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Joe Nathan's Torn UCL: Questions for the Injury Expert, Will Carroll

Joe Nathan

#36 / Pitcher / Minnesota Twins





Nov 22, 1974

Jesse:  How often do pitchers continue to throw with torn UCLs, and how many of them maintain their level of productivity?

Will Carroll:  Very seldom. Research by Jim Andrews showed that the success rate of rehab was much lower than expected. At the MLB level, I can only find two successful cases, though I'm sure there's more at the minor league level.

J:  Nathan is resting his elbow for the next couple of weeks.  Can "rest" do much help at this point?

WC:  Probably not, but two weeks delay is nothing if it helps him come to terms with it. We all want a miracle after bad news, so consider this a chance for a miracle.

J:  Let's say the rest actually does help and Nathan feels he can go without the surgery.  Can this pain just go away, or will he have to pitch through it?

WC:  The tear will heal -- this is not a rupture, which is a complete tear.  The confusion is in the terminology. Any tearing in a ligament is a sprain. A complete tear is a severe sprain. Follow all that? Nathan has a "significant" tear, which has a medical meaning - it's visible on imaging - not a rupture. It will heal some, but enough to hold up under the loads of pitching?

J:  Concentrating just on what's good for Joe, are there any benefits to not having the surgery?

WC:  He wouldn't have to go through surgery, but then again, he might never pitch again. Again, you're hoping for a miracle.

J:  Nathan is under contract through 2011 with an option for 2012.  Knowing what you know, how would you approach this?  Would you shut him down to get the most out of a healthy Nathan that you can in 2011 to make an informed decision on 2012, or do you risk having to shut him down later this season and lose him for all of 2011?

WC:  All this assumes the miracle. Look, you're not "shutting him down."  He's got a sprained UCL and in all likelihood will need Tommy John surgery if he intends to pitch again. If Nathan has the surgery now --- or in two weeks, that timeline really doesnt change much -- then he'll be throwing by this time next year. Ready to close? I don't know. Billy Wagner isn't a great comp, but he was back a bit under a year later. Having Nathan ready to pitch in December is irrelevant - it's having him ready next April. Just look how long it took Neshek to come back and he's not even all the way back.

Thanks to Will for taking my questions no short notice.  Follow him on Twitter, @injuryexpert.