Castro: Adam Miller's Career on the Line
Another surgery is possible
"Miller now has a week to 10 days to prove he can adjust to what is essentially a change in anatomy and gain enough command to compete as a professional pitcher. If he doesn't do so, the Indians will recommend that he has surgery to replace two pulley ligaments in his finger with a tendon from his wrist. If he has the surgery, he will be out of commission for six to nine months, and there is, of course, no guarantee that he'd be able to return to a competitive level."
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I was secretly hoping his nonbendable finger would give his pitches some kind of crazy unique movement. Oh well.
Proving once again that Rookie of the Year is just a movie.
by fleerdon on Mar 18, 2009 3:28 PM EDT up reply actions 3 recs
Q: Hey, Hoynsie: Could Adam Miller’s injured right middle finger be career threatening? — Angelo Costanzo, Cleveland.
A: Hey, Angelo: I think it will be more of an irritant than career threatening.
14 March 2009
by fleerdon on Mar 18, 2009 3:31 PM EDT reply actions
Just to be clear, I don’t mean this as a gotcha with respect to PH, just to demonstrate how crushing this really is as compared to what we’ve been led to believe.
by fleerdon on Mar 18, 2009 3:39 PM EDT up reply actions
I wish this weren’t true, but unlike with Hafner, I can’t say that I didn’t expect this.
by fleerdon on Mar 18, 2009 3:45 PM EDT up reply actions
Well, if it’s over, I got more use out of hoping for Adam Miller at $1MM than I did out of regretting Jeremy Guthrie at $4MM.
by fleerdon on Mar 18, 2009 3:35 PM EDT reply actions
So Googling a bit, it doesn’t look like it’s totally unheard of for pitchers to have those tendons replaced — I think Joel Zumaya had the same surgery, & it looks like Adam Eaton did too. Not the greatest comps, but Adam Eaton wasn’t too good before that happened either.
DISCLAIMER: I may be bitter.
I would love to have some reporter provide a detailed anatomical account of exactly what’s going on with this finger, even if it is highly technical and unlikely to be understood by most people. This just seems bizarre.
Yeah, the whole “he has no pain, but can’t move it” thing is really weird to me. I’m waiting for Castro’s followup on indians.com & hoping he goes into a little more detail.
DISCLAIMER: I may be bitter.
I’m confused by all this talk of pulley systems. If he can’t bend the distal segment of his finger, he’s presumably having a problem with either the flexor digitorum profundus tendon, the muscle, or the nerves associated with the muscle. I’m assuming we’d have more specific information if it was a nerve or muscle problem, so presumably it is the tendon itself. Can any of the doctor types here give us some information on what could prevent that tendon from acting?
Ok…a little investigation into some anatomy texts. The synovial sheath that covers the tendon of the flexor digitorum profundus has a series of anular and cruciform tendonous bands which help anchor it and serve as a pulley system for the joints of the finger. That would appear to be the problem. Again, I’d be interested in any actual medical knowledge, but this doesn’t sound good.
basically there’s a slipper covering on the tendon that connects to the last segment of your finger. This covering helps make sure everything functions correctly. This sheath is anchored by a series of bands, some of them sort of like circular rubber bands (annular), others like little cross stitches (cruciform). Something seems to have gone wrong with the bands (I think).
You’re right on here as far as my opinion goes. I’m not a doc, but I taught anatomy (dissecting cadavers) for a few years in grad school so I guess I’m qualified to chip in here.
The flexion of the end of the finger is a complex thing anatomically – there are ligaments that weave alternately “above and below” what you may think of as the central flexion/extension axis of the finger – so just flexing the distal part isn’t quite as simple as, say, pulling on a the end of a branch to bring it down to ground level. (has anybody ever had the far finger (distal phalanx) joint lock ‘up’ in extension while the rest of their finger was straight?’ – used to happen to me shooting pool sometimes, and is a similar type issue). But APV, you are right that part of the system is tight bands that keep tendons and/or ligaments in place and allow you the pleasure of bending your finger while maintaining distinct angles (and therefore strength) at your finger joints.
