Dane Dunning had Tommy John today

[NorthSideSox72]

Just now, Balta1701 said:

I’m sorry but this is not nearly as open and shut as you suggest. Per what we have been told in this forum by our expert, assesssing the degree of a tear based on either physical examination or MRI is nowhere near this straightforward. The injury last summer was probably a partial tear, sometimes those are able to partially or fully heal with rest (see Tanaka) but not always, and assessing the exact degree of a tear without the surgery has been suggested to be very difficult. While rehab is always preferable if possible, you cannot simply say “there was no tear last year” as open and shut as you’re saying here. The MRI often can’t show that.

You just kinda made the same case I did with more words. No tear, no surgery. Significant tear, probably surgery. Some small tear, well, that is a question with variables that are over all of our heads and the decision is fuzzy.

But you can't just throw around "should have had the surgery before", when there is no info (that I am aware of) that he had a tear last summer. That isn't how any of this works. Are you aware of a report of a tear? If not, we need to not suggest surgery thinking it is some magic fix for all elbow ailments.

 

[Balta1701]

1 minute ago, NorthSideSox72 said:

You just kinda made the same case I did with more words. No tear, no surgery. Significant tear, probably surgery. Some small tear, well, that is a question with variables that are over all of our heads and the decision is fuzzy.

But you can't just throw around "should have had the surgery before", when there is no info (that I am aware of) that he had a tear last summer. That isn't how any of this works. Are you aware of a report of a tear? If not, we need to not suggest surgery thinking it is some magic fix for all elbow ailments.

 

So you can’t say no tear like you did, it was probably a fuzzy one in the middle. I do not have any better information on the rest and will not say they should have done surgery last year, but I will say you can’t say the one thing that you said.

[caulfield12]

7 minutes ago, Balta1701 said:

I’m sorry but this is not nearly as open and shut as you suggest. Per what we have been told in this forum by our expert, assesssing the degree of a tear based on either physical examination or MRI is nowhere near this straightforward. The injury last summer was probably a partial tear, sometimes those are able to partially or fully heal with rest (see Tanaka) but not always, and assessing the exact degree of a tear without the surgery has been suggested to be very difficult. While rehab is always preferable if possible, you cannot simply say “there was no tear last year” as open and shut as you’re saying here. The MRI often can’t show that.

“The news on Class AA Birmingham right-hander Dane Dunning could have been worse, but it also could have been better. Dunning has a moderate elbow sprain that won’t require surgery, but his season is likely over.

Dunning, 23, was examined Wednesday in Chicago by team doctor Nik Verma and will begin a six- to eight-week program of rest and rehab. The Sox said Dunning will begin a throwing program after that, and a plan for his return to pitching will be determined.”

From Trib article last June 27th...

[Dam8610]

1 minute ago, NorthSideSox72 said:

You just kinda made the same case I did with more words. No tear, no surgery. Significant tear, probably surgery. Some small tear, well, that is a question with variables that are over all of our heads and the decision is fuzzy.

But you can't just throw around "should have had the surgery before", when there is no info (that I am aware of) that he had a tear last summer. That isn't how any of this works. Are you aware of a report of a tear? If not, we need to not suggest surgery thinking it is some magic fix for all elbow ailments.

 

They could've taken an approach of "any tear means surgery", in which case it might have been done last June. It's not that big of a deal (because this team is likely to have at least 2-3 more top 5 picks), but to pretend the front office is above criticism here is disingenuous.

[NorthSideSox72]

I guess this is one of those pet topics for me. The last few years especially, I see a lot of people dehumanizing players by just saying "clearly he has a torn UCL" when a pitcher's forearm hurts or "clearly he should have had TJS already" when they have zero knowledge of a tear. It is like saying they either know more than the doctors (laughable), or they see the players as video game characters and don't consider how serious surgery is.

I even saw a scouting-related blog insisting Alec Hansen "clearly has a torn UCL" when, again there was no evidence of and in fact there was every reason to believe otherwise. From a journalism perspective that's abhorrent to me - it is fast and loose with information and perpetuating lies while trying to make them look somehow knowledgeable.

