Pat Neshek: Was Rehab the Right Choice?

After injuring his throwing elbow in May this past season, Minnesota Twins reliever Pat Neshek was diagnosed with a partial tear of the ulnar collateral ligament. However, no surgery was required, as it was determined that rehab would heal the injury.

Fast foward six months.

Days away from completing rehab, Neshek experiences discomfort in the same elbow while throwing. An MRI revealed that the other side of the ligament was completely torn away from the bone, requiring Tommy John surgery.

The initial outcry from fans everywhere has been whether or not Neshek should have had surgery to begin with, rather than going through with the rehab.

The question is valid, but the team made the right decision.

Tommy John surgery requires at least a year to recover from, and in many cases it takes up to 15 months. The injury occurred on May 9 this past season.  Had Neshek's initial prognosis required surgery, it would have taken place closer to June.

Do the counting. From June, or for that matter, count 15 months from May and see what you come out with. If you counted correctly, you’ll get to August 2009.

Assuming the recovery would take 15 months, Neshek would have had the opportunity to return with one month remaining in the 2009 season. However, he would have likely needed some sort of minor-league rehab stint like Francisco Liriano did in 2008.

And it would be questionable whether he‘d see a major league mound.

Looking back now, surgery wouldn’t have been a bad option, regardless of the fact that  Neshek would have missed a good portion, if not all, of the 2009 season.  As it stands now, Neshek is guaranteed to not see the field at all next season.

At the time, it was a wise decision to allow him to rehab the partial tear, which has an 80-percent success rate. Had the rehab worked, and Neshek returned this spring, we would have all been happy that surgery was avoided.

More comfort in the decision can be gained from Dr. James Andrews, who performs the widely known Tommy John surgery. While it has been said that the Twins' doctors made the decision, according to Joe Christensen, Andrews did agree with their recommendation:

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When Neshek was first injured in May, he received a second opinion from Dr. James Andrews, who agreed with the Twins recommendation to rehab the injury, instead of having surgery.

“I don’t think the plan was wrong,” Smith said. “He re-injured it the other day, and now it’s a complete tear, and that changes the diagnosis completely.”

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It would be nice to think that immediate surgery would have been a better choice, but taking a shot at rehab and a shorter return timetable was the correct move.

The date of Neshek's surgery is irrelevant.  In either case, the timetable would have forced Neshek to miss the Metrodome’s final season and look ahead to Spring Training 2010.