Whitlock July 2 update: leaves start with right elbow tightness

The Gray Eagle

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(Update from today July 2 is below, after the posts from when he went on the IL in April)



Dammit.
Ulnar neuritis, to the IL. Bello called back up.
https://www.mlbtraderumors.com/2023/04/red-sox-place-garrett-whitlock-on-il-with-ulnar-neuritis.html

The Red Sox announced today that right-hander Garrett Whitlock has been placed on the 15-day injured list with right elbow ulnar neuritis. Fellow righty Brayan Bello was recalled to take his spot on the active roster.
The club didn’t provide any more information about Whitlock’s injury, so the severity isn’t publicly known at this time. It’s possible that they are still doing more testing, as ulnar neuritis comes with a wide range of possible outcomes. The ulnar nerve is commonly known as the “funny bone” due to the tingling sensation it causes when agitated. Neuritis is the medical term for when there is inflammation of the nerve.
It’s too early to draw conclusions but the diagnosis is nonetheless concerning. Rays left-hander Jeffrey Springs was recently diagnosed with ulnar neuritis and just a few days later was reported to require Tommy John surgery. That’s not to say that Whitlock is inevitably headed down the same path, as Blue Jays right-hander Jordan Romano was diagnosed with the same ailment in April of 2021 but was back after just 10 days.
So we hope that it's like Romano's problem and NOT like Springs'.
 
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radsoxfan

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The biggest problem with ulnar neuritis (at least for a pitcher) is when it's not actually ulnar neuritis.

Let's hope that diagnosis sticks after more testing/opinions.
 

DeadlySplitter

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And why is he only telling the staff now? This could explain his shaky start at Milwaukee after dominating the Angels
 

radsoxfan

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A pitcher going to the DL with medial elbow pain without getting an MRI is.... confusing to say the least.

Elbow MRIs in pitchers can be tricky to interpret, especially with prior Tommy John, but if it's serious enough to put him on the DL you need to know what you're dealing with.

Henry et al. must REALLY be trying to save a few bucks this year.


Edit: I suppose it's possible he's going to get one but they felt it was DL worthy either way so no rush on the MRI. But if he never gets one, that would be quite atypical.
 

Red(s)HawksFan

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Edit: I suppose it's possible he's going to get one but they felt it was DL worthy either way so no rush on the MRI. But if he never gets one, that would be quite atypical.
I think this is probably the case. Whitlock was scheduled to start tomorrow. Rather than wait for the MRI, might as well IL him now and get Bello up and ready to go in his place.
 

Red(s)HawksFan

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Because of the front office's fetish for pitchers with significant injury histories?
And the pitchers without significant injury histories would just magically stay healthy if they signed them instead?

Such a tired argument. Every pitcher is a ticking time bomb. If you get through whatever period you have a pitcher under team control without injury, you got lucky.
 

radsoxfan

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I think this is probably the case. Whitlock was scheduled to start tomorrow. Rather than wait for the MRI, might as well IL him now and get Bello up and ready to go in his place.
Could certainly be.

Though the Sox are at home and any MRI/MRI report would be done same day without question for an MLB pitcher if it was requested.

There is not really any wait for these things like there is for the general public.
 

Cassvt2023

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Well, the old adage "you can never have too much pitching" raises it's ugly head again. Paxton doesn't appear to be ready yet based on his last rehab start. It's a good thing they didn't trade Pivetta for a bag of balls at end of ST, as some were suggesting. It'd be great to see him go toe to toe with Beiber tonight.
 

soxin6

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And the pitchers without significant injury histories would just magically stay healthy if they signed them instead?

Such a tired argument. Every pitcher is a ticking time bomb. If you get through whatever period you have a pitcher under team control without injury, you got lucky.
Of course not, but you are assuming that the odds of significant injury is identical for two players, one without and previous significant injuries and one with. For many positions that is probably true, but elbow injuries with pitchers is likely not one of them.
 

Sandy Leon Trotsky

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Of course not, but you are assuming that the odds of significant injury is identical for two players, one without and previous significant injuries and one with. For many positions that is probably true, but elbow injuries with pitchers is likely not one of them.
When the Sox signed Price it was under the belief that he was a workhorse for life.
What FA pitcher doesn’t have significant injury risk? And if they don’t…. And are good…. What is their cost? Anyone want to have signed Verlander?
 

jon abbey

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A pitcher going to the DL with medial elbow pain without getting an MRI is.... confusing to say the least.

