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  • Elephant in the Room: Sano's Elbow

    From my perspective, this has been a very positive offseason overall for the Twins. They have delivered some strong statements by handing out unprecedented contracts to multiple free agent pitchers, they made a smart move by officially transitioning Joe Mauer away from catcher, and several prospects turned in encouraging performances while participating in winter ball.

    But all the while there has been a dark cloud looming overhead -- one that just won't seem to go away. That would be the condition of Miguel Sano's elbow.

    Sano missed some time in New Britain last July due to "arm fatigue," though not very much. The problem re-emerged while he was playing in the Dominican Winter League, where Sano was shut down after appearing in just two games due to elbow soreness.

    At that point, concern started to build that the elite slugging prospect might need the dreaded Tommy John surgery. Those worries were briefly alleviated when La Velle E. Neal III blogged in mid-December that the third baseman had been examined in Ft. Myers and given a "clean bill of health."

    Unfortunately, this thing won't go away. Asked recently about whether Sano will avoid going under the knife, Terry Ryan expressed what Mike Berardino described as "optimism but not certainty." Here's the quote:

    "That would be our hope," Ryan said. "Right now we don't think it is (going to require surgery), but I can't tell you for sure until we crank him up a little more."
    That's not exactly what we're hoping to hear at this stage of the offseason, especially after reports seemed to indicate that Sano was in the clear. The official diagnosis right now, per Berardino's article, is a "strained ulnar collateral ligament," which indicates that there is stretching or minor tearing in the UCL (though I believe "sprain" would be the more accurate term). In some cases these things clear up on their own, but often, the pain or deteriorating state of the ligament eventually leads to measures being taken.

    If Sano's elbow keeps barking as he transitions into his workouts over the next month, it'll be tough to imagine that surgery can be avoided. We're on the verge of a seven-month period where the 20-year-old will be throwing on a daily basis and the organization can hardly expect him to be playing through constant pain, especially if there's real danger of worsening the condition of the ligament.

    On the bright side, Tommy John surgery is significantly less serious for a position player than it is for a pitcher. Whereas the timeline for a hurler to return to full strength is generally between 12 and 14 months, many position players are able to return to the field in 6-8 months.

    Still, that would obviously mean Sano would miss a majority -- if not all -- of the 2014 season, which would be a huge bummer considering that he stands a pretty good chance of breaking into the majors this year if healthy, following a dominant 2013 campaign in the minors.

    As the Twins are fully dependent on prospects -- particularly the "Big Three" of Sano, Byron Buxton and Alex Meyer -- to lead their turnaround, losing one for a significant stretch of time in the prime of his development would be a heartbreaking turn, though sadly not uncharacteristic based on this snakebit franchise's recent history.

    It's certainly possible that this is all much ado about nothing, and that Sano's elbow -- having been given several weeks to rest -- will feel fine once he ramps up his workouts in the coming weeks.

    But when you step back and look at this situation as a whole, and you see an issue that first sprung up in July of last year and still hasn't cleared, it's difficult not to get an ominous feeling.

    We should know more once Sano has his elbow re-examined in Ft. Myers. That's expected to happen soon.
    This article was originally published in blog: Elephant in the Room: Sano's Elbow started by Nick Nelson
    Comments 43 Comments
    1. twinscowboysbulls's Avatar
      twinscowboysbulls -
      In other words, more precaution should've taken place in July, perhaps recognized he needed to get surgery then, meaning he would be in his 6th month of recovery right now? If there were concerns about his elbow, there is no way they should've sent him to DWL, which means he must've appeared to make a full recovery from his initial soreness/fatigue. Not sure if the Twins Medical staff is to blame here.
    1. twinsfan34's Avatar
      twinsfan34 -
      You would think, they'd like to find out as soon as possible for this. If he needs the surgery, have it immediately, maybe get some action in July, Aug, or Sept for him so the entire year isn't lost.

      Hate thinking about this.
    1. mike wants wins's Avatar
      mike wants wins -
      And this is one of many reasons why you can't build your entire philosophy around waiting for your prospects to work out all at the same time.......because there usually isn't a perfect storm of "every prospect working out" and "the one FA I need is available"....
    1. Thrylos's Avatar
      Thrylos -
      Roberto Alomar
      Jay Buhner
      Jose Canseco
      Shin-Soo Choo
      Carl Crawford
      Rafael Furcal
      Luis Gonzalez
      Jose Guillen
      Todd Hundley
      et al.
      Had TJ surgery and recovered pretty nicely.
      Lets hope that this is nothing as far as Sano goes.
    1. Lefty's Avatar
      Lefty -
      I wonder if they shut him down as just a precautionary thing? I would think that if they looked at it and gave him a "clean bill of health" that it probably is clean. I don't think they'd take any chances on "The Future." If not, they're not doing him any favors by making him wait until spring training to find out.

