Tommy John Surgery May be in Tyler Glasnow's Future

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The Tampa Bay Rays were hit with rough news today. Injuries are up across the board and every team is struggling, but that doesn't lessen the sting of a potential season-ending injury.

Taylor Glasnow, Tampa's ace and one of the top pitchers in the MLB this season, left yesterday's start after only four innings. Being second in the MLB in innings pitched, being pulled after four innings despite pitching well can only mean injury.

Glasnow pulled himself out of the start after feeling a "little tug" and "tightness" in his forearm, hoping to avoid a serious injury.

“I think I got it relatively early. I just was like, I don’t want to go back out and chance it,” he said (via Topkin). “The (velocity) and everything was still there. But it just felt not right.” - Tyler Glasnow

While his intentions were good, it was too little too late. If the symptoms are present, the damage has already been done. That doesn't mean he didn't prevent further injury, but this particular issue has been brewing for years.

The dreaded UCL tear

The Tampa Bay Rays training staff immediately ordered an MRI for Glasnow and the results were what everyone fears when the words "forearm tightness" are uttered.

Glasnow has a partially torn ulnar collateral ligament, a common precursor to Tommy John surgery. I say common, as Tommy John is not a foregone conclusion. Rehab is becoming a more common approach for partial UCL tears. The most well-known case of successful rehab is former Yankees ace Masahiro Tanaka.

The best-case scenario for Glasnow and the rays is about an eight-week absence. After rest and rehabilitation, Glasnow needs to build his arm strength and endurance back to be game-ready.

An interesting wrinkle to the injury is Glasnow's comment on how he believes the new MLB rules on eliminating "sticky stuff" contributed to his injury.

“Do it in the offseason, give us a chance to adjust to it. But I just threw 80-something, 70-whatever innings, and then you just told me I can’t use anything in the middle of the year? I had to change everything I’d been doing the entire season. Everything, out of the window, I had to start doing something completely new.

And then I’m telling you, I truly believe, that’s why I got hurt. Me throwing 100 and being 6’7″ is why I got hurt, but that contributed. I’m just frustrated that they don’t understand how hard it is to pitch, one, but to tell us to do something completely different in the middle of the season is insane. It’s ridiculous. There has to be some give and take here. You can’t just take away everything and not add something. Pitchers need to be able to have some sort of control or some sort of grip on the ball. And I just don’t want this to happen to somebody else, I don’t want a fastball to sail away and hit somebody in the face like it already has.

I understand you need to take an aggressive approach here, but I just think people are going about it all wrong. And I’m sitting here, my lifelong dream, I want to go out and win a Cy Young, I want to be an All-Star, and then now it’s all just shit on. Now it’s over. I have to try and rehab and come back in the playoffs. I’m clearly frustrated…people need to figure this out. You can’t just tell us to use nothing. It’s crazy.” - Tyler Glasnow

I can sympathize with Glasnow, but as he stated, the high volume and high velocity are the drivers of the injury. UCL tears develop over time, with micro-tearing gradually wearing away the ligament. The UCL is not designed to withstand the rigors of pitching 100 mph a couple of hundred times per week.

In fact, the use of sticky stuff likely increased the risk of injury. Sticky stuff allows pitchers to throw harder, generating more strain on the ligament and increasing the chances of tearing.

Regardless, that doesn't change the current situation for Glasnow or the rest of the Tampa Bay Rays. The timing of the injury is challenging, however.

Tommy John surgery typically takes 12-18 months of rehabilitation. For a starter, push the number closer to 18. If Glasnow gets the surgery now, he may be able to return in time for a playoff push next season - and Tampa is always competitive. If the rehabilitation fails, Glasnow will miss the rest of this year and all of next year. The Rays are one of the top teams this year though and are the defending AL champs.

I am in favor of the rehabilitation attempt and wish Glasnow and the rays the best of luck.

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