Brew News / Injury Updates

Jimmy Nelson: A Medical Review

Since BREW MATHs has a licensed M.D. on the team, we are uniquely qualified to analyze Jimmy Nelson’s injury. An in-depth review of the medical literature is performed. Only facts are considered with the hopes of stratifying Nelson’s chance at redemption.


A LOOK BACK…

THE ANATOMY

The shoulder is very ‘high-yield real estate.’ In other words, many vital structures are crammed into a small space:

This is not even including the nerves, vessels, and fibrous shoulder capsule that covers everything like a sheath:

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Once you have an understanding of shoulder anatomy, it becomes much easier to visualize what happened. By the look of the video it appears that Jimmy has a Type II SLAP (Superior Labral Anterior-Posterior) Injury. When they are of the traumatic variety (like Nelson’s) it is most often at the hands of a forward fall with outstretched hands…

When the arm is fully extended, the shoulder joint is already strained. If the player’s weight then comes crashing down upon the extended joint, the labrum (and even the covering capsule) can bare the brunt of the force. In Nelson’s case, the following structures were compromised:

  1. Anterior Labrum (partially torn; surgically repaired)
  2. Shoulder capsule (surgically repaired)
  3. Rotator cuff (strained)

What this tells us: Nelson had multiple injuries and widespread damage. This often leads to gross dysfunction / chronic pain.

SO WHAT IS A SLAP INJURY?

The specific tear ends up looking like this (multiple images are included to give a full perspective):

bony structures of the shoulder showing SLAP lesion and Bankart lesion

From any angle, it is plain to see that this type of injury would not be a good one for a “competitive thrower” to sustain. For many of them, it is the kiss of death that leads to a chronic, dull tightness. Elite level pitchers often complain their arm “went dead” after this type of tear…

This three-minute video does a great job of breaking it all down:

THE OPTIONS

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WHAT TO EXPECT

A QUICK LOOK AROUND…

If we take MLB SLAP injuries on a case-by-case basis, it is difficult to know how a pitcher will fare:

The most common quote amongst pitchers successfully returning from SLAP injuries is some form of this:

“I am not the same but can have success with a more efficient windup and compact throwing motion.”

It also should be noted that any surgery is “operator-dependent.” In other words, how good the surgeon is a massive factor. Nelson’s surgeon, Neal ElAttrache, is considered to be one of the world-wide leaders in correcting these injuries. He also happens to look like he could play James Bond… I don’t know how that helps but it can’t hurt.

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Since we cannot count on Mark Prior or Trevor Hoffman to predict Nelson’s future, let’s dig into what we can hang our hats on (i.e. medical facts).

THE HALLMARK SLAP STUDY

In 2016, an Article from The Orthopaedic Journal of Sports Medicine took a look at MLB Pitchers who returned from SLAP surgery. While there were many studies on the injury in the general public, there were very few on ‘elite-level competitive throwers.’ Thus, they did a retrospective study (i.e. mining data from the past) and found that between 2003-2010 that there were 24 pitchers that had returned from SLAP surgery. Who was included in that group is summarized nicely here:

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This shows us that Nelson was very similar to the players who were included in the study. While his age and years in the MLB are nearly identical, he did spend more time (i.e. 74 days) on the DL. Some of this can be attributed to his rehab plateau (as reported by The Journal-Sentinel) but some of it is just due to timing. Specifically, Nelson’s injury happened at the end of the 2017 season which caused it to linger through 2018.

  • AGE: Nelson was 28.3 years old at the time of the injury
  • YRS: He played 4.01 years before the surgery
  • DL: Nelson was on the disabled list (DL) 412 Days

RTP = Return to Play: Defined as being able to pitch longer than one year (in The MLB) upon return.

  • 62.5% of the pitchers who underwent the SLAP procedure were able to RTP

RTPP = Return to Previous Performance: Defined as an ERA within 2.00 and a WHIP within 0.500.

  • The RTPP reported for the whole group is 54.2%
    • Thus, once a pitcher has this type of surgery, their overall chance of return is slightly better than a coin flip
    • If we look closer at the players who were actually able to return to play (RTP), the numbers are more reassuring:

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  • The players that returned ranged in age from 22.7 – 33.9 years old (reassuring since Nelson is now 29yo)
  • The average pitcher lasted about 4 season after coming back (range: 1.76 – 5.58 years)
  • Of the pitchers who actually came back and lasted longer than a year, 86.7% of those were able to pitch like they used to (RTPP).

When we look more closely at the RTP Group’s baseball statistics, we see how the injury impacted their performance.

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  • ERA and WHIP findings are not statistically significant (i.e. not predictive)
  • Innings Pitched is the only significant finding here
    • Hurler’s typically cannot handle the same workload and pitch much less upon return (~35 innings less, on average)

RELATED STUDIES

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CONCLUSIONS

At this point, we cannot make too many bold statements about Nelson’s future. Since he is still healing and hasn’t pitched in a game situation, any prediction is speculative. In the same vein, aggressively applying these numbers to an individual is not helpful. Instead, we can only say the following with any confidence:

  • Nelson suffered one of the worst injuries a pitcher can go through (Labral tears are well-known to lead to “dead arms”).
  • The type of injury he had implies extensive damage to multiple structures within the shoulder
  • Nelson is in good hands with Dr. ElAttrache (arguably the best)
  • What the Study tells us:
    • As of now, Nelson has a 54.2 – 63% chance to return to his previous form (depending on which study you believe)
    • If he is able to make it through a whole year, his chances to reclaim his elite form are closer to 90% (in the long run).
    • Regardless of how he performs, it will have to be with a more efficient / compact throwing motion
    • Expect him to pitch much less and need more rest (esp. in the first two years)

Unfortunately, anything outside of this is conjecture… Until Nelson is back on the hill, Milwaukee has to hold its breath. An entire city roots for a shoulder…