Elbow MRIs in pitchers can be tricky to interpret, especially with prior Tommy John, but if it's serious enough to put him on the DL you need to know what you're dealing with.

Henry et al. must REALLY be trying to save a few bucks this year.


Edit: I suppose it's possible he's going to get one but they felt it was DL worthy either way so no rush on the MRI. But if he never gets one, that would be quite atypical.
This knowledgeable post leads me to guess that Whitlock is basically fine and they needed to put a pitcher on the IL to bring back Bello before his 15 days were up.
 

chrisfont9

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Of course not, but you are assuming that the odds of significant injury is identical for two players, one without and previous significant injuries and one with. For many positions that is probably true, but elbow injuries with pitchers is likely not one of them.
Guys who get TJ surgery are healed afterwards. Guys who haven't had it yet could be more likely to end up there before the post-TJ guy gets another operation. Hard to generalize. The past injuries = higher risk thing is all over the map. OTOH, if you said shoulders, I'd be more likely to agree. From what I gather, that's where careers start winding down, fast.
 

radsoxfan

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This knowledgeable post leads me to guess that Whitlock is basically fine and they needed to put a pitcher on the IL to bring back Bello before his 15 days were up.
Let's hope that is the case.

If no MRI in the next few days, I would have to assume suspicion for anything important must be extremely low and it's more of a break/roster manipulation.
 

czar

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Are there more studies on pitcher injuries begetting more pitcher injuries out there?

I thought a few years ago FG looked at "horses" and found they were just as likely to get injured the next year as guys who had previously had TJS, for example. Maybe I hallucinated it...
 

Sandy Leon Trotsky

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I'm skeptical about this claim.
Which? That he was a horse or that he was being sold as one? SOSH was pretty excited about him across the board regarding prefabs health. The biggest concern was his beef with Ortiz.
I’m just saying that even the absolute healthiest pitchers as a likely risk.
So far Pivetta has been a freak but he also doesn’t have many miles on his arm
 

nvalvo

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Which? That he was a horse or that he was being sold as one? SOSH was pretty excited about him across the board regarding prefabs health. The biggest concern was his beef with Ortiz.
I’m just saying that even the absolute healthiest pitchers as a likely risk.
So far Pivetta has been a freak but he also doesn’t have many miles on his arm
I read your previous post as being about what the Sox FO believed. If that wasn't the intention, never mind.
 

NJ_Sox_Fan

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I wish they had just left him in his 2021 bullpen role. May not have avoided the injury regardless but still …
 

cannonball 1729

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Are there more studies on pitcher injuries begetting more pitcher injuries out there?
There are. There was some discussion of this in the injury thread - mikcou posted some studies that rebutted the notion that all pitchers are equally likely to get injured:

We know this is not the case for soft tissue injuries. There have been plenty of studies that show specific players are more at risk for continued injuries (e.g., a single hamstring pull suggests an increased rate of recurrence). For example: https://journals.sagepub.com/doi/10.1177/2325967119861064.

We also know that is not the case for arm injuries with pitchers - shoulder injuries have an increased risk of recurrence. For example: https://pubmed.ncbi.nlm.nih.gov/26118941/

That isnt to say that all injuries make people more at risk for future injuries, but if you really want to make a case that a player who has never sustained a serious injury in his career is as likely to have an injury as a guy whos had them every year, I'd love to see some support for that as it: 1) definitely is contrary to what we know of soft tissue injuries specifically; and 2) seems completely illogical.
I also posted this in the thread in response to a similar question about whether such studies existed - it's too big for the quote function, so I'll just cross-post it:



Just pulling a couple - I don't know if these address your exact question, but here's some info about injury recurrence:

This one's probably closest to what you're looking for, since it's actually just baseball players: BP wrote an article in 2013 positing that risk of recurrence is actually much higher than risk of first-time injury. Here are the salient charts:



Condition Similar Event Last Year No Similar Event Last Year
Had an elbow injury 27.4% 2.0%
Had a shoulder injury 32.4% 2.8%
Had any injury 73.4% 5.1%
Spent time on DL 43.7% 4.9%



Condition Similar Event Two Years Ago No Similar Event Two Years Ago
Had an elbow injury 15.2% 1.8%
Had a shoulder injury 23.2% 2.3%
Had any injury 55.6% 2.7%
Spent time on DL 34.2% 3.5%


There are also some studies by actual medical professionals that show a generic higher risk of injury among previously injured people. For instance:

