By Abby Sims
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After hearing that Mets closer Bobby Parnell was diagnosed with an incomplete medial collateral ligament (MCL) tear in his right elbow, one jumps to the logical conclusion that surgery is in his immediate future.
That is especially so with a team physician — Dr. David Altchek — who pioneered a very successful modification of the original Tommy John procedure.
The first thing to realize is that the medial collateral ligament of the elbow is also known as the ulnar collateral ligament — or UCL — because of its attachments to the humerus and ulna at the inner (medial) elbow. Now that you know that, the first thought of any Mets fan might be that Matt Harvey recently succumbed to surgery to address the same injury. (Though perhaps the extent of the tears is not identical.) Both men complained of primary symptoms in the forearm.
Harvey resisted the knife initially, and now, evidently, Parnell is following suit. The Mets tweeted that after having a Platelet Rich Plasma (PRP) injection, Parnell will rest for two weeks before beginning a throwing program, after which it will be determined whether surgery will be required.
Well, what do you think the outcome will be?
First, consider that even a partially torn ligament does not heal in two weeks. In fact, complete healing might take a year. The tensile strength of the healing tissue is significantly impaired during the healing phase and is only at about 80 percent of capacity at the three-month mark. Will PRP accelerate things that much? Even if effective, that isn’t likely.
Next, keep in mind the extraordinary stresses that pitchers place on the medial (inner) elbow — and the excessive loading of the region — which can create inflammatory or degenerative conditions in a number of structures in the area. This may explain why Parnell’s symptoms — like Harvey’s — were not initially localized to the UCL, which is the primary stabilizer of the elbow.
Other tissues often affected include the wrist flexor muscles — which are in the forearm but whose tendons attach at the inner elbow — the forearm pronators (which turn the palm downward), the elbow joint capsule and the ulnar nerve. The repetitive demands of pitching and the nature of the motion itself — particularly the acceleration phase — are the primary culprits.
A partial tear of the UCL — also referred to as a moderate (Grade 2) sprain — causes laxity (looseness) of the ligament. This, in turn, creates joint instability. The resulting instability places even greater stress on the surrounding tissues. Even after the cumulative trauma of less significant Grade 1 injuries (micro-tears), ligaments may be weakened and tissues prone to inflammation. At worst, they could tear further. Additionally, other degenerative changes such as bone spurs may result.
So, placing excessive demand on weakened structures that were vulnerable even when at full capacity — in other words, pitching — doesn’t sound like a recipe for success. The two weeks of rest sound like a smokescreen to me, and like so many other pitchers who’ve already fallen to elbow issues at this early stage of the season, I wouldn’t expect Parnell to take the mound for the Mets until 2015.
If he does, it may not be for long.
Follow Abby on Twitter @abcsims.
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