Wheeler: Torn Ligament, Tommy John Surgery Likely

[dgwphotography]

Ceetar wrote: Ceetar wrote: No, he's asking why they didn't do something about it. According to our great GM's quote, they knew about this already. So, why not do something about it in the off-season, instead of pushing him and waiting until now? No. He didn't have a tear in January. It was only 'expected' because he's a freaking pitcher and his previous MRIs did show weakness. Unless he's talking about the crock idea of a preventative Tommy John surgery.

You do know that he was in pain all off-season, and needed a shot, don't you? If he didn't have the tear then, then why the pain?

[batmagadanleadoff]

The New York Times raises the possibility that Wheeler might have been misdiagnosed, noting that those tears, in their earliest stages, can be missed, even on MRI images.

Bad Luck or Bad Practices? It�s Tough for Mets to Tell
By DAVID WALDSTEIN MARCH 16, 2015

So extensive is the growing list of Mets pitchers who have needed Tommy John surgery in recent years that even their general manager had difficulty recalling all of them on Monday. �I don�t have all the cases in front of me,� the general manager, Sandy Alderson, said on a conference call with reporters, �but the four I can think of are deGrom, Matz, Wheeler now and Harvey. As well as Hefner, I guess, will be five.� More formally, the five are Jacob deGrom, Steven Matz, Matt Harvey, Jeremy Hefner and Zack Wheeler, who is the latest Mets pitcher found to have a tear in his ulnar collateral ligament, that tiny bit of sinew in the elbow that has cost so many pitchers at least a year of their careers. Alderson did not mention four other past and present Mets pitchers of note � Jenrry Mejia, Mike Pelfrey, Bobby Parnell and Josh Edgin � who have required the operation since 2010, with the team announcing Sunday that Edgin would have it this week. That makes for nine Mets pitchers in all � or 10 if you factor in that Hefner has had the procedure twice � a total that seems excessive even as teams across baseball lose more and more pitchers to elbow injuries. �You can always look at your practices in developing pitching,� Alderson said during the conference call. �Also look at mechanics and whether mechanics are clean or not clean, velocities, types and assortments of pitches. We will certainly continue to look at what we�re doing. But this is an industrywide problem, and there is some suggestion this goes back to pitching loads and things that predate even college. So it�s something baseball has to continue to look at. We do as well.� Because there is no real consensus on why so many pitchers are tearing their elbow ligaments, Alderson and the Mets will have a hard time figuring out whether they have simply been victims of bad luck or whether practices within the organization need to be addressed. �It does seem as if the Mets are consistently dealing with this issue,� said Dr. Craig Levitz, the chairman of orthopedic surgery at South Nassau Communities Hospital on Long Island. �It could be some of the things they are doing, it could be the pitchers that they pursue, and it could just be bad luck. It�s very hard to know.� After Harvey hurt his elbow in 2013, the Mets looked into pitch counts and rest days but made no substantial changes regarding the way their pitchers were treated, Alderson said. �Caution is the best thing one can learn from any of these,� he said. Still, the Mets did not act more cautiously with Wheeler in camp this year than they did with other pitchers, Alderson said, citing advice from the team�s medical staff. Wheeler had pitched with elbow discomfort in 2014 and had magnetic resonance imaging tests on his elbow in September and January. �If the doctors had felt that we needed to treat him in a different way, we would have,� Alderson said. Levitz, who has worked alongside Dr. James Andrews, the orthopedic surgeon widely regarded as the leading expert on Tommy John surgery, has not examined Wheeler but followed his case in recent days through published reports. Levitz said Wheeler�s injury � a full tear of the ligament, as detected by an M.R.I. over the weekend � almost certainly did not come out of nowhere in the last week. In all likelihood, Levitz said, the two previous M.R.I.s missed a small partial tear in Wheeler�s elbow that eventually became a full one. Had the full tear occurred several months from now, in the middle of the season, it might have been independent of the elbow tendinitis that Wheeler was feeling last year, Levitz said. But the fact that he felt discomfort after only one spring training start indicated that it was related to his problems from last season. M.R.I.s sometimes give false negatives, especially when they are used without a dye that can help expose even the smallest tears, Levitz said. But Levitz, citing the three M.R.I.s the Mets gave Wheeler in seven months, said it was clear that the team�s doctors had been suspicious of something. �It was probably ulnar collateral ligament stuff that masqueraded as tendinitis because the M.R.I. was normal,� Levitz said. �Ulnar collateral ligament tears are very difficult to diagnose sometimes. It could have been a very small tear that didn�t show up, and even if it did, you might have followed the same protocol for the player that they did.�

http://www.nytimes.com/2015/03/17/sports/baseball/bad-luck-or-bad-practices-its-tough-for-mets-to-tell.html?_r=0

Edited March 17, 2015 by Guest

[Ceetar]

he _didn't_ have the tear. The MRI in January did not show it.