- The NIH has a literature study from 2014:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196323/

ACL injury was linked to a successive injury of the same ACL, and other injuries in the LE. HS was associated with subsequent ipsilateral HS and knee injuries. Previous achilles tendon rupture increased the risk of an analogous injury on the contralateral side. An ankle sprain was associated with a re‐injury of either the ipsilateral or the contralateral ankle. Post‐injury changes were present in strength, proprioception, and kinematics, which may have led to overall changes in motor control and function.
- Here's one from the NIH in 2022: that study tracked about 1400 people and found that while only about 1/3 of the participants ended up with some sort of injury, 55% of those with a previous injury ended up with some sort of injury.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9577931/

When specifically talking about Tommy John or pitching arm stuff...there's also some reason to think that TJ issues can be related to poor mechanics. Here's a study that shows that early trunk rotation is related to increased injury risk:

https://journals.sagepub.com/doi/full/10.1177/2325967115581594

Using a Cox proportional hazards model for risk analysis using the measured number of innings pitched at time of surgery as an approximate index of exposure and adjusting for age and fastball speed at time of surgery, early trunk rotation was associated with significantly increased risk of shoulder and/or elbow surgery with hazard ratio estimate of 1.69 (95% CI, 1.02-2.80).
(Edit: For what it's worth, the study seems to lean in the direction that inverted W is an issue as well, but the evidence is not at the 95% confidence level, so no such conclusion could be reached.)

Someone who learned a certain type of pitching mechanics may well have a hard time changing their arm positioning and/or trunk rotation timing post-surgery, leading to the same injury again.
 

lexrageorge

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It is indeed correct that pitchers that have had TJ surgery have no more risk of tearing their repaired elbow ligament as a pitcher that's never had it. But there does seem to be some clustering when looking at pitcher injuries. But whether those studies correctly account for age (for which there is a very high correlation with injury risk) is still unclear.
 

Yo La Tengo

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And why is he only telling the staff now? This could explain his shaky start at Milwaukee after dominating the Angels
Having pitched up to the college level (not a flex, I was a middling DIII pitcher at best), there was never a time during the season that something didn't feel a bit off in my elbow. This was the norm for almost all pitchers that I knew (regularly feeling something funky in their elbow or shoulder). Plus, I think there is something psychological about not wanting to acknowledge a twinge that you really hope is nothing but definitely could be a problem.

I'm guessing that this issue felt weird but not painful so Whitlock was hoping to work through it.
 

DaveRoberts'Shoes

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I talked to Alex Speier about this yesterday and they said there was no indication they were going to get an MRI, which I take as a good sign. Ulnar neuritis can be diagnosed clinically (a.k.a. just by symptoms) and without an MRI. If they thought there was any chance of structural damage I‘m sure he already would have had an MRI
 

cannonball 1729

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It is indeed correct that pitchers that have had TJ surgery have no more risk of tearing their repaired elbow ligament as a pitcher that's never had it. But there does seem to be some clustering when looking at pitcher injuries. But whether those studies correctly account for age (for which there is a very high correlation with injury risk) is still unclear.
Hmm…the BP article says,
For what it's worth, I ran similar logistic regressions with several interaction terms (most of the above factors by age, and by injury history last year). The message remained the same. Injury history was still the top predictor, along with raw number of pitches thrown, and as you might expect, having a previous injury or being older made things somewhat worse.
The second article I posted deals with young service members with an average age of 23.

In the literature review I posted, the authors cite two studies where the average age is 21, another where the average age is 24, and another where the oldest person in the study was 28.

With any studies/data on TJ surgery, age probably won’t play much of a role anyway because TJ isn’t usually done on older pitchers. Looking at the TJ tracker, the number of pitchers over 30 in MLB or MiLB who go in for TJ in a given year is usually a single-digit number out of the 100 or so that get the surgery overall.

So I’m not sure that factor is overlooked here.
 

sezwho

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Hmm…the BP article says,

The second article I posted deals with young service members with an average age of 23.

In the literature review I posted, the authors cite two studies where the average age is 21, another where the average age is 24, and another where the oldest person in the study was 28.

With any studies/data on TJ surgery, age probably won’t play much of a role anyway because TJ isn’t usually done on older pitchers. Looking at the TJ tracker, the number of pitchers over 30 in MLB or MiLB who go in for TJ in a given year is usually a single-digit number out of the 100 or so that get the surgery overall.

