Tommy John surgeries a stumbling block for White Sox

As I alluded to in this morning’s Minor Keys, Rick Hahn had a lot of bad news to break at the start of the homestand, and it was all about elbows. Carlos Rodón, Nate Jones and Micker Adolfo are all done for the year, but for slightly different reasons.

  • Rodón is having the Tommy John surgery that he braced for when the White Sox announced he needed to have it examined.
  • Jones is having surgery to repair a torn flexor muscle in his right forearm.
  • Adolfo is undergoing arthroscopic surgery on his right elbow for a debridement, and “potentially some work done on the nerve, a nerve transposition of the forearm.”

Unlike other Rodón injuries of the past, Hahn didn’t shy away from establishing an early timetable for his recovery:

But such a tidy, 14-month recovery from Tommy John surgery is getting difficult to believe. For one, Rodón is the one undergoing the procedure, and he’s no stranger to pitching less than everybody hopes (Keith Law wondered if it could be traced back to overuse in college).

More specific to this case, the White Sox as a whole have had a really difficult time coming back from UCL repairs. Hell, these three injured White Sox are sort-of Ghosts of Tommy John Past, Present and Future.

Rodón: Undergoing Tommy John surgery, just like the other two.

Adolfo: Undergoing a possible nerve transposition in his forearm on an elbow that was already surgically repaired once, much like …

Jones: … who had Tommy John surgery, the ulnar transposition surgery, and is now having a third major surgery on his right arm for the torn muscle.

Jones’ case is worth revisiting. He had his TJS in July of 2014, returned for 19 games in 2015, then pitched a full, effective season in 2016. He hasn’t done so since. In July of 2017, he had the procedure Adolfo’s scheduled for, which Hahn described like this:

“Part of the Tommy John surgery sometimes is moving the nerve, to have it displaced. Over the course of time since his Tommy John surgery, as happens in some cases, some scar tissue forms around the nerve, which creates irritation with throwing, and that is unfortunately what Nate experienced, and ultimately they had to go in and clean up the scar tissue, best I can understand it.

“From a long-term prognosis standpoint, yes he is out for the year. However, he’s expected to make a full recovery and be ready for the start of Spring Training next year. Obviously we all know how hard of a worker Nate is, and we saw how successful he came back from the original surgery, so we are optimistic that he’ll follow the same path this time around and be a solid contributor in ’18.”

Hahn was half correct. Jones indeed was ready for the start for the 2018 season, but then a forearm strain popped up in mid-June, and he missed three months before a nominal return in September. At the time, Jones was spared by the MRI machine:

There was a sense of relief when an MRI showed no ligament damage for a pitcher who has already had season-ending Tommy John and nerve repositioning surgeries on the same arm.

“They compared my Tommy John ligament from last year to this year, and nothing’s changed,” Jones said. “The flexor tendon, I guess the flexor mass or mass flexor — whatever it is, I’m not really sure about all the medical terms — but we’re back there getting it right.

After 13 so-so appearance featuring more walks, fewer strikeouts and lower velocity than usual, Jones is back on the operating table. It’s probably the last one he’ll receive as a member of the White Sox, but more because the Sox have another team option on his contract, and they shouldn’t have exercised the last one.

It’s easy to write off Jones as a special case. His arm surgeries were preceded by a season-ending back procedure, and his unique mechanics appear to be visibly stressful on all of his parts, so maybe he’s somebody who can’t stay on the road after his five-year/50,000-mile warranty.

I wouldn’t put him out of mind, though, as it’s possible he’s Patient Zero in what’s turning out to be a string of laborious, incomplete recoveries from Tommy John surgery. Adolfo needs to have his elbow adjusted before he could even use it in regular game action. Zack Burdi’s maximum fastball is 5 mph slower than it was before he tore his UCL, and he had his Tommy John surgery 22 months ago.

I looked at Jon Roegele’s exhaustive list of Tommy John surgeries to see if success stories were underrepresented over the last five years, and here’s the summary of significant cases.

*Zach Putnam? He hasn’t pitched in a recorded game since his surgery in 2017, although the White Sox non-tendered him after the season, so maybe his recovery isn’t their responsibility.

*Corey Zangari? He’s only played in 27 games the last two years after undergoing TJS in 2017. Last year’s absences were attributable to an errant pitch, but the start of his 2019 season was delayed by almost a full month, and now he’s been out of the lineup the last four games.

*Aaron Bummer? He missed all of 2015 and most of 2016 due to Tommy John surgery. He’s exceeded his 19th-round expectations since then, and is throwing two ticks harder this year. That’s one for the success column.

*Jace Fry? He had already underwent Tommy John surgery at Oregon State before getting sidelined by another in 2016. The fact that he’s had any MLB career at all is a victory.

*Tyler Saladino? He tore his UCL trying to play the outfield in 2014, but it only cost him a call-up that season. He recovered to play 100-plus games the following year and fulfill his utility infielder profile since.

It’s not all whiffs, so maybe Jones isn’t a true index case. However, the disappointing results outnumber the full recoveries, they’re on a losing streak, and the White Sox haven’t helped a starting pitcher get back to 100 percent. Add it all up, and it’s hard to expect Rodón to make it back to a major-league game in 14 months. Maybe his diminished velocity was more attributable to his elbow issue than his shoulder surgery, but getting a card punched for both procedures doesn’t get him any closer to a reward.