[dgwphotography]

Ceetar wrote: he _didn't_ have the tear. The MRI in January did not show it.

Look up one post. These tears can be missed, even in MRI images

[batmagadanleadoff]

Ceetar wrote: he _didn't_ have the tear. The MRI in January did not show it.

Unless the MRI did show it, but was missed by Mets doctors. Or unless the MRI ought to have shown it, but not enough dye was injected into Wheeler, so as to reveal the already existing injury. See NYT piece, above.

[Edgy MD]

Well, those two statements don't necessarily follow each other. it's certainly possible, as the Time speculates, that he did have the tear, but the examination didn't show it.

OE: Or what he said. And what he said.

[batmagadanleadoff]

Edgy MD wrote: Well, those two statements don't necessarily follow each other. it's certainly possible, as the Time speculates, that he did have the tear, but the examination didn't show it.

Yeah. But if you're addressing my post, that's why I used the word "unless". All three possibilities are in play.

[Ceetar]

Edgy MD wrote: Well, those two statements don't necessarily follow each other. it's certainly possible, as the Time speculates, that he did have the tear, but the examination didn't show it. OE: Or what he said. And what he said.

So the Met should've what? Known the MRI test is wrong? Not trusted the doctors?

Maybe they should've sent him for an MRI in the offseason to ..oh wait.

And when he still felt pain in March they should've..oh wait..

What Klapisch is suggesting is the the Mets should've told him, so he could fill column space in the offseason with some news type stuff.

[Edgy MD]

batmagadanleadoff wrote: Edgy MD wrote: Well, those two statements don't necessarily follow each other. it's certainly possible, as the Time speculates, that he did have the tear, but the examination didn't show it. Yeah. But if you're addressing my post, that's why I used the word "unless". All three possibilities are in play.

No, I was addressing ceetar's post.

I don't pretend to know what the Mets should have done. I'm just pointing out that the MRI giving a negative result with regard to a tear doesn't necessarily lead to the conclusion that the tear was there.

I'm just loyal to the logic, man. I don't know why you chose my point to play that jazzy "oh, wait" game.

[batmagadanleadoff]

I thought you were responding to my post, that's all.

[Edgy MD]

Yes, and just to clarify, the next two paragraphs of my post above were addressed to my friend, ceetar, and his comments in response to mine, which I bequoted.

[Benjamin Grimm]

And this is addressed to Zack Wheeler:

Get well soon!

[nymr83]

Maybe the Mets should have anounced to the entire leafue that they might be without their #2 starter from a year ago and they were now trading and negotiating from a weaker position. Oh, wait, that doesnt make sense does it?

Maybe the doctors should have violated hippa to satiate the writers' curiosity and feed the conspiracy theorists... No, that doesnt work either.

Maybe everyone did everything just fine and there is nothing to see here?

[Guest LeiterWagnerFasterStrongr]

"BUT WHY DIDN'T THEY TELL MEEEEEEEEEE?"

-The subtext of each and every critique of the Met "handling" of the Wheeler injury that I've read so far

[nymr83]

LeiterWagnerFasterStrongr wrote: "BUT WHY DIDN'T THEY TELL MEEEEEEEEEE?" -The subtext of each and every critique of the Met "handling" of the Wheeler injury that I've read so far

Yup.

[Guest Mets Guy in Michigan]

I think "transparency" is a word that applies to governments, not baseball teams. Baseball teams don't have to tell anyone anything.

Reporters are grumbling because they have to justify not knowing about this months ago.

[Frayed Knot]

The other take on this seems to be: 'Injuries show weakness in Sandy's plan' -- as opposed to those other GMs whose plans are unaffected by two TJ surgeries in the same week.

