Odds Against Masahiro Tanaka Staying Healthy

After an uncharacteristically rough outing from Masahiro Tanaka in Cleveland on July 8 — 11 baserunners, five runs allowed, two homers — New York Yankees fans received the worst news imaginable: Tanaka, who had made the All-Star team and appeared to be worth every penny of the $175 million the Yankees had laid out to import him from Japan prior to the season, had to be placed on the disabled list after an MRI revealed a partially torn ulnar collateral ligament in his right elbow, also known as the injury that generally leads to Tommy John surgery.

Rather than undergo surgery, which would have cost him most of the 2015 season, as well, Tanaka chose the path of rest and rehab, including platelet-rich plasma (PRP) injections. After missing more than two months, he made two appearances in September — one positive (5 1/3 innings of one-run ball against Toronto on Sept. 21) and one much less so (seven runs in 1 2/3 innings in Boston on Sept. 27). He reportedly has had no problems with the elbow since, successfully completing several bullpen sessions at Yankees camp while hoping that the work he has done to strengthen the arm muscles around the ligament, along with changes in his delivery, will keep him whole.

For the Yankees, part of what appears to be a tightly packed AL East, there may be no player more vital to their success than a healthy Tanaka. That’s not only because he’s one of baseball’s best pitchers when healthy; it’s because with CC Sabathia’s knee still acting up, Ivan Nova still recovering from elbow surgery, Shane Greene and Brandon McCarthy off to Detroit and Los Angeles, respectively, and Michael Pineda having thrown only 76 innings in the past three seasons combined, this rotation is more than a little risky. It’s not a stretch to say that the Yankees are contenders with Tanaka and hopeless without him — and unfortunately for both player and team, the odds aren’t in his favor.

Not a good track record for rehabbing elbow injuries

Let’s stipulate up front that every elbow injury is unique, both in the type and severity of the issue and in the player who’s dealing with it. What ends one career may only sidetrack another. But what’s indisputable is that elbow ligaments, once torn, don’t heal themselves. For those who choose to forgo surgery, the best hope is they can manage to strengthen the area around the tear enough so that the ligament receives less stress and doesn’t snap.

That’s what Chad Billingsley hoped for anyway. Near the end of a successful 2012 season, he suffered a similar injury to Tanaka’s. Not wanting to see his 2013 wiped away due to surgery, he attempted the rest/rehab/PRP path, as well, reporting great results all during the 2012-13 offseason. A mere 12 innings into that 2013 season, the elbow gave out. He missed the rest of the season, then all of 2014 after another arm injury. The Dodgers declined his 2015 option, and he’s now in Phillies camp on a one-year deal, hoping to revive a career that had once seemed promising.

Chad Billingsley opted for the non-surgical route on his UCL injury, and it derailed a promising career.AP Photo/Paul Sancya
While Billingsley is just a single data point, that’s the kind of risk Tanaka faces here, and the fact is that for pitchers with a partially torn UCL, attempting to skip surgery and remain on the mound is a risk that rarely works out. Take, for example, Lucas Giolito, who was the No. 8 prospect (and top pitcher) in Keith Law’s recent top 100 prospects list. In March 2012, Giolito injured the UCL in his elbow, ending his high school career and pushing him from a probable No. 1 overall selection to the Washington Nationals at No. 16. He attempted to avoid surgery and lasted all of two innings into his pro career before the elbow blew, delaying his development for a year-plus.

The list of pitchers who tried and failed to avoid the zipper with rehab is seemingly endless. Toronto’s Drew Hutchison, who had a quietly good season in 2014, felt pain on June 15, 2012, and spent nearly two months attempting to rehab before going under the knife in August. Tanaka’s teammate, Chris Capuano, felt elbow pain in March 2009 while a member of the Brewers, and tried to avoid the procedure until May, when surgery became inevitable. In 2013, Matt Harvey spent nearly three months from August through October trying to get through his own torn UCL without surgery before accepting the inevitable.

It’s the timing that’s important here, really. In Harvey’s case, getting the procedure when he did meant that he lost all of 2014, but it also allows him to come back in 2015 a full 17 months since the surgery. Had he waited and found himself more fully injured in early 2014, he’d have missed the remainder of that season and much of 2015, as well, a potentially fatal blow to a Mets team hoping to contend for the first time in years.

We could go on for hours with examples of pitchers who tried and failed to rehab elbow injuries — Francisco Liriano, Pat Neshek, Cory Luebke, Bronson Arroyo, Eric Gagne and many others fall under this category — but the numbers tell a clear story. Because the ligament won’t heal itself, it’s almost impossible to avoid the inevitable.

Can he be the next Adam Wainwright or Ervin Santana?

It’s not entirely impossible to rehab, return and succeed following a UCL injury. In digging through years of injury data, we did manage to unearth a few known cases where trying to pitch through a partially torn UCL actually paid off, though two of them aren’t relevant to Tanaka. The first two aren’t, partially because Takashi Saito and Scott Atchison were one-inning relievers, and mostly because they were in their mid-to-late 30s, making surgery a potential career-ender. As a starter who turns 27 in November, Tanaka’s case is much different.

If Tanaka is looking for inspiration, however, he can look to Adam Wainwright and Ervin Santana. Yes, that’s the same Wainwright who lost the entire 2011 season to Tommy John surgery, but the difference is that he didn’t suffer his initial injury the year before. He actually suffered it seven years earlier, while in the minors, and managed not only to survive but to thrive, proving himself among baseball’s best both before and after. Santana, meanwhile, missed a chunk of 2009 with a sprained UCL, but didn’t have surgery and has topped 200 innings three times since.

Those examples mean that it is possible, albeit not probable, and remember that not only did we not list every single example of a pitcher who tried and failed to pitch through the injury, there’s certainly countless cases in which we learned only that lower-profile pitchers had undergone surgery, not that they’d attempted to rehab through it.

It’s just too risky

There’s no right or wrong decision here. No moral judgment intended, of course, because nothing is certain. Tanaka could pitch through the injury. He could stay healthy and help the Yankees to the playoffs, because again, every arm and injury is unique, and Tanaka is no doubt hoping to earn the $22 million the Yankees are paying him this year.

This can work. It just overwhelmingly doesn’t work, and those are the odds he faces as he attempts to help the Yankees back into the playoff race in 2015. If it doesn’t, and a good chunk of his 2016 evaporates, as well, the decision not to have surgery in 2014 is going to loom large.