Rodón’s results are more or less inconsequential to the White Sox rebuild, because his injury history is already scarred enough to expect less, and he’ll hit free agency after the 2021. The point in going in-depth about Rodón’s timetable — and maybe you’ve been doing this the whole time — is that everything everybody’s saying about him also applies to Michael Kopech and Dane Dunning, and their recoveries are far more important to the big picture.

Not being privy to medical records or having any background in surgery or physical therapy, I can only raise the question. I can also bring up Jake Burger’s twice-ruptured Achilles and wonder if the White Sox should spring for better than builder-grade cadavers.

Anybody who’s read The Arm by Jeff Passan knows that recovering from Tommy John surgery is more difficult than the discourse depicted. That said, the White Sox have been on the wrong end of the outcome spectrum more often than not. Now, that half of the rebuild hinges on them either getting it right or paying more for pitching, and it’s hard to tell which one is more likely.

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evenyoudorn

Savvy placement of the Guaranteed Rate logo.

karkovice squad

The Sox have piled up a lot of evidence that they have an outdated approach to pitching from start to finish.

Yeah, there’s quite a bit of luck involved in who gets hurt and whether they can recover. But the Sox don’t seem to have kept up with any of the advances in prevention and treatment, whether in training, usage, or rehab.

Milky✌️

As mentioned, there’s never been a more pertinent time to pick up The Arm, if you haven’t already. It is a great read at least.

Neat_on_the_rocks

Do we think the departure of Herm Schneider being in an every day roll has any impact on all of this?

jorgefabregas

I don’t remember which outlet it was in, but in a recent interview Dane Dunning mentioned that he and Kopech had different surgeons–Dunning Andrews and Kopech ElAttrache (Rodon is using ElAttrache as well). Dunning mentioned in comparing notes with Kopech that ElAttrache was more aggressive about early movement. We can keep an eye on each to see if there’s any difference in recovery.

Nate Jones used Andrews.
Adolfo used Dr. Timothy Kremchek
I couldn’t find surgeon info for Bummer or Fry.

evenyoudorn

I guess I just assumed Jerry used John Paxson for all of this.

lil jimmy

Doctor Vinnie Boombatz, I believe.

GoGoSoxFan

Underrated.

GrinnellSteve

Pertinent to the discussion is whether elbow surgeries are up all over baseball. Is every team’s fan base gnashing their collective teeth? Perhaps it looks worse for us because A) 3 happened yesterday; B) we pay more attention to our own guys, particularly the poor results; and C) it’s happening to key prospects.

Also, as the velo revolution continues, bodies are being strained beyond what they were born to handle.

I don’t have answers. I’m merely asking more questions and posing some additional thoughts.

karkovice squad

So it’s complicated. Sox used to be about the best in class at avoiding time lost to injury (partly from prevention but also in recovery like Peavy). As of earlier this decade they’d fallen to around the median. Kopech, Jones, and Rodon’s 2019s might tip the balance, however.

A caveat is that they also managed to trade away guys who then got hurt.

For UCL repairs specifically, Joe Roegele’s been tracking publicly reported surgeries.

https://docs.google.com/spreadsheets/d/1gQujXQQGOVNaiuwSN680Hq-FDVsCwvN-3AazykOBON0/edit#gid=0

By his admittedly incomplete count the Sox have mostly avoided players on their active roster needing UCL repairs compared to the rest with only 11 reported, T-6th in baseball, including Rodon’s. Their minors haven’t been so fortunate with 31, T-20th.

By year total, (position player):
2019 2
2018 4, (1)
2017 5, (2)
2016 4, (1)
2015 4
2014 6, (2)
2013 5, (1)
2012 3, (1)
2011 3
2010 2
2008 1
2006 2
2005 (3)
2004 1
2002 1
2000 2
1999 2
1998 1
1996 2
1994 1

The trend starts to accelerate in 2010 but it’s difficult to say how much of that is an increase in injuries, increase in surgeries to treat injuries that otherwise would’ve just been retirements, or due to more reporting.

There have been 1065 reported UCL repairs since 1/1/10. The Sox have 38 of them. The average would be 35.5 if they were distributed evenly.

*Additional caveat that I eyeballed the yearly counts on my phone.

karkovice squad

Also, @GrinnellSteve, here’s a lengthy interview with Driveline’s Kyle Boddy from awhile back.

https://www.beyondtheboxscore.com/2017/6/13/15782420/kyle-boddy-driveline-interview-weighted-balls-sabermetrics-rehab

What was especially interesting was his point that research suggests pitchers are training and used in ways that are almost perfectly designed to cause injuries.

GrinnellSteve

Wonderful info, Kark. Thank you. I’ve long thought pitchers were physical freaks. Some can withstand the rigors and pitch at a high level forever. Others can be coddled all day long and break down anyway. You don’t know which bucket to put a particular pitcher in so you use him and hope. But it would be nice to actually get ahead of injuries.

Papa Giorgio

It’s almost like you already knew the answer in October:

1. A healthy Jones can basically slot into any bullpen in baseball.
2. Jones is seldom healthy.