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Expert Prognosis on Adam Miller

There's been quite a lot of discussion on Adam Miller's finger and his prognosis as a pitcher in the future. I forwarded Castro's latest article to my pop, who is an orthopedic microsurgeon in Columbus. He has specialized in hands for 30 some years. He has not examined Miller so PLEASE don't take this as gospel, but he is an expert in this area.

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.

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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.

So, there you have it. Nothing definitive, for sure, but man, it doesn't sound good.

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