While anymore speculation to the exact injury is semi-pointless, it’s seems pretty safe to say that the ligaments in the end of his fingers are messed up. I can’t comment on the prognosis of repair procedures, but I think I’d rather have him undergo TJ surgery. FWIW.
maybe this will be the start of “Adam Miller Surgery” and our children can look back and say how amazing his career was for the Indians after that.
by Brick. on Mar 18, 2009 6:05 PM EDT up reply actions 2 recs
OK, I’ll take a shot at this. A little background: the docs who do this kinda work come in two flavors, orthopods – cuz it’s bones and tendons – and plastic surgeons – cuz it’s real, real, delicate work and requires precise cutting and sowing. To give you and idea, gynecologists use a lot of 2-O and 3-O sutures – you can dock a boat with that stuff – general surgeons use more 4-O and 5-O sutures, pretty fine material, plastics use 8-O virgin silk for much of their finer work and ophthalmologists use 8-O silk for scleral – the white part of the eye – closures.
And Adam and Thommy gave you some idea about the normal anatomy – but the piece they left out is the pathology. Most likely the cause of Mr. Miller’s symptoms is his previous surgery. What’s “locking up” his finger is the scar tissue around his flexor digitorum profundus tendon – bullseye here Adam – immobilizing, painlessly, his middle finger. So whatya do? Well you try to mobilize the tendon by debreding the scare tissue. Only one problem: the chances that you produce additional scare tissue which in turn aggravate the problem is fairly high. To quote one of my surgeon mentors, “the more you stir it, the more it stinks.”
I searched the Journal of Hand Surgery for some references – I am not a subscriber – but here’s one article of interest. And just to give you an idea of how well studied this phenomenon is – not very – here’s a list of 74 abstracts from the same journal. Note that one talks about the therapuetic use of leeches.
This is a highly specialized field of medicine certainly outside my expertise, but my medically tuned gut tells me that Mr. Millers baseball career is in deep, deep trouble. However, this kinda stuff is where many of the newer treatment techniques – stuff developed long after I left medicine – offer a chance for a break through. The guy that fixes this injury is gotta be one hell of a doc.
by mauichuck on Mar 19, 2009 1:23 AM EDT up reply actions 3 recs
I often hear about trainers and therapists using manipulated motion and massage as an adjunct way to reduce scar tissue and its interference during surgery rehab.
If the procedure is so iffy, and recovery so long, why wouldn’t they explore some non-surgical regimen before going under the knife?
yeah – and I think Hoynes actually manages to get the real frightening quote from Soloff:
“That gives it the extra giddy-up and command and location,” said Soloff. “It is a the most important finger for any pitcher. Adam is a big guy, with long arms and fingers and he throws very, very hard.”
I’m pretty sure that translates to, “this is a big big problem”
My pop is an orthopedic microsurgeon in Columbus. He has specialized in hands for 30 some years. Here is his response:
He does not have a profundus tendon rupture as I suspected.
But, he has ripped out the pulleys in the tendon sheath. They function to hold the tendons tight to the bones in the finger to achieve maximum mechanical force of finger flexion.
Without the pulleys the tendon will "bowstring" away from the bones, decreasing flexion power. This is not essential in normal daily activities, but would be essential for a professional pitcher.
Look at the illustration; the pulleys labeled A-2 and A-4 are the critical ones that are needed.
Since the injury is ‘chronic’ (occurred last year) a repair would not be possible. The alternative is a ‘reconstruction’ of the pulleys using a graft. The graft material can either be retinacular tissue from the back of the wrist or a slip of a tendon. This operation is not commonly performed. I would anticipate a two month healing process where he can only bend the finger, followed by strengthening for one to three months. To do this procedure the entire volar (palm side) of the finger must be opened. The scar created from this will take 6 mo to one year to mature.
Bottom line: get the operation and sit out this year.
Don't be stupid. PUT IN MELOAN.
by gte619n on Mar 19, 2009 3:39 PM EDT up reply actions 3 recs
This really should be a FanPost of its on. If you’ll re-post it there, we’ll put it on the front page.
Well, that's just, like, your opinion, man.
You’re going to injure a finger as well if you keep that up.
by fleerdon on Mar 18, 2009 3:42 PM EDT up reply actions
Forget that jazz. I want Fastball George back.
by fleerdon on Mar 18, 2009 3:43 PM EDT up reply actions
maybe we can teach Zachson a fastball.
by Brick. on Mar 18, 2009 3:47 PM EDT up reply actions 1 recs
That was pretty to watch. I was afraid for a few days that he was going to be good again…good thing it’s Ferd we’re talking about.
by supermarioelia on Mar 18, 2009 10:07 PM EDT up reply actions
On that note: Guthrie got knocked around tonight against Venezuela.
by cleveland teamer on Mar 18, 2009 11:11 PM EDT up reply actions
What the hell are you doing posting here and writing fanposts to boot? Aren’t you on T Surg? Back in the day, when Brontosaurus’s roamed down High St. and I was on T Surg, we didn’t have time to sleep, let alone goof around and shoot the breeze about baseball. How the hell do you find the time for this frivolity? I swear, you’re gonna end up working night admissions in some Manitoba free clinic for sure.
