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A New York Yankees blog by Chad Jennings and the staff of The Journal News


Questions linger in the wake of Tanaka’s injury

Posted by: Chad Jennings - Posted in Misc on Jul 11, 2014 Print This Post Print This Post | Email This Post Email This Post

Masahiro Tanaka

Just a few obvious questions and whatever answers the Yankees have provided in the wake of yesterday’s Masahiro Tanaka news.

How often does this PRP injection and rehab protocol actually work?

Although surgery is almost always seen as a last resort, if this rehab procedure doesn’t work, the Yankees will be simply delaying the inevitable and forcing Tanaka to miss even more of next season. This is only a good plan if it actually avoids surgery. If it simply delays surgery for six weeks, then it’s a bad plan.

“That’s a fair question,” Brian Cashman said. “It’s one that I asked myself. The response I got was essentially, every player is different. (The doctors) have had, and they reminded me of players that we’ve had that we’ve had success with, circumstances that are long forgotten. Since I’ve been the GM, we’ve experienced this, dealt with it, and then obviously the success stories, they’re something that’s on the forefront of your mind especially through the process, and then as they continue to progress and have success and return to form without incident, then you kind of forget about them over time. I was reminded about a certain number of cases tonight on the call (with the doctors). But it’s hard to put a specific percentage on them.

“It’s just hard because every circumstance is different. Every player is different. We have a tremendously gifted and tough player. We’ll just see how he responds to that. It will be a success, and if it’s not, we’re looking at an obvious solution to it from the surgical side. I’ll repeat, we’re hopeful and optimistic that the recommendations provided by all three physicians – which are terrific physicians in their own right – will be a successful course of action, but there is no guarantee on that.”

What other pitchers have had success with this procedure?

It’s perhaps the most obvious follow-up question that hangs over the entire situation, but neither Cashman nor Joe Girardi has provided a name. Both say that pitchers in and out of the Yankees organization have had success using this procedure to avoid — or at least significantly delay — Tommy John surgery, but it’s hard for an outsider to make comparisons because it’s hard to know which UCL tears were similar to Tanaka’s. It’s also hard to know whether some pitchers might have had a similar injury that was downplayed as something less significant.

“I wouldn’t say (which pitchers),” Cashman said. “Some of which are pitching elsewhere. Some of which have pitched for us in the past and have now retired. Some of which we have in the minors. Let’s just put it this way: I’m the GM here for 17 years and the rehab protocols we have in play, we have personally had success with. Altchek and ElAttrache have also had success with them. But it’s not an obvious solution that we’re going to. It’s not one of those situations that fixes all people. Depending on the circumstances and the size of the tear, ligaments can repair themselves. They’ve had success with it, and we’ve personally experienced that.

“In terms of the individuals, I don’t want to say that, but I know each one of your papers or media outlets have specialty doctors they can go to confer on that. There are success stories with that. We clearly are going to follow their rehab protocols and their suggestions. If this was an obvious situation that he needed surgery at the outset, then that’s what we’d be doing. But that’s not what we’re getting. We’re actually getting, ‘Here’s the finding, here’s the results, and here’s our recommendation’ — and all three are in agreement on that.”

Why did Ivan Nova go for Tommy John right away, but Tanaka is going to try this first?

The answer seems obvious, but it’s worth asking.

“Different circumstances,” Cashman said. “The imaging and the physical test results, and the combination and collaboration of all three doctors, it has nothing to do with Tanaka. I think they just act accordingly based on other physical assessments of the player and then the imaging that updates the player. In Nova’s case, it’s hard to speak to, but I suspect that his was a rather obvious circumstance. You have a completely torn or significantly torn ligament. There is only one solution. Sometimes, and many times — most of the times, I would suspect — that’s the case. That’s not the case in this circumstance. The one thing that all three physicians have conveyed is that it is a small tear in the ligament. Because of that, the recommendation they provided were based on their physical assessments as well as looking at the imaging. They believe this is the proper course of action with no influence from the club.

“If we knew today that the best course of action was Tommy John surgery, despite the name and the amount of the investment, we would be doing Tommy John surgery. But this is one of those circumstances where you take the profile of the player and the investment in the player, you take all of that different stuff out of it. This is pure guidance by a sophisticated medical team that offers the best of the best here in the country. All three suggest the same route. If their suggestion was otherwise, then we would follow that suggestion.”

Could the Yankees have monitored Tanaka differently,
and will they have to treat him differently in the future?

Fact is, Tanaka came into this season with quite the workload. That was an obvious and acknowledged fact even before he signed with the Yankees. He was moved along slowly in spring training, given extra rest and every opportunity during the season, and he was rarely asked for more than 110 pitches in a start. He didn’t throw more than 99 pitches in either of his past two starts.

“I think we managed him the best we could,” Girardi said. “We were careful. If you can remember, I was asked a thousand times why I moved him back about two weeks ago. We did everything we could to give him extra rest and not have him throw too many pitches. And we’ll continue to do that because we know we’ve got to keep him healthy.”

Trade deadline is three weeks away. How does this affect the Yankees approach?

In the past week the Yankees have traded for Brandon McCarthy and called up Shane Greene, but each of those moves came in the two days before Tanaka’s last start. Does the latest rotation injury leave the Yankees more desperate to make a move, or does it leave them out of hope and with little reason to give up potential pieces of the future?

“We’ve been aggressive because now we’ve got four starters that we were planning to have in the rotation are out,” Cashman said. “Because of that, we have been aggressive, and we will continue to be aggressive unless I’m told otherwise. We are in the middle of a division fight, and we want to stay in the fight, so we’ll continue to look at any opportunities and options that present themselves to upgrade. Unless told otherwise, I’ll continue the course of action, even though we don’t have as much to show for those efforts, the efforts have been made thus far and they’ll continue to be made.”

Associated Press photo

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