The Phillies finally announced that top prospect Andrew Painter has suffered a strain to his ulnar collateral ligament. After seeking an opinion from the team medical staff as well renowned orthopedic surgeon Dr, Neal ElAttrache, the team and Painter have decided on a plan of rest for four weeks followed by a light throwing program.
As of right now, no one directly involved believes that Painter needs Tommy John surgery. The hope is that the tear in his UCL will heal itself with proper rest, and he can return to pitch again at some point this season without any further issues.
Naturally though, whenever the UCL is involved, most fans immediately jump to Tommy John surgery. That is usually the last resort of repairing damage to a UCL. In Painter’s case and many others, fans may be left to wonder why teams and players don’t just opt for the surgery now rather than putting it off, thus ripping off the proverbial band aid immediately.
Phillies fans in particularly can point to the case of Seranthony Dominguez as an example of the rest and rehab plan not working as intended. Dominguez suffered a similar injury to his UCL and opted to try and pitch through it after rest and receiving a PRP injection from Dr. James Andrews.
It didn’t work and Dominguez underwent Tommy John surgery in July of 2020. He ultimately appeared in just 28 games from 2019-2021.
However, there’s another example from the Phillies where surgery was actually avoided. As pointed out by The Athletic’s Matt Gelb on Twitter, Aaron Nola was diagnosed with a mild UCL sprain and mild flexor strain in August of 2016 and received a PRP injection like Dominguez. Nola avoided surgery and hasn’t had any other major issues flare up in the six seasons since. He did have the benefit of having a whole offseason to rest, however.
https://t.co/KMSETDjo6H— Matt Gelb (@MattGelb) March 10, 2023
Since this tweet, Nola has made 170 starts and thrown 1,039 innings in six seasons.
There are more recent examples outside of the Phillies as well of pitchers who avoided surgery. The Diamondbacks’ Zac Gallen was diagnosed with a UCL sprain in May of 2021 when he was 25 years old. Much like Painter, it was considered to be a minor strain that didn’t require surgery. Gallen was shut down for roughly five weeks and then returned to make 19 more starts and throw over 100 more innings in 2021. He finished fifth in the Cy Young award voting in 2022 after the best season of his career.
Of course, there’s a chance that Painter does eventually need surgery. Even if it’s not necessarily from this incident. Power pitchers of his archetype seem almost destined for it in the modern game. None of the pitchers discussed above had the same combination of youth and velocity on their pitches as Painter does when they suffered their injury.
However, that doesn’t mean he needs to be rushed under the knife before it’s absolutely necessary.
The knowledge of UCL injuries and Tommy John surgery have advanced tremendously in the last twenty-five years. It’s no longer a death knell to pitcher’s careers. Justin Verlander had Tommy John surgery at age 37 in 2020 and then went on to win his third Cy Young award in 2022 at age 39. But it’s still an operation, and a rather intense and invasive one at that, with a long rehab time.
Surgery should only be undertaken when medical professionals recommend it as the best option for recovery. In Painter’s case, both the Phillies medical staff and the most renowned Tommy John specialist in the country recommended a plan of rest instead of surgery. A study posted by ESPN’s Jeff Passan showed evidence that 17 of 21 pitchers who had their injury in the same specific location as Painter’s were able to avoid surgery.
Important follow-up here: The fact that Andrew Painter's UCL tear is proximal -- or on the side that attaches to the medial epicondyle -- could really matter a lot. In a study on UCL management, 17 of the 19 pitchers with proximal tears avoided surgery: https://t.co/zmn6lXkV2X— Jeff.eth (@JeffPassan) March 10, 2023
Four weeks from Painter’s injury will be March 29th. We will know more about what the future holds around that date if he does indeed start throwing again. There’s a chance his elbow has healed, and he can pitch again in 2023. There’s also a chance it hasn’t, and he can’t. Regardless, there’s no point in rushing to surgery before it’s needed, especially on someone who is only 19 years old.