The New York Yankees were forced to move Carlos Beltran to the disabled list (DL) on Thursday due to issues arising from a bone spur in his elbow, per Bryan Hoch of MLB.com. Beltran first felt the spur over the weekend and had a cortisone injection on Tuesday, according to Hoch. For now, Beltran is not heading for surgery, but the option remains if there's no progress.
Beltran first began having problems over the weekend. Initially diagnosed as a hyperextended elbow, an MRI showed the bone spur. Joel Sherman of the New York Post called it an "old bone spur," which implies that the Yankees knew about this, and that at some point it's either caused problems for Beltran that were managed or transient, or that it was visualized, likely during a physical.
Thus far, surgery is an option but one that both the team and Beltran are trying to avoid. Beltran told Bryan Hoch that it hadn't been discussed yet on Thursday. This is somewhat surprising given the inability of the team to get quick results and the short absence he would have with surgery.
Beltran told Jorge Castillo of the Star-Ledger that the decision would be made at the end of his DL stint, tacking on two weeks to the normal six-to-eight-week recovery period. The variations in return are pretty wide, but again are complicated because there's not much of a sample size for players comparable to Beltran.
The best-case scenario would be that of Rich Aurilia. The San Francisco Giants shortstop had his bone chips removed in 2002 and was back at the minimum 15 days, a real testament to the rehab work of the late Barney Nugent.
The surgery itself is simple. A small incision is made and an arthroscope is placed inside the joint space. Another small incision is made to insert a camera. The spur is then ground down or sawed off and removed. Any debris is suctioned up and the joint is checked thoroughly to look for any other spurs, chips or other issues. Surgeons often joke that it's exactly what they used to do in the game Operation.
Without surgery, Beltran could be back at the 15-day minimum. The Yankees could find a treatment that will keep him functional and comfortable, though it is certainly not a positive sign that the first cortisone injection didn't have much effect. That Beltran couldn't be shifted to the DH slot also indicates that it is not just throws that are bothering him, another negative sign.
With either surgery or standard treatment there really is no rehab. The elbow is managed for pain and function. Surgery only adds some minor inflammation and infection risk, as with any surgery, but it does eliminate the problem going forward. Players that do have spurs or chips are susceptible to recurrence if they continue to make throws in the same way.
This is not an uncommon injury for MLB players. While it is more often seen in pitchers, any athlete with poor throwing mechanics can cause spurs or chips. A spur is somewhat like a blister. The bone reacts to either a trauma or an irritation by creating a thicker area of bone. If it grows too large, it can interfere with other structures.
If the spur breaks off and floats around the joint, it is called a bone chip. These are also common and are problematic when they get into an area and cause inflammation or irritation.
The usual cause of either spurs or chips in the elbow is that the bones of the arm that meet at the elbow are being forced into each other. That collision will create either inflammation or even small fractures. The olecranon, the point of the elbow, is often involved, which creates inflammation and point tenderness as well.
The Yankees filled Beltran's roster spot with Chase Whitley, who will be taking CC Sabathia's rotation slot for now. Ichiro Suzuki will take over in right field while Beltran is out, though the 40-year-old future Hall of Famer is having some back problems of his own. Zoilo Almonte will also fill in, especially if Beltran's injury goes past the minimum.
This injury could be worse, but it's a very bad omen for a Yankees team already dealing with a number of injuries. The continued workload on the medical staff can lead to further problems, and as the Yankees slide down the depth chart it will get a lot harder, even for a team with the Yanks' payroll strength, to put out a competitive team night after night.