searchMasahiro Tanaka, now on the DL with a diagnosis of a partial ulnar collateral ligament (UCL) tear in his right elbow, got a consensus of opinion as to a plan of care when he was saw three specialists on Thursday.  The good news was that they agreed on managing the injury conservatively rather than jumping right to surgery. That is clearly an indication that the tear is relatively small.  However, it seems, as it generally does, that though the course of treatment may be conservative, the estimate for the player’s possible return to action is anything but.

As I’ve written before, even with rest, PRP (platelet-rich plasma) injection and rehab, a torn ligament does not regain full tensile strength in a matter of weeks. And, pitching – especially at full velocity – before it does so puts the already weakened tissue at further risk. Though we all root for a successful outcome for the young Yankees’ All Star, saying that if he is able to return in six weeks, Tanaka will avoid surgery, may be pushing it.

We’ve seen other pitchers attempt to rebound from UCL tears without undergoing Tommy John surgery. Few succeed. A very small tear – if that is what it is – improves Tanaka’s chances of being one of the outliers. However, even if he makes it back before the end of this season, we’ll only know if the pitcher is able to escape without treating the elbow more aggressively if it stands up to repeated stresses once he returns to the rotation. How he performs, not just initially, but over time would clearly be the key.

The six-week timetable for Tanaka’s recovery that has been reported in the media may simply be in play to make the decision to opt for surgery more straightforward. If his condition hasn’t sufficiently improved by then, there is always Plan B. Surgery clearly offers a more decisive outcome.

Dr. James Andrews’ outlined his thoughts on the epidemic of Tommy John surgeries in a recent position paper, in which he also addressed the ways in which UCL injuries might be avoided.  The cumulative effects of the demands of youth programs can only be modified for the pros of tomorrow.  For Tanaka, being mindful that pitching without sufficient rest, when fatigued and at consistently high velocities increases risk. Always pitching full out in bullpen and flat ground sessions may contribute to the vulnerability of the ligament.

So will hastening his return.

Follow Abby on Twitter @abcsims.


About the author

Abby serves as the Injury Expert for CBS New York where, since 2010, her Injury Breakdown Blog examines injuries in professional sports. She also blogs on health & fitness as well as sports injuries for Huffington Post, and Recovery Physical Therapy.com, where her blog earned a top ten mention for physical therapy blogs in 2012 @ WorldWideLearn.com. In a ranking of the Top 30 Healthcare Blogs for 2012, Top Masters in Healthcare also rated Abby’s blog in the top three in Physical Therapy! Abby is the founder of Fit-Screen and she welcomes your comments and questions!

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