[Benjamin Grimm]

That may be an argument you can make regarding Edgin, with the Mets now without a clear option for who will be their left-handed reliever. But Wheeler is a different story entirely. His injury has caused the Mets to go from having nine starting pitchers to having only eight. This sucks for Zack Wheeler, of course, and there certainly will be a ripple effect, but with Wheeler gone they still have Colon-Niese-deGrom-Gee-Harvey-Montero-Syndergaard-Matz. On this front, you have to give Sandy credit for building and maintaining all that depth.

[nymr83]

Some more quotes for any idiots who want to criticize the Mets on this...

B.B. Abbott, Wheeler's agent, said he had no issue with the way the Mets handled the right-hander. The agent added that he had sought independent analysis of Wheeler's elbow issue, and Wheeler was treated consistently with doctors' recommendations. "Anything that happened last year, or any other time Zack has been a Met, has been with complete and full knowledge of the circumstances, and occurred after consultation with qualified orthopedic surgeons," Abbott said.

http://espn.go.com/new-york/mlb/story/_/id/12501348/sandy-alderson-defends-new-york-mets-handling-zach-wheeler-elbow

[batmagadanleadoff]

[fimg=273]https://s0.wp.com/wp-content/themes/vip/espn-grantland/img/grantland-logo@2x.png[/fimg]


March Sadness: Understanding the True Cost of the Spring Tommy John Surge
March 19, 2015
by Ben Lindbergh

[fimg=744]https://espngrantland.files.wordpress.com/2015/03/zack-wheeler-mets-tri.jpg?w=750[/fimg]

excerpt:

The carefully curated MLB preview plan that Grantland�s baseball brain trust put together last month said that today�s feature would be about the depth of two NL East rotations: the Washington Nationals� and the New York Mets�. The schedule stayed that way until Monday morning, when news broke that Mets starter Zack Wheeler�s sore right elbow, which he said last week wasn�t painful enough to have cost him a start during the regular season, would cost him all of his starts during the regular season. Wheeler has a fully torn ulnar collateral ligament that will require Tommy John surgery, ending his season before it could begin. Wheeler�s absence opens a rotation spot for Dillon Gee � an uninspiring but acceptable replacement by fifth-starter standards � at least until he�s displaced by one or more members of the Mets� trio of just-about-big-league-ready pitching prospects: Noah Syndergaard, Steven Matz, and Rafael Montero. Although the Mets� depth isn�t as enviable as it was a week ago, that�s only because some of their surplus has already served its purpose, cushioning the rotation from what must have seemed to GM Sandy Alderson like an almost inevitable blow. Just as Wheeler�s injury reshaped the right-hander�s anatomy, the Mets� roster, and the NL wild-card race, it altered our topic for today. Instead of writing about the ways in which teams build depth, I�m writing about the way depth gets depleted. It�s a relevant topic at this time of year, because while March probably can�t make a bad baseball team better, it can kill a competitive one. [***] The takeaway: March is a tough time for pitchers, period. (We miss you, Marcus Stroman.) Compared with other pitcher surgeries, TJs are far more front-loaded, but even non-TJ surgeries for pitchers reach their highest point as April approaches. Batters, meanwhile, don�t have it noticeably harder in the spring than they do during the summer. Both groups see significant bumps in the fall, as players break down from fatigue and those who�ve been playing through injuries finish their seasons and have no reason to avoid getting whatever is broken fixed.

http://grantland.com/the-triangle/mlb-preview-tommy-john-spring-training-surge-zack-wheeler-yu-darvish/

[Fman99]

Now Rubin is saying with the elbow issues that Wheeler is not expected back until next June. Which makes me way sadder than if he were back in March.

[Frayed Knot]

Tj surgery is generally talked about as needing AT LEAST 12 months of recovery and the advice survivors give their newbie teammates undergoing for the first time is usually DON'T RUSH IT --- so, yeah, we shouldn't expect ZW for opening day of 2016.

[Benjamin Grimm]

I'd be glad to see him in July.

[Frayed Knot]

Specifically with Wheeler, his procedure is one "that will be somewhat more complex than most, since he also will have his partially torn tendon repaired [and] a bone spur on his elbow removed".

Even without those complications though, 14 months or so is probably an average for recovery time.

[Edgy MD]

The difference between April and June won't be as awful in practice as it is in theory right now. We'll have moved on to other disappointments by then.