So I’m not sure that factor is overlooked here.
Thanks for breaking this down @cannonball 1729 , this idea that injuries are a complete random walk is one of the most persistently asserted sosh thought balloons. I’m too tired to rehash the argument every time.
 

ookami7m

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I talked to Alex Speier about this yesterday and they said there was no indication they were going to get an MRI, which I take as a good sign. Ulnar neuritis can be diagnosed clinically (a.k.a. just by symptoms) and without an MRI. If they thought there was any chance of structural damage I‘m sure he already would have had an MRI
Does Speier get a discount or is it $10 for him too?
 

The Gray Eagle

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Speier in the Glob says Whitlock will throw 3 simulated innings today, then have at least one rehab start, maybe 2.
Hopefully everything goes well.
https://www.bostonglobe.com/2023/05/10/sports/red-sox-pitching-prospect-bryan-mata-has-leave-game-with-shoulder-problem/
Garrett Whitlock (right ulnar neuritis) will throw a three-inning simulated game at Fenway Park Thursday. From there, Whitlock will get a rehab start that will likely take place next Tuesday. Manager Alex Cora is uncertain if Whitlock will need one or two rehab starts before joining the big league club.
 

The Gray Eagle

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Update: Whitlock left his start today after 1 inning with elbow tightness.
After the game, Cora said Whitlock was feeling similar to the time he went on the IL in April with ulnar neuritis. Last time it took about a month before he was back.

He's getting an MRI tomorrow. Hoping for good results.
 

radsoxfan

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DRS said above that Whitlock never got an MRI.... I genuinely cannot believe a major league pitcher could miss a month with medial elbow pain and not get an MRI. Even if they were 95+% sure nothing structural, hard to believe they wouldn't want to take a look. Ulnar neuritis can definitely be diagnosed clinically, but that doesn't rule out a UCL issue as well.

The ulnar nerve is very close to the UCL and if there is a UCL injury there is swelling medially that often inflames the nerve and gives ulnar neuritis type symptoms. Having ulnar neuritis isn't exactly reassuring, plenty of the UCL injuries also get some neuritis with it.
 

The Gray Eagle

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Whitlock said that actually it doesn't feel the same as his last injury. MRI today.
https://theathletic.com/4661536/2023/07/02/red-sox-garrett-whitlock-injury/

After Sunday’s 5-4 win in Toronto, manager Alex Cora said Garrett Whitlock’s elbow felt a lot like it did earlier in the season when he went on the injured list with a nerve issue. Then Whitlock spoke to reporters and said this was different and that his elbow had been stiff for a while. So, who knows? Whitlock will get an MRI on Monday, and maybe the Red Sox will receive some good news. But it’s hard to be optimistic given the way everything else has gone this season.
Hence the sinking feeling even after an overwhelmingly positive weekend.
Even with Whitlock, the Red Sox were playing with a four-man rotation. They haven’t had a fifth starter since Tanner Houck was hit by a comebacker that fractured his face in the middle of June. They’ve been using a bunch of openers and long relievers.

Not yet clear what the rotation will be going into the all-star break. They might start the only 3 healthy starters against Texas, rather than giving them an extra day, and have a couple bullpen games against Oakland. That would mean Bello starting Tuesday and Sunday, and more Bello starts are good. But they might not want to push him that hard yet, given his inexperience.

Monday’s off day and next week’s All-Star break will buy the Red Sox a little time. Their next series is against the first-place Rangers beginning Tuesday. The Red Sox could use their three healthy starters — Brayan Bello, James Paxton and Kutter Crawford — on normal rest for those three games. They would probably prefer to give everyone an extra day of rest, but even before Whitlock’s injury, the Red Sox had not officially announced a starter for Tuesday, suggesting they were at least considering keeping everyone on their turn.
 

simplicio

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DRS bringing the bad news in the injury thread:
Whitlock having a bone bruise is immediate short-term good news, but it worries me for his long term elbow situation. Getting a bone bruise from no trauma aside from pitching (traumatic enough, no doubt) makes me think that maybe his UCL is getting a little loose, allowing for more trauma to the bones than they would otherwise see. UCL injuries are frequently chronic attritional injuries- guys will lose a little velocity, some command, start injuring other structures in and around the
elbow… I’m not terribly optimistic about that elbow over the next couple of years.
And the prescription for a long term fix:
It would be revision Tommy John. Not a career death sentence but not great
 

simplicio

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The fact that they didn't describe it as "bone bruise due to ____" seems like pretty good indication of that.