The worst case happened for Bryce Harper. As I noted yesterday, Harper was headed to Dr. Thomas Graham in Cleveland to have his thumb checked. That opinion will lead to surgery to correct a severe sprain of a ligament in his hand, according to MLB.com and others. The surgery is expected to take place on Tuesday, leaving Harper sidelined until July.
This is the same type of surgery that Josh Hamilton had and much the same mechanism. Last year, Dustin Pedroia had a similar injury and was able to play through it. Another well-known case with a similar injury was another Red Sox player, Kevin Youkilis. Youkilis had the same type of surgery Harper will have done by Dr. Graham, so his return is a reasonable data point.
The injury turns out to be the worst-case scenario after Harper originally believed he would be able to avoid the DL. "It was a sprain like they said, and they are really trying figure out in 15 days how I feel," Harper told Bill Ladson of MLB.com. "I'm not worried too much. We have a lot of off-days in the next two weeks, so that is huge. I'll try to get a lot of treatment on it. We'll see where I'm at."
While much is being made of Harper's sliding head-first, there have been studies on this. The best study was done in 2000 by Dr. Robert Hosey using data from college baseball and softball. Surprisingly, the incidence rate of injuries after feet-first slides was more than double that of sliding head-first or even just diving back to the bag on a pickoff play.
The surgery is relatively simple, reconnecting the ligament. There is usually no need for harvesting a replacement. Dr. Steven Shin of the Kerlan-Jobe Clinic told me "Almost always, the torn ligament itself can be repaired, usually back to the bone that it tore off of." There is a small scar on the back of the hand, but the surgery can be done with minimal invasion or trauma to the rest of the hand and wrist.
The rehab for this kind of injury normally takes between six and eight weeks, with additional time necessary to regain the swing and timing. The rehab focuses on mobility, strength and function for the thumb and the repaired ligament. There is also work done with the muscles and supporting stabilizers in order to guard against having the repaired ligament overtaxed in early stages.
Seeing as this type of injury is almost always the result of a single trauma, there tends to be little associated damage. Once the ligament is surgically repaired and healed, the rest of the hand should be fine. There is some slight worry about atrophy and the loss of grip strength, but the rehab will address this as soon as possible.
The Washington Nationals do not have a great track record at keeping players healthy or at returning them from inaction. Over the past decade, the Nats have been at or near the bottom in terms of days and dollars lost, though for much of that time they were hamstrung by substandard facilities. Once they moved to their new park, that excuse went away and there has been some improvement.
A wild card in the rehab process may be Scott Boras. Harper's agent has long run the Boras Sports Training Institute near his offices in California. Run by former White Sox strength coach Steve Odgers, Boras has often had his players do their rehabs there, under Odgers' supervision. As with doctor choice, the player can also choose to rehab away from the team, though many teams fight for control of this process. Harper's close relationship with Boras and his value may push this solution.
The earliest sign to look for that things are going well is seeing if Harper can hold a bat. While he won't be swinging a real bat for a while, any sign of grip strength returning is a positive. This will normally come at the two- to three-week mark post-surgery.
The major factor for Harper will be grip strength and the fine muscular control necessary to adjust to the movement of pitches. It's not uncommon to see more swings and misses as the player regains his strength, control and timing. Power is often affected in very early stages, but seems to come back more quickly than with wrist injuries.
Dr. Shin reminded me in our conversation that it is more than just the thumb that will need rehab. "It is important to also make sure one rehabs the wrist and fingers, as well as the rest of the upper extremity, which might have become deconditioned during the immobilization period," he explained. "If the thumb is on the bottom hand when swinging, I am more cautious about starting swinging, usually around four weeks post-op. If the thumb is on the top hand, I'm less concerned and will allow swinging shortly after the cast is removed."
The normal timeline would have Harper heading out on a rehab assignment sometime around early June. As long as Harper doesn't slide back into July for any reason—aside from the Nats being very cautious with their young star—it shouldn't be considered a major negative. Again, look for signs that Harper is controlling the bat. Power should come, but focus much more on his ability to make contact.
Harper shouldn't have great difficulty returning from this surgery. His thumb should return to full function, keeping his swing unchanged. The greatest loss is time, with the Nationals missing a couple months of Harper's skills. After last year's games lost, another year of playing 120 games or fewer will get many wondering whether Harper's hustle is costing him durability and possibly shortening his career.
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