We’re on our March Break right now, hence me writing a huge post about my time in Goodyear. And I’m currently recovering from wisdom tooth extraction today. My current plan is to be a GP here in my hometown, so no risk of being exiled to Manitoba, thank goodness. In my defense, I have been spending far less time on here.
by supermarioelia on Mar 19, 2009 11:53 AM EDT up reply actions
BTW, the Chief of Cardiac Surgery at OSU came over to dinner last night – he’s on vacation out here – and told me to tell you that you need to read up on the anatomy and pathology for your cases pre-op. He says that the current batch of med students want everything spoon-fed to them and he absolutely hates it. Just a word to the wise.
Oh don’t worry, I was prepared stellarly for the surgeries. Now it’s onto two weeks of emerg.
by supermarioelia on Mar 21, 2009 5:26 PM EDT up reply actions
Hoynes has weighed in, not much new.
http://www.cleveland.com/tribe/index.ssf/2009/03/cleveland_indians_adam_miller_1.html
"Soloff said that Miller played catch today, making throws up to 105 feet. When Miller threw off the mound, however, he had no control of where the ball was going. The last finger a pitcher has contract with the ball before he throws is his middle finger.
“That gives it the extra giddy-up and command and location,” said Soloff. “It is a the most important finger for any pitcher. Adam is a big guy, with long arms and fingers and he throws very, very hard.”"
by millionairesrow on Mar 18, 2009 4:17 PM EDT reply actions
“maybe one day when you are older i will tell you . . .”
by Les Fleurs Du Mal on Mar 18, 2009 4:22 PM EDT up reply actions
“And then you’ll understand why I can never go back to Sea World”
by world dictator on Mar 18, 2009 4:25 PM EDT up reply actions 2 recs
This is just really sad for the guy personally. I’ll start caring about what it means to the Indians later.
Yes, it sucks as a fan, but it has to suck so much more to have your career aspirations dashed by something out of your control.
by OddlyGaussian on Mar 18, 2009 4:48 PM EDT up reply actions
Thoughts:
The Cleveland fan in me feels strangely validated by the clockwork arrival of dashed expectations.
Not sure I understand the rush to surgery.
So, a few days ago, on the last throw of long toss, the tip of his finger locks up all of a sudden, resulting in a permanent condition? No rehab, micromassage, natural course to see if it’ll loosen, just start counting backward from 100 and slice his finger and wrist open for a questionable peocedure?
I was joking before, but really, try pliers before knives.
It does kind of make you wonder how much more they knew going into spring, that it could be an all-or-nothing scenario with this guy.
by Tribe Fan Matt on Mar 18, 2009 5:38 PM EDT up reply actions
This is often my concerns when guys rush to TJ surgery. We’re jumping into a 1.5+ year rehab without even at least a month of trying conservative measures? I would understand the rush from the player’s perspective given the high success rate of the procedure and the fact that they usually get pain regardless, but from the team’s point of view I’m surprised they don’t see the player as a quickly expiring asset for which over a year gone from the contract can be devastating.
by supermarioelia on Mar 18, 2009 10:11 PM EDT up reply actions
Wow quite the grammar in the first sentence there.
by supermarioelia on Mar 18, 2009 10:12 PM EDT up reply actions
So that’s what it feels like to be offended by a word.
Carmona for Cy Young 2009
by danvail on Mar 18, 2009 7:53 PM EDT up reply actions 1 recs
Ugh. I suppose it’s too much to ask Miller to go all Ronnie Lott on that finger, right?
"Lotta heart in Cleveland." - Ian Hunter
by Denver Tribe Fan on Mar 18, 2009 5:54 PM EDT reply actions
Do we get an extra option year with this then, assuming he has the surgery? Meaning he wouldn’t be out of options going into the 2010 season?
Why I’m asking I don’t know… where do you even begin?
Miller has two options remaining, so he won’t be out of options for 2010 regardless. That is important.
There are two possibilities, as I understand it. Either we option him and put him on the DL, in which case we lose an option year, or we put him on the big-league DL, in which case we preserve an option year but he gains a year of service time.
Worse, I’m not totally sure that the first possibility is allowed. He’s suffered an injury while on the major league roster (40-man) and while not assigned to a minor league club, which suggests to me that he’ll be on the big-league DL, earning service time.
Well, that's just, like, your opinion, man.