Maybe Dunning had a tear, maybe he didn't, but the initial reports were that he did NOT. Did it happen later and they elected to try to heal anyway? Maybe, I don't know nor does anyone else here I don't think. But believing the doctors knew surgery was needed and then for some unspecified reason avoided it anyway is ridiculous.

 

[ChiSox59]

11 minutes ago, caulfield12 said:

See Ohtani, Shohei, one of the important players ever to come over from Japan.  Similar situations in terms of hoping for the situstion to turn around on its own, along with the possibility of contending with him purely as a hitter.

Mickey Adolfo would be another.

Tanaka also comes to mind over an extended period...where they did platelet injections and all kinds of tricks to get him through it to the other side still intact.

Lol, and how did those two work out, Caulfield? 

[NorthSideSox72]

1 minute ago, Dam8610 said:

They could've taken an approach of "any tear means surgery", in which case it might have been done last June. It's not that big of a deal (because this team is likely to have at least 2-3 more top 5 picks), but to pretend the front office is above criticism here is disingenuous.

Not sure how you made this leap. This isn't front office as in management if you will - it is medical staff. And to pretend you know more than them is most certainly disingenuous.

[caulfield12]

Just now, ChiSox59 said:

Lol, and how did those two work out, Caulfield? 

Well, you can argue waiting it out for Tanaka was at least moderately successful, as opposed to losing him for 18 months in the prime of a contention window.

[ChiSox59]

Just now, caulfield12 said:

Well, you can argue waiting it out for Tanaka was at least moderately successful, as opposed to losing him for 18 months in the prime of a contention window.

Was referring to Ohtani and Micker. 

[caulfield12]

Just now, ChiSox59 said:

Was referring to Ohtani and Micker. 

Ohtani is a special situation as a two-way player.

With Adolfo, he needed those at-bats during the season, and he definitely proved he belonged in High A.  That said, his defensive value is largely going to come from assists in RF, but I’d worry just as much about him eating his way out of the outfield as the TJS not providing him an even better arm than previously.

[CaliSoxFanViaSWside]

1 minute ago, NorthSideSox72 said:

Not sure how you made this leap. This isn't front office as in management if you will - it is medical staff. And to pretend you know more than them is most certainly disingenuous.

Ever since Machado was botched and the injuries have started piling up everything the Sox do has come under the gun from our knowledgeable fan base of diehards. Should've spend more, should've spent less, should've had surgery before, need a new medical staff, should've signed him instead of him . It's ugly round here.

The utter insanity of the Manny thrill ride has disintegrated from thinking the Sox could complete this year with Machado , Joc and another pitcher into every part of the Sox organization sucks.

[Dam8610]

28 minutes ago, NorthSideSox72 said:

Not sure how you made this leap. This isn't front office as in management if you will - it is medical staff. And to pretend you know more than them is most certainly disingenuous.

I never said I know more than them. I was lamenting the additional recovery time being essentially wasted with the benefit of hindsight. Like I said, though, it doesn't matter much because this organization is probably going to see 2-3 more top 5 picks anyway.

[mqr]

I just got a notification from MLB At-Bat that said 'Fulmer may need Tommy John', I started laughing out lout until I realized they were talking about Michael. 

[Dick Allen]

1 hour ago, NorthSideSox72 said:

You just kinda made the same case I did with more words. No tear, no surgery. Significant tear, probably surgery. Some small tear, well, that is a question with variables that are over all of our heads and the decision is fuzzy.

But you can't just throw around "should have had the surgery before", when there is no info (that I am aware of) that he had a tear last summer. That isn't how any of this works. Are you aware of a report of a tear? If not, we need to not suggest surgery thinking it is some magic fix for all elbow ailments.

