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Is Liriano destined for Tommy John?
Posted by Stephania Bell at 9/15/2006 2:41:00 AM
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So I was asked today: If Liriano has a mild tear of his ulnar collateral ligament,isn't it a matter of when and not if he needs Tommy John surgery? I considered it - and unfortunately, the answer is not an easy yes or no. Here's why. If a player is being reported as having a mild "tear" that sounds like a little more than the typically reported "sprain" - and even though a sprain is, in fact, a tear, it can be microscopic - hard to visualize, resolves easily - and for whatever reason is rarely reported as a tear. The fact that they're calling it a tear suggests a little more (although I have no evidence of that obviously, just a hunch) - and when you're talking about a pitcher, the further the degree of damage, the more likelihood he's headed for the TJ - especially a young guy with a big future. It's all a continuum - and at some point you decide (the MD decides) that you're essentially past the point of no return and the surgery is recommended. Of course, it's also an issue of timing. Surgery soon would put him back potentially in time for the end of next year - depends on a number of factors - but could mean not back until spring '08. However, if they DON'T do surgery, shut him down, and then in spring he fails, ends up needing it, then he's lost another season (wouldn't be back before mid-'08). Now to flip it. If it is indeed a Gr I sprain that just didn't have enough total rest, they can splint him now for 6 weeks to allow the ligament to scar over better (obviously he came back to pitch within 6 weeks so more rest could be all he needs), then progress him back gradually and he could (emphasis on could) be fine. Another option would be to scope it, check it out for real, and decide then whether he needs the full procedure or whether a little clean up and scar repair would do the trick. So - try and sort that all out. Here's my hunch for what it's worth. They will likely scope it and decide from there. My guess is the 2nd opinion he's waiting on is with the revered James Andrews. If he's done for the season, there's no setback with a scope - and then they'll know free and clear what he really needs.


The presence of a even a microscopic tear should mean surgery. Rehab (strength and flexibility) coupled with a mechanical change in his motion aren't enough. He'd be fine until he hit about 75% of maximal effort and force on that elbow and then he'd have an immediate, precipitous drop-off in effectiveness. It is difficult to replicate the stresses of a game situation (adrenaline induced effort) during practice so he probably never reached that effort level before hitting game speed (Wednesday was a prime example of this). He probably has dozens of "microscopic tears" through years of the force exerted during the late cocking to early acceleration phase of his pitching motion. Microscopic tears mean an eventual rupture, surgery and a 12-18 month rehab. Two of every three athletes return to their pre-injury level by the 12 month point; full recovery (physically, not psychologically) comes somewhere around the 13-14 month point. Get thee to Andrews tomorrow and make the decision -- either way -- immediately. His future depends on it.
Posted by eaglehawk at 9/15/2006 5:39:00 PM
You could see something wasn't right, because he was only hitting 92-94 mph on his fastball, which is usually in the 94-97 mph range. He's our franchise and I hope he'll be alright. What's with all the young pitchers petering out this year?
Posted by schwang2u at 9/16/2006 12:15:00 AM
Isn't this a repeat injury he had with San Francisco..,was treated naturally, ie. (rest,scar tissue buildup), scar tissue breaks a month or so ago (again rest) comes back, pitches two innings.. out - mri shows status of the month ago...

just a fringe guess, but maybe the tj best thing to stop the pattern?

scar tissue build up is a weaker fix than original condition while t.j. has shown (best circumtances) to be a stronger fix than the original condition.

seems like if this is the pattern that has played out with his health history, that would be a strong indicator toward tj.
Posted by dryice at 9/17/2006 9:11:00 AM

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