      I also don't wanna think about this! Ever since starting to log on and read on twinsdaily I find myself staring at prospects and wondering what we'll be like down the road. It's exciting to think of these prospects as being Cabrera and Trout in 2016, but they're just prospects at this point. I wish I could get more excited about the big league club right NOW.
    1. COtwin's Avatar
      COtwin -
      Part of me wants them to decide to just do the surgery now. My nightmare for this is that they wait a couple more months before pulling out the blades. This shouldn't be that hard to diagnose. There should be lots of data on how injuries like this heal and what to expect. If this type of injury has any tendency to linger if surgery is not performed than he should get cut now. If they do perform surgery in a couple of months than somebody(s) need to look for other lines of work.
    1. jmlease1's Avatar
      jmlease1 -
      The Twins medical staff has done nothing in the past seasons to inspire confidence in their decision-making, so Sano's elbow makes me incredibly nervous. how many times have they botched one?!?

      Ugh.
    1. TheLeviathan's Avatar
      TheLeviathan -
      I feel like I've heard this version of events before.......which means his operation should happen in July of 2015 after extensive rest and rehab.

      Something like that.
    1. Lenny Green's Avatar
      Lenny Green -
      Given Sano's hitting prowess and the fact it might not be clear what to do with the elbow, why not exclusively DH him for the first few months? No throwing at all allowed for some time, then get surgery after the year if it doesn't get better.
    1. Halsey Hall's Avatar
      Halsey Hall -
      I'd think if there is continuing pain we'd know about it pretty soon. He's working out in the weight room now under the eyes of Perry C. and other trainers. If they spot something he would be shut down.
    1. Seth Stohs's Avatar
      Seth Stohs -
      Quote Originally Posted by jmlease1 View Post
      The Twins medical staff has done nothing in the past seasons to inspire confidence in their decision-making, so Sano's elbow makes me incredibly nervous. how many times have they botched one?!?

      Ugh.
      I may be mis-remembering, but didn't Sano go visit Dr. Andrews, and he basically recommended how the Twins move forward... check him in December, check him in January, go from there? Can't really blame the Twins medical staff, though it is fun, I guess.
    1. JB_Iowa's Avatar
      JB_Iowa -
      Quote Originally Posted by Seth Stohs View Post
      I may be mis-remembering, but didn't Sano go visit Dr. Andrews, and he basically recommended how the Twins move forward... check him in December, check him in January, go from there? Can't really blame the Twins medical staff, though it is fun, I guess.
      He saw Andrews sometime before November: http://www.milb.com/news/article.jsp...vkey=news_milb


      Not sure when or if he has seen him since.

      Always have to remember that even though a lot of medicine is science, there is still some art involved as well.
    1. crarko's Avatar
      crarko -
      I'm waiting on the article predicting the amputation.
    1. cmathewson's Avatar
      cmathewson -
      Thing A has happened 9 out of 10 times. Ergo, thing A is going to happen this time. Faulty logic.
    1. Jim Crikket's Avatar
      Jim Crikket -
      Sano not being a pitcher makes this a whole different thing, I think. Like it or not, the accepted medical approach for this kind of strain/spran/stretch of the UCL appears to be rest-recheck-throw and if all else fails, do surgery. You may skip some of the process for a pitcher who would have perhaps twice the recovery time, but for a position player, I don't think you rush to surgery.

      Honestly, even if the doctors decided right now that surgery is likely to be needed, I think I'd rather have Sano start spring training and try to get a couple of months of baseball in at AA-AAA, even if it's almost all at DH. Then he could have surgery in June-July and still be good to go to open 2015 spring training. That seems preferable to me over doing surgery now and essentially losing his entire 2014 of development at the plate against high-minors pitching.
    1. Brock Beauchamp's Avatar
      Brock Beauchamp -
      Quote Originally Posted by cmathewson View Post
      Thing A has happened 9 out of 10 times. Ergo, thing A is going to happen this time. Faulty logic.
      Except for that time it didn't happen to Alex Meyer and everyone predicted it would.
    1. cmathewson's Avatar
      cmathewson -
      Quote Originally Posted by Brock Beauchamp View Post
      Except for that time it didn't happen to Alex Meyer and everyone predicted it would.
      That was the 10th time. The other 9:

      Mays, Milton, Liriano, Neshek, Blackburn, Slowey, Gibson, Wimmers, Deduno

      Milton was a knee and Deduno was a shoulder. But the other seven were UCLs.
    1. johnnydakota's Avatar
      johnnydakota -
      Just move Mauer to 3rd now ....
    1. B Richard's Avatar
      B Richard -
      I feel as though TR has the tendency to speak rather conservatively or cautiously at times (and rightly so, I do appreciate his methodical approach). This was one of those instances.

      Here's what's important. We have no reason, as of now, to be any more alarmed about his elbow than we did when he got shut down in winter ball. If anything, we should be more optimistic given that he received a clean bill of health in mid December. This next check is part of the program he is on-- it is NOT a reaction to any newfound or recent tweaks. Everything is going according to plan. Perhaps he will require TJ, but we have no reason to suspect that more than we did at the beginning of December.
    1. twinsfan34's Avatar
      twinsfan34 -
      Quote Originally Posted by crarko View Post
      I'm waiting on the article predicting the amputation.

      Hahahahahahahahahahahaha
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