Kyle Gibson Injury Analysis: Flexor Pronator Muscle Strains and Partial UCL Tears

As Jon pointed out yesterday, MLB.com's Rhett Bollinger announced that both Kyle Gibson and Anthony Slama would "avoid" Tommy John surgery. I agree with Jon in that this is more of a delay than anything else, because Tommy John isn't something that can be avoided. Some players choose to pitch through the pain at certain points in their careers, but this is not something either Gibson or Slama should be doing. If something strains too far or a ligament tears, that's it. You'll need Tommy John, it can't be avoided. Not for pitchers in their 20s.

Both Gibson and Slama have been diagnosed with flexor pronator muscle strains. These muscles are located on the side of the forearm, opposite the thumb, and their job is to protect the elbow by countering torque during the throwing motion. In this situation these muscles have suffered from repetitive stress due to the throwing motion, causing pain during "the late cocking or acceleration phases of throwing". Obviously, recurring issues here can be an issue, leading to bigger problems.

via sailjamehra.files.wordpress.com

A number of medical websites indicate that flexor muscles respond to rest and medication, physical therapy and an eventual return to throwing. We'll get into this a bit more after the jump.

J.J. Putz suffered a flexor pronator muscle strain during spring training in 2007. He saved 40 games for the Mariners that season in his career year to date, although he hasn't been the same since '07. Stephen Strasburg was initially diagnosed with a flexor pronator strain but after a second test went under the knife for Tommy John in 2010.

Examples like this exist through baseball history, which is sort of a mixed bag for Slama. If it really is nothing more than a flexor pronator muscle strain, rest will probably do the trick for him. He won't be able to pitch for the remainder of 2011, but he'd be ready to go by spring training next February. But for Gibson I remain convinced that a wait only delays his big league career.

Partial UCL tears can, sometimes, heal enough for a pitcher to compete. But in many circumstances problems will recur again. And again. One website goes to far as to say "those athletes who had had a partial tear or "sprain" of their UCL while in amateur baseball had a very high recurrence rate and often had their careers cut short by their elbow injuries. So, when a thrower has repeated episodes of pain on the inner side of the elbow coming from a partially torn or stretched UCL a reconstruction may be necessary."

Major League Baseball is certainly not amateur baseball, and I certainly wouldn't dub triple-A in that fashion either. But I doubt that changes anything.

My biggest concern is that Gibson's long-term health may be put at jeopardy by not having the surgery, which I believe he's going to need at some point whether that's now or in six months or in two years. Going under now means he'd be unavailable for all of 2012 but would have 18 months to recover and rehabilitate before February 2013. Waiting six months means he's still unavailable for all of '12, and it also puts '13 at a gamble at best. And not having the surgery at all, even if he somehow manages to avoid Tommy John surgery, means rolling loaded dice for as long as it takes before the elbow finally goes out on him.

I appreciate the philosphy of surgery as a last resort. But recent Twins history is littered with names of pitchers who have tried rest before causing themselves more pain and keeping them out of the game even longer: Francisco Liriano, Joe Nathan, Scott Baker, Pat Neshek, Boof Bonser. Sometimes it's better it's better to look at the long-term risks and secure the future instead of hoping for a miracle that would help in the present...or 2012.