Down goes Parnell

[MFS62]

Lefty Specialist wrote: Hopefully Wilmer gets a start out of this.

And I hope he gets to Wally Pipp someone, and start a long career with the Mets.

Later

[batmagadanleadoff]

Abby Sims has a Masters Degree in Physical Therapy from Duke University and writes a sports injury column for CBS-New York. She doesn't think that Bobby Parnell will pitch again this season.

Sims: Don�t Expect Bobby Parnell To Pitch For Mets Again This Season
April 2, 2014 11:44 AM

After hearing that Mets closer Bobby Parnell was diagnosed with an incomplete medial collateral ligament (MCL) tear in his right elbow, one jumps to the logical conclusion that surgery is in his immediate future. That is especially so with a team physician � Dr. David Altchek � who pioneered a very successful modification of the original Tommy John procedure. The first thing to realize is that the medial collateral ligament of the elbow is also known as the ulnar collateral ligament � or UCL � because of its attachments to the humerus and ulna at the inner (medial) elbow. Now that you know that, the first thought of any Mets fan might be that Matt Harvey recently succumbed to surgery to address the same injury. (Though perhaps the extent of the tears is not identical.) Both men complained of primary symptoms in the forearm. Harvey resisted the knife initially, and now, evidently, Parnell is following suit. The Mets tweeted that after having a Platelet Rich Plasma (PRP) injection, Parnell will rest for two weeks before beginning a throwing program, after which it will be determined whether surgery will be required. Well, what do you think the outcome will be? First, consider that even a partially torn ligament does not heal in two weeks. In fact, complete healing might take a year. The tensile strength of the healing tissue is significantly impaired during the healing phase and is only at about 80 percent of capacity at the three-month mark. Will PRP accelerate things that much? Even if effective, that isn�t likely. Next, keep in mind the extraordinary stresses that pitchers place on the medial (inner) elbow � and the excessive loading of the region � which can create inflammatory or degenerative conditions in a number of structures in the area. This may explain why Parnell�s symptoms � like Harvey�s � were not initially localized to the UCL, which is the primary stabilizer of the elbow. Other tissues often affected include the wrist flexor muscles � which are in the forearm but whose tendons attach at the inner elbow � the forearm pronators (which turn the palm downward), the elbow joint capsule and the ulnar nerve. The repetitive demands of pitching and the nature of the motion itself � particularly the acceleration phase � are the primary culprits. A partial tear of the UCL � also referred to as a moderate (Grade 2) sprain � causes laxity (looseness) of the ligament. This, in turn, creates joint instability. The resulting instability places even greater stress on the surrounding tissues. Even after the cumulative trauma of less significant Grade 1 injuries (micro-tears), ligaments may be weakened and tissues prone to inflammation. At worst, they could tear further. Additionally, other degenerative changes such as bone spurs may result. So, placing excessive demand on weakened structures that were vulnerable even when at full capacity � in other words, pitching � doesn�t sound like a recipe for success. The two weeks of rest sound like a smokescreen to me, and like so many other pitchers who�ve already fallen to elbow issues at this early stage of the season, I wouldn�t expect Parnell to take the mound for the Mets until 2015. If he does, it may not be for long.

http://newyork.cbslocal.com/2014/04/02/sims-dont-expect-bobby-parnell-to-pitch-for-mets-again-this-season/

[batmagadanleadoff]

batmagadanleadoff wrote: Abby Sims has a Masters Degree in Physical Therapy from Duke University and writes a sports injury column for CBS-New York. She doesn't think that Bobby Parnell will pitch again this season. http://newyork.cbslocal.com/2014/04/02/sims-dont-expect-bobby-parnell-to-pitch-for-mets-again-this-season/

How can Sims be so sure without, I assume, access to Parnell's medical records? Does every injury of this kind, no matter the degree, require a minimum of six, seven or ten months of rehab?

[Guest John Cougar Lunchbucket]

You can't much trust diagnosis by media, but obviously you have to assume the worst with an elbow injury and any return this year ought to be wildly optimistic.

I'd sooner bet on Bobby Pee's entire Mets career being over than his returning this year.

[Edgy MD]

She has an MA in physical therapy. I can't possibly doubt those sorts of credentials.

[ashie62]

That two weeks Parnell wants may be more of a coming to grips emotionally with a potentially career ending injury and some denial tossed in....

[metsmarathon]

i think the specifics of the medical file would allow some refinement of hte injury timeframe, but really, i think that based on her background and hte info available, her diagnosis and prognosis is very likely to be correct.

i think that a partially torn UCL is not something that can simply be healed away quickly in any way that will allow for a speedy return to action, unless the initial diagnosis greatly overstates the injury (grade 1 instead of a grade 2 strain, perhaps).

also, given her schooling in physical therapy, i think she's very reliable in terms of being able to forecast recovery times.

maybe bobby pee is a freak like adrian petersen, and wil be back to 100% in 4-6 months. but i really wouldn't hold my breath.

[metsmarathon]

i wonder if taking the two weeks off, and having the prp treatment, might be a thing to do to improve outcomes. but i have no fucking idea.

[Ceetar]

I'm sure the odds fall on the Tommy John side, but Harvey's medical history has little to do with Parnell's.

And they wouldn't be attempting the PRP treatment if it never worked.

[Edgy MD]

I think there's a huge amount of ambiguity in the word "partial." We're all in the dark there.

[metsmarathon]

except that it's the same injury. might of course be some differences in where exactly the tear is in the ligament, and that could drive the decision to attempt the prp or not go ahead with the surgery. but the important pieces here are that its the UCL in the throwing arm of a major league pitcher. those things get heavily stressed, and not fixing them all the way means eventually breaking htem all over again, or breaking other things, some of which could be much worse things to break. and successfully healing a ligament takes a known amount of time, with some variation. that variation is extremely unlikely to extend all the way down to 2 weeks, or really any period of time that should allow bobby parnell to return to the field this season without causing massive risk of near-future injury.

prp is valid therapy if hte player might not go ahead with tjs, and might want to attempt to go full-rehab instead of the surgery path. and since i doubt that it would negatively impact the outcome of an eventual tjs, there's no reason, really, not to do it. especially if you have the money.

[Lefty Specialist]

A friend's brother had the same injury and had the PRP. He said that the treatment really did speed his recovery. Of course, he wasn't throwing a baseball 94 MPH for a living, either.

He also said that the injection was the most painful thing he'd ever gone through in his life. He was braced for some pain but this was off the charts.

Good luck, Bobby Pee.

[metsmarathon]

y'know, it occurred to me that if this spate of pre- and early-season elbow injuries had happened in a WBC year, the entire world of baseball would explode with the fury of a thousand supernovae.

but since its not a WBC year, there's a collective whimper, a sigh, a "whaddayagonnado", and we all go on with our lives.

[Edgy MD]

Partial tear:
[fimg=600:r0ffwz3b]http://makezineblog.files.wordpress.com/2009/03/patch7.jpg[/fimg:r0ffwz3b]

Partial tear:
[fimg=600:r0ffwz3b]https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcQMjSQ7t4Citdzz1DW7AWXQwFPEa4M6AuqD_noziUVCzQGSVWFx[/fimg:r0ffwz3b]

[Frayed Knot]

metsmarathon wrote: y'know, it occurred to me that if this spate of pre- and early-season elbow injuries had happened in a WBC year, the entire world of baseball would explode with the fury of a thousand supernovae. but since its not a WBC year, there's a collective whimper, a sigh, a "whaddayagonnado", and we all go on with our lives.

That's what happens when folks pre-reach their conclusions and then go hunting for evidence that they think backs it up.