The Kansas City Royals received good news on Tuesday after the MRI results on rookie phenom Yordano Ventura came back. Royals general manager Dayton Moore told MLB Network (via Matt Snyder of CBS Sports) that Ventura would miss only one start, though he declined to offer specifics about the injury.
Ventura worried Royals fans when he left his Monday start holding his elbow tightly to his side. Ventura had not shown his normal velocity, causing manager Ned Yost to ask if he was throwing changeups, according to Andy McCullough of The Kansas City Star. Ventura has been clocked at the magic 100 mph mark several times this season, so the drop-off was very noticeable.
Initial reports came from the mouth of Yost, who said that all of Ventura's pain was on the lateral side of the elbow, which can be confusing to many due to anatomical positions used to describe the elbow. While the ulnar collateral ligament is on the medial side—it is also called the medial collateral ligament by some, including Mets team physician David Altchek—there are cases of referred pain.
The lateral aspect has many possibilities, including an olecranon fracture, bursitis or bone spurs. With Yost also saying that Ventura was "banging his fastball," there's the possibility that Ventura is literally banging the bones of his upper and lower arm together on every pitch. (Go ahead and try this at home. Gently (!) extend your arm. If you push just past a comfortable lock, you will feel the bones touch.)
Since X-rays are quick, the fracture and spurs are unlikely to be the culprit.
Instead, the short-term timeline and lack of a differential diagnosis leaves us with the vagaries of inflammation. The Royals have yet to elucidate us on causation, which makes me wonder whether they know. It's easy to rest Ventura and get the inflammation out with ice and anti-inflammatory medication but harder to fix the cause, especially if it's unknown.
Many, including Jeff Passan of Yahoo!, question whether or not Ventura's velocity is the problem, citing issues with other hard throwers. The problem is less about velocity and more about stress. Can a pitcher create huge forces without transferring too much load? We know that some pitchers create over 60 Newton-meters of force on a ligament that breaks at about 32 Newton-meters.
An analogy to this would be a race between two cars. Imagine taking your car and running it alongside a Ferrari around the Indianapolis Motor Speedway. Sure, your car is probably nice, but I'm guessing it's not a Ferrari. Both can probably do 100 mph around the track, but one of them will be taking a Sunday drive while the other is likely going to be bouncing off the red line and screeching around the turns. Pitchers are the same way; some deal with the stress better, though we don't know why.
The problem is that teams also don't know. Yordano Ventura has never had a biomechanical analysis done, so the Royals have no idea how much stress he's creating with every pitch. To continue with the car analogy, the Royals are buying a Ferrari without getting the Carfax. That analysis would cost $199 at the University of Missouri's lab, far less than the loss of even one start of a minimum-salary player like Ventura.
If Ventura really is going to miss only one start, he'll have limited rest. He would need to be back on a mound shortly after his missed start, doing side work to keep himself in shape. With limited time to beat the inflammation and none to make any mechanical changes, the Royals must either believe this is very minor or have reached new levels of self-delusion.
Ventura will not go on the disabled list now, but this is a low-risk move. The Royals will retain the possibility of placing him on the DL at any time, with a retroactive move to Tuesday. Ventura is too good to drop in any format, so wait and see is the only move.