BOSTON -- Joel Hanrahan is suffering from what manager John Farrell described as "damage to the flexor muscle tendon" and will choose between season-ending surgery or a course of rest and rehabilitation that will still result in significant time missed.
Hanrahan, who was injured Monday night while pitching against the Twins, was examined by noted sports surgeon Dr. James Andrews on Friday morning. He was placed on the 15-day disabled list Tuesday, and then was switched to the 60-day DL on Thursday.
"What's been pretty conclusive, or in agreement with other examinations, is that [Hanrahan's] got some damage to the flexor muscle tendon,” said manager John Farrell. “So he's en route back here to Boston as we speak and I know that he'll revisit with the training staff and medical staff here. So at some point there's got to be a decision as to which course he's going to take to rectify the situation.”
If Hanrahan opts for surgery, Farrell said that would end his season. If the right-hander decides on rest and rehab, Farrell said Hanrahan is "looking at a prolonged shutdown period, so that would be a six-week shutdown and then begin [to work his way] back at that point."
According to the TMI Sports Medicine website:
“The flexor tendon and muscle sits immediately on top of the ligament. And, a healthy flexor tendon and muscle is just as critical to the healthy elbow in maintaining stability as the ligament. In fact, from laboratory biomechanical data we know that each structure, the flexor muscle-tendon unit and ligament, is responsible for doing about 50% of the job. Therefore, when muscle becomes fatigued from overthrowing the ligament becomes “unshielded” and the ligament could be at a higher risk for injury.
“Inflammation to the tendon alone can be treated with ice / rest / oral anti-inflammatory medication and proper strengthening exercises. Tears can be easily diagnosed by MRI. When tears reach a critical size surgery may be required. Some tears can be treated with debridement alone involving removal of the diseased tissue. In the thrower it’s far more critical to restore the structural integrity of the tendon so repair of the tendon back to bone is often required. Although the procedure is somewhat less involved than reconstruction of the ligament, recovery from such a procedure can take from 8-12 mos. Failure to treat tendon tears aggressively enough can leave the underlying ligament unprotected and result in further tearing of the tendon but also tearing of the ligament. This combination of injury can be potentially career ending. Fortunately surgical repair of the tendon [alone] is generally successful.”
Asked if injury to the ligament was ruled out, Farrell replied:
“To a certain extent, but again . . . in situations such as these . . . once they have the ability to open up the arm and look at it directly, then they can make a ore clear decision at that time if in fact Tommy John [surgery] is needed."
Farrell was uncertain when a decision would be made on Hanrahan’s course of treatment.
"Hard to tell,” he said. “In speaking with Joel directly today, he hasn't given an indication of when he’ll make the decision. When he's ready, certainly, that's the simplest answer I can give you.”
The ultimate decision would fall to Hanrahan.
"In situations like this it’s not uncommon for the player to make the final decision,” Farrell said. “Certainly, it's his career, it's his arm. Recommendations can be given through multiple opinions that he's already received. And I think he's doing a very good job of getting his arms around it with the information gathered. So that decision will become more clear-cut in Joel's mind."
It is uncertain how the injury happened. Hanrahan had a similar injury in 2010, when he started the season on the DL while with the Pirates. It is possible, Farrell said, wear and tear and the cumulative effects of a seven-season major league career could have had an impact.
"Joel has talked about having some discomfort back in 2009,” Farrell said. “I got to believe the number of years he's pitched it’s probably a cumulative affect and then ultimately as we saw on one pitch the other night."