Alright, after further review I disapprove of Castro’s tone on this piece and the one posted to indians.com.
If this is a 6-9 month recovery time, and if the surgery is successful (which I tend to think the odds of that aren’t too bad if I ignore Castro’s negativity) and use my head, so he misses a years time. It sucks, I get it. But he’s 24, not 30, and he’s already pretty much ML ready – right? So development time isn’t the issue, nor is recovery time (9 month recovery has him in good shape for next spring even with a setback), nor is breaking into the majors at 25.
To me, Castro is being a bit of a fan here, showing that he is disappointed as well. Granted, he’s picking up on the disappointment of the people around him, but his closing statement, below, is just too much for my taste.
Right now, Miller doesn’t have it. And if he doesn’t find it soon, his once-promising Major League career may be snuffed out before it begins.
For some reason, I like this quote better:
“I don’t want to go in the cart. I’m feeling much better. I think I’ll go for a walk!”
I may be wrong, but I say keep your heads up.
/rant
Lost time does matter. Miller hasn’t pitched much the past two seasons. At some point he has to pitch just to maintain arm strength and endurance so that he can actually fill a role on a pitching staff.
Of course lost time matters – but it’s not developmental time, so to speak, as he’s ML ready. Arm strength, sure, but that’s less of a concern considering he’s a reliever for his first season in the majors either this season or next, and his IP jump if he moves to a starting role will be identical either year he makes the move.
Adam Miller Surgery #1, you mean. He’s going to contribute so much to baseball medicine he’ll make Tommy John look like Tom Glavine.
Also!
I pretty much agree. I don’t think there’s any way his career is over if in the next 10 days he can muster some control. Now, if the surgery is a failure, I suppose it’s lights out, but if the surgery works, there’s no reason to beleive that he can’t pitch for the Indians next year – otherwise the Indians wouldn’t “recommend” he get the surgery. They’d recommend he go to college.
I agree with you, the “career in jeopardy” line does seem to be a stretch.
Well, that's just, like, your opinion, man.
I think it’s in Jeopardy! the same way any pitcher having a non-routine surgery on his pitching shoulder, elbow, or hand has a career in jeopardy.
Castro is obviously indicating something much more dramatic, which doesn’t really seem appropriate. I mean, any time a guy has a labrum problem his career is in jeopardy but I can’t remember seeing it reported that way.
In a way, it pisses me off a little; Miller’s bound to see the article and that can’t be a good thing for him to read. Still, that doesn’t really seem worth getting upset about.
Or maybe we don’t get it and his career is actually in jeopardy.
Hey now fellas. I was just completing the “I think I’ll go for a walk!” quote.
by Fire Slider on Mar 18, 2009 10:45 PM EDT up reply actions
Definitely agree. I read all of these comments and then looked at the article and “Career possibly in jeopardy” is the headline!
Shouldn’t Mark be “The Pink” if we’re translating? And Matt “The Carrier”?
Carmona for Cy Young 2009
Mr. Pink?
Well, that's just, like, your opinion, man.
by Jay on Mar 18, 2009 11:35 PM EDT up reply actions 1 recs
There’s no tags at funerals
Ben Francisco's only fan on LGT
by Toxicadam on Mar 19, 2009 3:37 AM EDT up reply actions 1 recs
This has the best visual and verbal description of the injury I’ve seen yet.
Seems pretty thorough, but no mention of the urgency to do the surgery now rather than wait to see if time and rehab improve the outlook. There’s been no reporting on that other than Castro’s initial statement.
Apparently the procedure is unprecedented for a pitcher. Absolutely no way to project a result.
I think the urgency is that nobody really thinks that time and rehab will make any difference. Either he somehow, miraculously can pitch with no real control of his middle finger, or he won’t ever be able to.
Well, that's just, like, your opinion, man.
Apparently that’s the case they think that, I’m just wondering why.
They’ve already mentioned giving him a period to see if he can adjust. Why expect him to make that adjustment in 3 throwing sessions? Why not at least try some non-surgical means to get flexion back, etc.
My own anecdotal perception in the general sports/injury/rehab world is that the trend is going away from surgery, or at least away from it as a first option in many cases, with a greater recognition that surgery in itself is an injury, albeit targeted, with its own insult to surrounding tissue and structure (particularly if you’re removing same), along with advances in rehab theory and practice.
Pro athletes are a bit of an exception, because of the pressure to use any means to get them back to playing in the least amount of time. But there are instances where a player’s career has been shelved not so much because of the iniital injury, but more so by the accumulated effects of the repeated surgeries themselves. See Matt Whitney.
