Expert Prognosis on Adam Miller

by gte619n on Mar 19, 2009 5:43 PM EDT

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.

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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Comments

silver lining: that is a totally rad picture.

by mrich on Mar 19, 2009 5:55 PM EDT reply actions

To do this procedure the entire volar (palm side) of the finger must be opened.

Yeesh.

by Brick. on Mar 19, 2009 6:02 PM EDT reply actions

Thanks for the update. The range and depth of knowledge that this community regularly generates is astounding.

by Jeffrey R on Mar 19, 2009 6:18 PM EDT reply actions 1 recs

The issue about the scar along the length of the finger is interesting.

by APV on Mar 19, 2009 6:36 PM EDT reply actions

To a goth.

by afh4 on Mar 19, 2009 6:37 PM EDT up reply actions

Visigoth, maybe

by APV on Mar 19, 2009 6:42 PM EDT up reply actions

This?

So 2009.

by Gradyforpresident on Mar 19, 2009 7:26 PM EDT up reply actions

If it does heal right, a large scar the length of the underside of that finger could bring some crazy movement to any breaking ball.

Just looking for a silver lining here

by NatiTribeFan on Mar 19, 2009 7:14 PM EDT up reply actions

Excellent information. Terrible situation. Poop.

Carmona for Cy Young 2009

by danvail on Mar 19, 2009 7:11 PM EDT reply actions

so A-2 and A-4 are the problems, but it’s the end of the finger past A-5 that doesn’t bend?

by Brick. on Mar 19, 2009 7:29 PM EDT reply actions

I guess they work in stages???

by jhon on Mar 19, 2009 8:46 PM EDT up reply actions

Aw c’mon, I’m sure Hoynsie will give us the same level of analysis…

Stuart Dean

by stuart dean on Mar 19, 2009 7:31 PM EDT reply actions 5 recs

that’s what i’m talking about. rec.

by emil minty on Mar 19, 2009 8:38 PM EDT reply actions

Hello gte619n,

Thank you for asking your father about this situation – greatly appreciate the additional info.

Overall, the situation does not sound good – at this point, I think the chances of Miller contributing anything to the Indians is remote at best (granted, they weren’t very promising before this latest setback, but there was always that hope and reasonable expectation that Miller would at some point make his ML debut and contribute in a meaningful fashion, if not dominate. Now, if he even appears in an Indians’ uniform at some point will be incredible).

The "cream of the crop" doesn't always rise to the top.

by indiansfan on Mar 19, 2009 8:41 PM EDT reply actions

This is good stuff, very interesting. So now we understand why all the dire predictions.

by odradek on Mar 19, 2009 11:22 PM EDT reply actions

If there were a bring your father (or mother) to the internet day, I imagine that some serious knowledge would get dropped.

This clears up a lot of what’s going on with Adam. The diagram is a big help for me, although it makes me wince every time I look at it.

by jhon on Mar 19, 2009 11:40 PM EDT reply actions

As a kid I was the first one to have email in my household.

Dad thought it would be useful to have the residents email him pictures of the injury from the remote hospitals so he could better diagnose the (horrible) injury. He didn’t have an email address.

“Patient 25839 – Mt. Vernon ER” does not hold a lot of meaning to a 14 year old. Let’s just say it was traumatic.

Don't be stupid. PUT IN MELOAN.

by gte619n on Mar 20, 2009 12:00 AM EDT up reply actions

I sympathize — my mom is a pathologist, and I grew up hanging out in her lab. So the smell of formaldehyde and freaky biopsy samples were a big part of my childhood.

by mrich on Mar 20, 2009 11:04 AM EDT up reply actions

My wife works in a cytogenetics lab. The worst part is when she notices obituaries that were a part of her caseload, especially if they’re children.

Signature to be named later.

by emd2k3 on Mar 20, 2009 11:22 AM EDT up reply actions

I don’t know what makes me want to vomit more, the news of another finger injury to Adam Miller or that anatomical finger diagram. Why is the bone all brokeneny looking at the end? Gross.

Really good post—despite my nausea.

No, not you. Your helmet!

by PatBordersHelmet on Mar 20, 2009 8:47 AM EDT reply actions

Mordecai Brown doesn’t understand why this is a problem.

by Buzz on Mar 20, 2009 10:07 AM EDT reply actions

Mordecai Brown still had use of his middle finger, which I believe is Adam’s problem.

Signature to be named later.

by emd2k3 on Mar 20, 2009 11:02 AM EDT up reply actions

Again, this photo is Mordecai Brown’s actual hand. I can’t get enough of this picture.

In retirement, Brown had the thrasher he lost the finger in on display outside the general store he owned and ran.

No, not you. Your helmet!

by PatBordersHelmet on Mar 20, 2009 12:26 PM EDT up reply actions

Wow, I bet he never threw anything straight.

by Ryan on Mar 20, 2009 5:19 PM EDT up reply actions

A couple more angles:

by ShawnK on Mar 20, 2009 1:48 PM EDT reply actions

This marks the first time LGT has actually made me queasy.

by Brad D on Mar 20, 2009 6:43 PM EDT up reply actions

Vs. Wainwright

Good stuff. I’m failing to see why this is any different than Adam Wainwright, who had a similar injury.

Will Carroll
Lead Reporter, Baseball Prospectus
Contributor, Sports Illustrated/SI.com

by theinjuryexpert on Mar 21, 2009 2:21 PM EDT reply actions 2 recs

This FanPost will now forever be known as “the post that prompted Will Carroll to finally register for an SBN account.”

Well, that's just, like, your opinion, man.

by Jay on Mar 21, 2009 2:35 PM EDT up reply actions 2 recs

Let’s Go Tribe is getting kind of huge.

So 2009.

by Gradyforpresident on Mar 21, 2009 2:49 PM EDT up reply actions

I heard Obama is registering as we speak.

by hans on Mar 21, 2009 4:37 PM EDT up reply actions

IT"S THE ~~LGT~~ ECONOMY STUPID.

Signature to be named later.

by emd2k3 on Mar 21, 2009 9:59 PM EDT up reply actions

I’m failing to see why this is any different than Adam Wainwright

Well for one thing Wainwright’s injury wasn’t precipitated by a previous hand surgery and probably not complicated by adhesions. It’s quite likely that Miller’s injury will be much more difficult to treat.

by mauichuck on Mar 21, 2009 4:32 PM EDT up reply actions