(*) THE BIG HURT: Review of 2020 (and earlier) injuries

This is our annual review of players who experienced injuries in 2020 of the off-season (or in some cases earlier). We’ll take a look at players who may have questions coming into 2021, in the hope that we can answer a few of them.

Yordan Alvarez (DH, HOU) – R knee, torn patellar tendon; L knee, routine clean-up (2018?)
The patellar tendon connects the bottom of the kneecap to the shin muscles. Tears of this tendon can be very painful and can also cause weakness and instability in the joint. Based on the reporting of his symptoms, the tear may have begun in late 2018 or even earlier. That he was able to perform at the level he did in 2019 is a testament to his hitting talent. The prognosis is very good—most patients return to full function and strength in the joint, or very close to it. While there may be some rust to shake off after not playing for most of a year, he’s had plenty of time to heal and should be at 100% to start the season.

Nolan Arenado (3B, STL) – L shoulder, AC joint inflammation and bone bruise (9/11/2020)
While we still don’t know exactly how the injury occurred, it’s likely the result of trauma, either a fall or perhaps sliding into a base. An injury to the AC joint (at the end of the collarbone) will have healed by now, but the bone bruise is something that could linger. While it’s likely that he’s back to full health, he’s worth keeping an eye on as he goes through spring training.

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Cody Bellinger (1B/OF, LA) – R shoulder surgery, dislocation (10/19/2020)
He suffered a dislocation on an elbow bump (is that the name?) after hitting a home run in Game 7 of the NLCS. Not the strangest injury that we’ve seen, but it’s right up there. There’s no real detail on exactly what was repaired, but it’s likely he had a minor tear in the rotator cuff. He throws left-handed, so there’s no issue there. It’s possible he experiences some minor issues with mobility and tightness as he gets back into swinging—the back of the right shoulder gets stretched as the swing loads, and the muscles there are important to pulling the bat forward during the swing. However, he has plenty of time to rest and recover and the risks at this point are minimal.

Rhys Hoskins (1B, PHI) – L elbow, torn ulnar collateral ligament (10/2/2020)
According to sources, this was not Tommy John surgery, but an internal brace repair. Similar injury, but different treatment. With an internal brace, the ligament is reinforced with a collagen-coated tape which provides support while the ligament heals (and beyond). It’s a relatively new technology, but limited studies show athletes returning to their previous level within 6 months as opposed to the 12-month average for Tommy John surgery (where a tendon from the leg replaces the UCL). Because of the location of the UCL, there’s not a ton of stress placed on it during the swing—it’s the rotation of the shoulder and its pull on the forearm during the throwing motion that puts the most stress on the ligament. The biggest holdup for position players, then, is being able to throw again, but that’s not an issue here since it's his non-throwing arm. We wouldn’t count on him to be ready at the start of the season, but it’s a real possibility. There’s some risk going forward, especially because it’s a relatively new procedure, but it’s minor.

Dinelson Lamet (RHP, SD) – R elbow problems (9/25/2020)
He had TJS in 2018 and missed a big chunk of 2019 as well. It took him 15 months to get back to the mound, which is longer than the average. He experienced biceps tightness in September and had a platelet-rich plasma (PRP) injection to treat elbow inflammation. PRP is not a panacea, and its efficacy has yet to be definitively established. If he’s improved this spring, it’s possible that the time off allowed him to heal, rather than the PRP. In either case, he could well be ready to start the season, but will be an extreme risk. At this point, pretty much any pain or discomfort should be treated as a serious issue until it’s shown that it’s not. If you do pay, pay close to nothing.

Tommy Pham (OF, SD) – L wrist surgery; stab wound (October 2020)
The stab wound, while potentially salacious, is not a major concern going forward and is (hopefully) not likely to recur. He had two procedures on his wrist, one to repair a broken hamate and one to repair a cartilage tear on the pinky side of the wrist. The hamate is the infamous power killer, but with six months to heal, his odds of being fully recovered are good. The cartilage repair is significant; any pain or weakness in that part of the wrist could help explain his hitting woes in 2020. If there’s a lingering effect, it’s probably the hamate, but there’s a very good chance we see the old Tommy Pham (though now actually getting old) in 2021.

Gregory Polanco (OF, PIT) – R wrist fracture; Lingering shoulder woes (12/24/2020; 2018)
The wrist fracture appears to be a minor one and it’s likely that it will be cleared up by the start of the season. We are wondering if his shoulder injury from late 2018 was still causing him problems in 2020. While it’s been two years since the surgery, devastating injuries like that can take a long time to heal. Loss of mobility or flexibility could contribute to his high strikeout rate, which is the main culprit in his hitting woes. It’s a long shot, but it’s possible he turns things around in 2021. If not, it’s unlikely that his health is to blame.

A.J. Puk (LHP, OAK) – L shoulder surgery (9/15/2020)
The team’s expectation is that he’ll be back and ready to go because it was “just” a debridement. A debridement is the cutting away of frayed tissues, which he had on both the labrum and the rotator cuff. It could have been much worse, but that doesn’t mean it’s a good thing. In one meta-study, most elite pitchers saw improvement post-surgery but did not return to their pre-injury peak. He’s now gone from TJS in 2018 to a major shoulder issue in 2020, without much in the way of good health in between. We are very pessimistic about his potential to reach his prospect upside; at this point, turning into a decent reliever would be a win. There’s still a chance of success, but it comes with a heaping pile of risk.

Chris Sale (LHP, BOS), Luis Severino (RHP, NYY), Noah Syndergaard (RHP, NYM) – Throwing arm, Tommy John surgery (Spring 2020)
A trio of elite pitchers, they all had TJS within a month of each other in the late spring of 2020. All three appear to be on track for a recovery—this is just a reminder that being back on the mound does not mean they’re “back.” Sale and Severino may not see action until mid-season or later, as their respective teams appear to be taking cautious approaches. None of these guys should go for anywhere near full value.

Kirby Yates (RHP, TOR) – R elbow, bone chips (8/15/2020)
The injury wasn’t serious, and removal of bone chips has a high rate of success. His chances of coming back as an elite reliever are good, though his age and team situation call into question his 2021 role. He’s completed his rehab from surgery and is now beginning his normal ramp-up to spring training. Keep an eye on him there; if he’s pitching well without discomfort, he should be good to go.

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