 

It's going with probability. When Dunning went down last year, most probably felt, even maybe yourself, it is going to happen sooner or later. Now I don't know how operating on a UCL that doesn't need operating on at the time will help, but I'm sure most of us saw the writing on the wall. Tanaka avoiding surgery seems to be the exception to the rule. They called it a sprain last year. I think a sprain is technically a small tear. Personally, I think it's better it is happening now than a month or 2 from now.

Edited March 19, 2019 by Dick Allen

[NorthSideSox72]

7 minutes ago, Dick Allen said:

It's going with probability. When Dunning went down last year, most probably felt, even maybe yourself, it is going to happen sooner or later. Now I don't know how operating on a UCL that doesn't need operating on at the time will help, but I'm sure most of us saw the writing on the wall. Tanaka avoiding surgery seems to be the exception to the rule. They called it a sprain last year. I think a sprain is technically a small tear. Personally, I think it's better it is happening now than a month or 2 from now.

A sprain can be a tear, but not all sprains are tears.

And yeah I was in the same boat as everyone else, knowing there was a good chance that is where it would end up. That makes perfect sense. But that's not the same as saying he should have had surgery then when - if there was no tear - that wasn't even possible.

 

[ChiSox59]

14 minutes ago, NorthSideSox72 said:

A sprain can be a tear, but not all sprains are tears.

And yeah I was in the same boat as everyone else, knowing there was a good chance that is where it would end up. That makes perfect sense. But that's not the same as saying he should have had surgery then when - if there was no tear - that wasn't even possible.

 

Except there is nothing concrete we have to go on saying there was no tear.  There likely was a tear, it was just small or partial.  It is what is now, but obviously essentially wasting 2 years of development on a then close to MLB ready starter is......not ideal. 

[NorthSideSox72]

9 minutes ago, ChiSox59 said:

Except there is nothing concrete we have to go on saying there was no tear.  There likely was a tear, it was just small or partial.  It is what is now, but obviously essentially wasting 2 years of development on a then close to MLB ready starter is......not ideal. 

First, it is not "likely" there was a tear. And besides, you have no idea, nor do I. But the early report was specific that there was a moderate sprain, saying nothing of a tear (sprains sometimes are a tear and sometimes not), so making the leap to "likely" is nonsensical. Possible, yes.

Second, again, there is zero motive for the medical staff to do what you are supposing - to avoid surgery when a tear was already present and mess up Dunning's career. They clearly would want to do the opposite.

Third, that is not how medicine works. You do surgery when necessary, or as a last resort. Surgery is not some flippant thing they do because maybe there's something doable in there. You do it when you have to, because surgery has risks.

Fourth and finally, no matter how you characterize the decision, it did not result in losing two more years of development. At worst it added the loss of a July-August period in 2019, which is 2 months of play. Surgery today means he's likely back to normal a year from now, give or take a month or two either direction.

 

[Chisox378]

There is no way this is a coincidence that all our best minor league pitchers are hurt.  The training or the coaching needs to be examined.  That way there can be no excuses if the White Sox rebuild falls short. As far as developing hitters, I see that as a problem too. Now is the time when we need the best training staff,coaching, and philosophy in the minors.

[GenericUserName]

3 minutes ago, Chisox378 said:

There is no way this is a coincidence that all our best minor league pitchers are hurt.  The training or the coaching needs to be examined.  That way there can be no excuses if the White Sox rebuild falls short. As far as developing hitters, I see that as a problem too. Now is the time when we need the best training staff,coaching, and philosophy in the minors.

Right, right, but see that would cost money and we need that money to pay Eloy in 7 years.

[ptatc]

3 hours ago, NorthSideSox72 said:

 

Please stop saying this crap. It is unfounded in anything factual.

TJS is a procedure to replace ligament tissue, either from elsewhere in the body or cadaverous material. It is done to replace a TORN UCL. If there is nothing torn, there is nothing to replace. If Dunning has a strained/sprained UCL that did not include a tear, then the only viable option was to try the heal/strengthen route and then ramp him up again. Sometimes that works, sometimes it doesn't.

