTheNickname]

119 major league players on 40 man rosters are injured and will not start the season, which averages 3.9 players injured per team.

 

The Twins have 4.

 

As usual, seeing injuries as homegrown incidents with fault laid on coaches, etc. would appear to be more imaginative thinking than sound thinking.

 

A dove recently fell out of the sky and landed in the branches of a tree where it lay suspended for two weeks, then dropped to the ground where it lay for another week before mysteriously disappearing. I blame Sigmund Freud!

 

http://www.cbssports.com/mlb/injuries

Edited March 11, 2017 by ScrapTheNickname

[Bark's Lounge]

May deserved better than this. He was a good soldier in 2015. I hope that wasn't the start of the domino's starting to fall. I wonder if this might be the end of him as a starter?

 

I hope your recovery exceeds the highest level of expectation.

 

Opinions are mixed, but I was on the side of believing he could cut as quality starter with an ability to miss some bats.

[spinowner]

Heezy, thanks greatly for allowing us to read your expert analysis. I think I speak for everyone when I say I hope you will consent to be on call to answer any sports medicine questions that may occur in the future.

[Deduno Abides]

Nope. He went between starting and relieving for four full years.

Mostly as a long man. Different role from what was asked of May. Santana pitched consecutive games only once in 2002 and once in 2003.

[Doomtints]

 

Mostly as a long man. Different role from what was asked of May. Santana pitched consecutive games only once in 2002 and once in 2003.

 

Still a ridiculous argument. Should I list every pitcher who has pitched consecutive games who did not have back problems and torn UCLs?

[Deduno Abides]

Sounds  like just your opinion.    I know people that would only get out there for the Hokey Pokey so whatever dancing skills they might have had would only get better, in my opinion.   Any sportswriters with opinions on this?  Any factual evidence?  If in fact the Hokey Pokey is what its all about then all other dancing would be for the purpose of getting better at the Hokey Pokey rather than otherwise.

You're right. It would be good to get Reusse's first-hand opinion, with pictures.

[Deduno Abides]

Still a ridiculous argument. Should I list every pitcher who has pitched consecutive games who did not have back problems and torn UCLs?

Lighten up, Francis.

[bighat]

Why panic?  I never understood the "bro crush" everyone has on May, as he goes out and posts a 5+ ERA every year.   This'll just make the Berrios decision easier.   We've got more than a few guys to back him up, too.  May seems like a good dude, and it's a bad break for him personally - but as far as this team's hopes go, I hope nobody really believed he'd be an impact player. 

[Heezy1323]

 

Heezy, thanks greatly for allowing us to read your expert analysis. I think I speak for everyone when I say I hope you will consent to be on call to answer any sports medicine questions that may occur in the future.

I enjoy participating in these discussions, and am happy to do my best to answer questions as they arise. I had considered starting an 'Injury' thread so that people could post there, since I may not always see posts in other threads. If people think that would be helpful, I'd be happy to do so.

[USAFChief]

Unfortunate, to say the least. Get well, and best of luck.

 

I'd also like to ask, as a mod, that posters both

 

1) ease up on loosely founded and wildly skeptical blame, and

 

2) ease up on attacking those who do.

 

Neither are worthy of these forums.

 

Thanks.

[Bark's Lounge]

Addressing some of the posts in this thread. Everyone is different. Some people thrive in having one sole focus, some thrive under a more chaotic, multi-tasking strength.

 

I think it is important for an organization to understand the mental mechanics of their players and put them in a position to succeed. Sometimes needs will arise that put you between a rock and a hard place.

 

That is what probably separates the good organizations from the rest... the ability to know when to pull a trigger and when not to pull one.

 

I am not stating that this is the case with the Twins or Trevor May, but you have to take it into consideration. We are not robots, we are all uniquely different as humans and just because one guy can do something diverse, does not mean the next guy can.

[jud6312]

 

It's the Twins. You really can't imagine a worse scenario? Andrew Albers? Scott Diamond? I could go on all afternoon.

By Twins standards, Santana, Gibson, Hughes, Voglesong, and Mejia is a Starting rotation version of Murderer's Row. There is a chance they're all actual MLB rotation caliber pitchers, even if nothing more than a collection of #5s. They're normally rolling out a couple a guys that wouldn't sniff a 40-man slot on any other club, let alone a rotation spot.

Is that you, Mrs. Vogelsong? 

[DaveW]

Unfortunate, to say the least. Get well, and best of luck.

 

I'd also like to ask, as a mod, that posters both

 

1) ease up on loosely founded and wildly skeptical blame, and

 

2) ease up on attacking those who do.

 

Neither are worthy of these forums.

 

Thanks.

Since this is partially in reference to my original statement, I hardly would call it loosely founded or wildly skeptical. I linked to one of the most well respected baseball minds who shares the opinion of putting a pitcher into the pen, then back into the rotation etc causes these sorts of issues.

 

Additionally May has said as much himself, stating that the bullpen usage may be to blame for his back issues.

 

Having a guy go from a decade or so of pitching every 4th or 5th day, to pitching back to back days or 3 in 5 days etc is going to have an effect. As is suddenly "stretching" him out again.

Yes, the Twins are far from the only team to do this, but more often then not it results in said high upside pitcher ultimately getting injured on ineffective. Part of me wonders know if Hughes injuries are because the Yankees pulled the same nonsense on him.

 

Ditto with Joba etc

 

All of this in summation: I don't think the Twins helped Trevor may and his health etc by putting him back and forth between rotation and pen.

 

People can disagree, which is fine, but for a team that has finished last 5 of 6 years, with a terrible pitching staff overall in that time, I have a tough time giving them the benefit of the doubt at this stage.

Edited March 12, 2017 by DaveW

[Richie the Rally Goat]

May is a back end guy too, but you believe bouncing him around destroyed his arm.

 

I'm not getting you today, at all.

you can be great at things that might not be good for you.

[DaveW]

I think people tend to underestimate the value of a guy who can be a solid #3 starter. Those types get $12-$15 mil a year on the FA market (see: Santana)

 

May isn't and wasn't going to be an ace, but he could miss bats, and could pitch well. This is a huge loss from the rotation IMO.

[Doomtints]

 

By Twins standards, Santana, Gibson, Hughes, Voglesong, and Mejia is a Starting rotation version of Murderer's Row. There is a chance they're all actual MLB rotation caliber pitchers, even if nothing more than a collection of #5s. They're normally rolling out a couple a guys that wouldn't sniff a 40-man slot on any other club, let alone a rotation spot.

 

There's a reason scouts have started a new distinction -- #4 pitchers, and #4 pitchers for the Twins.

Mejia is slated to be a #4 pitcher -- for the Twins.