Masahiro Tanaka's Elbow Presents Unique Risk Regardless of 2014 or 2015 Return

Will Carroll@injuryexpertSports Injuries Lead WriterAugust 25, 2014

New York Yankees pitching coach Larry Rothschild, left, watches pitcher Masahiro Tanaka, right, throw in the bullpen before a baseball game between the Yankees and the Tampa Bay Rays Saturday, Aug. 16, 2014 in St. Petersburg, Fla. (AP Photo/Steve Nesius)
Steve Nesius/Associated Press

"Shut him down!"

With each pitch that Masahiro Tanaka throws, the cries from fans echo fainter. When it would have been simpler to let their ace wait and watch as Derek Jeter's last season faded away rather than burned out, the New York Yankees didn't go the easy way. They went the smart way.

Instead of shutting him down, the Yankees sent Tanaka all the way across the country to have his elbow examined. It was a bit of a fluke that Dr. Chris Ahmad, the Yankees team physician and one of the top doctors in baseball, was at a convention of orthopedists. Tanaka was not only checked by his own doctor, but by a few more of the best in the business. 

All agreed that the small tear, said to be around a 10 percent tear, did not need surgery. The standard is that a 25 to 33 percent tear is in a grey area, but anything above that normally will need a reconstruction (Tommy John surgery). With the small tear, the consensus was that Tanaka had a good chance of rehabbing through the injury and pitching again in 2014. 

Ahmad and the Yankees agreed to rest Tanaka for several weeks and then set him up on a conservative rehab throwing program. They also used an injection of platelet-rich plasma on Tanaka's elbow.

This standard but still poorly understood procedure uses a patient's own blood to help stimulate healing. The early discomfort that Tanaka reported in his elbow may well have been his body's reaction to this procedure. That Tanaka made rapid progress after the first two weeks of pure rest matches this.

It will probably be a good trivia question someday, but Tanaka owes a small debt to another Japanese pitcher if he recovers well. Takashi Saito was the first MLB pitcher to undergo PRP for an elbow injury. His injury and recovery went very well.

Tanaka had no problems at all through the various phases of the rehab throwing program. Most pitchers with more significant sprains will fail at these early stages, such as how Matt Moore did in his first throwing session. As he extended out and then progressed to a mound, Tanaka had no issues. 

Tanaka's next step is to throw a simulated game. He'll do that Thursday, on the road in Detroit, according to MLB.com. This will test his ability to recover between innings and should elicit any lingering pain or inflammation from the elbow. 

The Yankees may not have been working blind. Though the team has refused to confirm, sources tell me that they have used a portable ultrasound to check the ligament throughout the process. (I detailed this device near the bottom of this B/R article.) By actually looking at the ligament and monitoring its progress through the process, the Yankees were able to make educated decisions at each step.

Compare this to what the Washington Nationals have done with Stephen Strasburg and other pitchers. Several seasons back, the Nats shut down their ace near the end of the season as he passed 150 innings pitched. Strasburg was coming back from Tommy John surgery and should have been at his strongest.

While I'm not advocating throwing him if fatigued, the Nats essentially picked a random number to stop him at. Worse, the shutdown did nothing to reduce the risk of future injury for Strasburg.

While Strasburg has been healthy, and it is hoped he continues to be healthy, there's no direct causation to the shutdown. Most pitchers in the four- to five-year period after surgery remain healthy and have no issues. The Nats did similar things with Jordan Zimmermann and recently with Lucas Giolito, the top pitching prospect in the minors.

Tanaka will remain risky once he returns. The ligament is functional, but not as strong as it was, even when completely healed. A ligament is like the rest of the body and heals in an involved manner. Over time, the ligament will get stronger until it is almost back to normal.

Adam Wainwright pitched several top-notch years in a similar situation. Eventually the ligament did give out, though it's unclear if it was directly related to the original injury.

In fact, Wainwright brings up the biggest risk for Tanaka. If the definition of insanity is doing the same thing and expecting a different result, pitching with the same injurious mechanics and expecting different results is pure insanity. Tanaka's mechanics certainly look odd and appear to have significant timing issues.

That said, he's been exceptionally successful and durable with those mechanics prior to this injury. Add in that Larry Rothschild, the Yankees pitching coach, is not known as a tinkerer, and it's unlikely that Tanaka will make any significant changes during the rehab process. 

Tanaka has shown a high levels of skill and integrity. His apology for his injury to fans is certainly one of the more unique things that I can remember happening after a player went on the DL. At no stage has Tanaka shown that he wasn't willing to do whatever it took to get back. His stoic exterior has disguised any pain, but it has also disguised how hard he's worked in rehab. 

One thing to keep in mind is that Tanaka's results are unusual and very individual. The low-grade sprain gave the medical staff something to work with. A significant sprain is still going to lead to surgery, but it's a reminder that there's progress being made.

Along with the years of work they've put in on Michael Pineda, the Yankees medical staff certainly appears to have a win. While Tanaka is not back yet and could have a setback with any pitch, things certainly look very positive for a September return. He's risky, but the return could be exceptionally valuable as they sit just a few games out of the second wild-card spot. 

Shut him down? No. But with every pitch Tanaka throws from now until the end of the season, even if one of them ends in injury, the Yankees are telling those that called for a shut down to simply shut up.


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