You can think the Sox training/medical staff has made mistakes, and maybe they have. But do you really think they would KNOW there was a significant tear, and try to avoid the surgery anyway? That helps literally no one, the Sox or the player or anyone else. There is zero motivation for that. Therefore, clearly there was no significant tear yet, so they took the only medically responsible path available to them.

This sucks, but the conspiracy theories are ridiculous.

 

A sprain is a tear. It just depends on the size of the tear. If it's fairly small they will always try conservative treatment first. It is still the practice of medicine eventhough we are getting better with research and evidence based practice. 

Besides it's not the training staff that makes the final decision on any of this, it's the physicians. In this case James Andrews.

[ChiSox59]

27 minutes ago, NorthSideSox72 said:

First, it is not "likely" there was a tear. And besides, you have no idea, nor do I. But the early report was specific that there was a moderate sprain, saying nothing of a tear (sprains sometimes are a tear and sometimes not), so making the leap to "likely" is nonsensical. Possible, yes.

Second, again, there is zero motive for the medical staff to do what you are supposing - to avoid surgery when a tear was already present and mess up Dunning's career. They clearly would want to do the opposite.

Third, that is not how medicine works. You do surgery when necessary, or as a last resort. Surgery is not some flippant thing they do because maybe there's something doable in there. You do it when you have to, because surgery has risks.

Fourth and finally, no matter how you characterize the decision, it did not result in losing two more years of development. At worst it added the loss of a July-August period in 2019, which is 2 months of play. Surgery today means he's likely back to normal a year from now, give or take a month or two either direction.

I think you're misinterpreting my angle a bit.  I am not suggesting I know more about medicine or how to rehab an arm injury than the White Sox. Just the way this played out is pretty shitty.  If the Sox did the surgery last July (again...lets just assume for a second for the purposes of this example that he had a slight tear ), he likely misses all of 2019 anyway, but is probably already throwing and would be much more ramped up and ready to go for 2020.  Now, he's likely to miss a good chunk of 2020.  So either way he's missing a ton of development time, but trying to rehab the injury did cost him more game development time.  

Again, it is what is.  But IF he had a partial tear (I don't know, you don't know, no one but Dunning, his family and the White Sox know), I think they misplayed this.  Its certainly possible that he didn't and this was just going to happen at some point, and in that scenario, I guess better now than late in the 2019 season. 

[ptatc]

2 hours ago, ChiSox59 said:

Do we know for a fact there wasn't a slight tear and they tried to rehab it?  

Andrew's. Is always a tear with an injury severe enough to stop pitching. It just depends on the size. A sprain is just a tear, it can be very small or a total rupture. It's obvious that the previous tear was small enough that the physicians thought conservative treatment was the way to go. They were wrong, it happens.

[ChiSox59]

1 minute ago, ptatc said:

Andrew's. Is always a tear with an injury severe enough to stop pitching. It just depends on the size. A sprain is just a tear, it can be very small or a total rupture. It's obvious that the previous tear was small enough that the physicians thought conservative treatment was the way to go. They were wrong, it happens.

Right - thanks for proving my point with NSS. 

[ptatc]

2 hours ago, ChiSox59 said:

Such a bummer.  I am certainly not a doctor, but just seems like this should have been done last summer.  Dunning is now behind the 8 ball. He isn't that young.  

It's probably should have been done last summer based on the results now. But that's hindsight. Obviously they thought conservative treatment would work. It didn't. This isn't the first time it's happened and it won't be the last. They should ALWAYS err on the side of caution and conservative treatment.

[ptatc]

2 hours ago, Dam8610 said:

They could've taken an approach of "any tear means surgery", in which case it might have been done last June. It's not that big of a deal (because this team is likely to have at least 2-3 more top 5 picks), but to pretend the front office is above criticism here is disingenuous.

The front office had no decision about surgery. That would be up to the physician and the player. No one takes the approach that any tear means surgery nor should they. Pitching is so important that management leaves the decision to the medical team. They have goo much invested in these players. This isn't a sprained ankle by a second baseman.