Chris Sale Hits DL with Arm Problems, Sox Look for Answers on Ace's Injury

Will Carroll@injuryexpertSports Injuries Lead WriterApril 22, 2014

USA Today

The Chicago White Sox placed team ace Chris Sale on the disabled list with what they called a flexor strain in his pitching elbow, according to Scott Merkin of However, Robin Ventura took that specific diagnosis and cast a bit of smoke around it, claiming the soreness was not specific to the elbow. Sources indicate to me that the strain is minor and focused, but there is no indication of damage to the ligament.

Sale did have an MRI on Monday night, and various media reports indicate that the images did not show structural damage. General manager Rick Hahn indicated that the soreness was in a similar location and width of location to his previous issues, but that he did not believe that there was any further damage to the elbow itself. (There's some debate as to whether the flexor mass is "elbow" or "forearm," but this illustration shows that it's semantics.) 

Sale did have a similar, previous issue in both 2012 and 2013. However, in both cases, the problem was with his shoulder. The Sox went as far as removing Sale from the rotation and making plans for him to move to the closer role, but he successfully lobbied for a return and was back in the rotation after one appearance from the pen.  

Many are pointing to the 127-pitch outing that Sale had in his last game. While this is high for 2014, it's not that high historically, and there is no evidence that it contributed to the current issue. Last time Sale missed time, he'd gone 113 pitches in his previous start before missing a couple of starts. 

It's also worth noting that Sale had two 124-pitch outings in 2013, both coming after his missed starts. On the other hand, Sale did come in the top five of Pitcher Abuse Points in 2013 and leads the league early this season. In 2012, Sale had problems but no games with a pitch count over 119. At best, the data here is mixed. 

There's also plenty of talk about Sale's rail-thin frame and his awkward mechanics. It's the same frame and mechanics that caused teams to red flag him in the draft, leading him to fall to the Sox in the first place. While concerns are there and valid, Sale's results have gone above and beyond players considered more solid and who "looked better in a uniform," as scouts like to say. There's no evidence that either contributed to this current injury.

The Sox did seem to know well before the MRI that the issue was not with the ulnar collateral ligament (UCL), which confused many. Beyond the fact that Sale and the Sox medical staff have seen this issue before and could say "this feels the same," there are also simple manual tests that can determine the integrity of the UCL. No doubt that head trainer Herm Schneider did these tests and more as necessary.

There are situations where flexor mass issues eventually become UCL issues. The most recent that comes to mind is Orioles prospect Dylan Bundy. Again, there's simply no evidence to indicate that Rick Hahn and his organization are lying about this injury. There's no advantage to doing so. If something changes and if the problem gets worse, this isn't going to look good, so most get the info out. Let's face it, everything leaks.

As well, sources indicate that Sale will get an injection of platelet rich plasma (PRP), which is a common treatment for many athletic injuries to soft tissue. If so, Sale will likely not throw for the next five to seven days before starting back onto a limited throwing program. If he stays on track to return at or near the minimum, the Sox will look to "match" him with another pitcher, likely his replacement Charlie Leesman, who will start Tuesday.

While not related to this specifically, I should note that after my appearance on MLB Network's High Heat on Friday afternoon, several sources told me that there were a couple of teams using diagnostic ultrasound currently, though only a few had it available during games. (Most teams have the unit available but do not have the doctor trained to use and read it available during games.) One of those teams that I was tipped to was the White Sox. They could have used this to check the integrity of both the UCL and the flexor mass.

The Sox do have one of the top-rated medical staffs in the game, with an enviable record of pitcher health under Herm Schneider. With that on his side and a couple of shoulder episodes that ended with nothing more than a couple of lost starts, there's positives here. However, don't be fooled into complacency. This is Sale's first bout with elbow problems and the first to push him to the DL. The Sox may just be playing this very conservatively, but they're doing so in a way they haven't before. 

Sale will bear watching over the next 10 days. If he's back on a mound and throwing in time to put him back on track for a start at or near the minimum, Sox fans can exhale. In the meantime, they'll have to hope that Charlie Leesman can fill in, but it's difficult to replace an ace.


Data courtesy Baseball Reference and Baseball Prospectus, as indicated.