Just think it deserves more reporting of the issues involved. If Miller gets the surgery done asap, they will get a read on whether he can continue his career that much sooner (9-12 months?). But if it turns out he can’t pitch at that time, odds are it will be due to the accumulated scar tissue as primary symptom, rather than the initial ligament injury.
Interesting that what has been reported are some details concerning last year’s operation – that they would have done a more extensive ligament repair, which was indicated, if it had not been for the risk of infection. Yet they went ahead and did what surgery they could immediately rather than wait for the fistula to heal and the risk of infection diminish. The idea being that it may not matter and if this fixes it he’ll be able to engage in offseason throwing and have a better timeline for ‘09, etc. Subtext is that now they can go back and deal with areas of the finger that needed attention but couldn’t access last year.
Just a cautionary ramble, mind you – no pointed fingers. Ouch – unintended ref/pun…
Castro has recently posted an update on this issue, specifically the part about “career-threatening.” Depressingly, that’s apparently SOLOFF’S!!!! wording. So that sucks.
Meanwhile, now we know for sure Castro reads LGT every day.
What kind of training does Soloff have out of curiosity?
by supermarioelia on Mar 19, 2009 1:02 PM EDT up reply actions
Imagine if you had a lotto ticket in your hand and just before you walk in the door to cash it in, someone kicks you in the nuts. Then they let you get up, only to do it 2 or 3 more times. As you lay there writhing in pain, unable to move, the lotto store closes and your ticket is not worth nearly as much as it used to be. You were only a few steps away.
That’s the Adam Miller story.
Ben Francisco's only fan on LGT
We get all sorts of interesting metaphorical vendors on LGT. I think The Lotto Store is a cut below the Torch and Pitchfork Rental Shop.
by fleerdon on Mar 19, 2009 2:50 PM EDT up reply actions
Also, the lotto ticket has already cost you several million dollars in signing bonus, salary, and medical fees.
Wait.
by fleerdon on Mar 19, 2009 2:48 PM EDT up reply actions
he lotto store closes and your ticket is not worth nearly as much as it used to be
The ticket is still worth the same, though, if it is a winning ticket. Now, if someone stole the ticket, that would be more akin to “Stolen Promise: The Adam Miller Story” now showing on Lifetime Movie Network.
Signature to be named later.
Hello everyone,
I read through a good portion of this thread, though admittedly, not all of it, so I may have missed this, but two main questions:
1. What specifically caused the pulley system in the finger to fail? I’ve never heard of something like this, so I just wondered – is it just a fluke type of injury that just happened to Miller, or was there some warning sign that this would occur? I know he had the finger problem last year, but did anyone have an idea that this specific injury now was likely?
2. Did the elbow injury he sustained in 2005 Spring Training have anything (to the best of knowledge) to do with the current condition of his finger? I believe that it was mentioned at the time of the finger injury last year that the elbow injury had no known correlation with that finger injury, but I just want to be as sure as possible on whether the elbow injury had nothing to do with the current condition of Adam’s finger.
Regarding Miller, of course, we as fans want to see him play and contribute for the Indians, but as was mentioned earlier in this thread, it has to be really disconcerting for Miller himself, especially considering he has all the physical tools, the mental aptitude, and the track record to project that he had a solid to good chance of becoming an “elite” pitcher, not just a pitcher who would make it in the Majors, but “excel” in the Majors. Essentially, his ceiling was/is (hopefully, still is) so high that he himself has to feel such anguish and disappointment over this latest setback, a setback that is going to probably result in a type of surgery that really has no track record on whether a pitcher can come back and compete (especially at a high, elite level) in the Majors.
As was also mentioned in this thread, if this surgery is successful and Miller somehow delivers on the promise he has shown to this point, perhaps this surgery will get the name the “Adam Miller Surgery,” just as Tommy John had the tendon replacement surgery (I think that is the surgery, but I could be mistaken on the name) named after him, being that he was the first successful case to pitch effectively in the Majors after having the surgery.
Let’s hope that the surgery leads to Miller having the surgery named after him (i.e. he becomes a successful and effective ML pitcher after having this surgery). Best of luck to him in his recovery.
The "cream of the crop" doesn't always rise to the top.
1. Let me preface by saying this is, at best, an educated guess. I believe the pulley injury is a complication of his earlier surgery to address the fistula caused by his blister. The surgery led to localized inflammation causing a cellular degeneration in and around the pulleys. This either caused scarring and adhesions around the pulleys or weakening leading to detachment. Either way, they ain’t workin’ like they should.
2. No.
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