The Doctor Says: Rafael Furcal

Last week, Cardinal Nation seemed to get an early gift to be extra thankful for — Rafael Furcal, 100 percent healed.

According to Derrick Goold, John Mozeliak saw results of the latest MRI that led him to believe the veteran short stop will be ready to go without hesitation, come spring training.

How secure is Rafael Furcal’s place in the 2013 middle infield?

The encouraging news the Cardinals received last week about Rafael Furcal’s right elbow was confirmed Monday by a scan taken of the shortstop’s injured arm, general manager John Mozeliak told a national radio show.

After returning to his offseason home from the Dominican Republic, Furcal met with medical staff in Florida for an MRI scan of his elbow and its torn ligament Monday.

“His ligament looked completely healed,” Mozeliak told “Inside Pitch” on Sirius XM radio. “Right now there’s no reason to think he won’t be ready to go and expect a full year out of him. It’s a little bit of a relief for us.”

Sounds great, right? “Completely healed” sounds fantastic. And yet I found myself struggling to be excited. Honestly, I was struggling to even be “relieved.” Early predictions of mint-condition ligaments, especially without the surgery that tends to be required for a full recovery, are a little less than reliable most times.

So, I was cautious. Skeptical. Hesitant to emotionally buy into Furcal as the 2013 everyday short stop.

But, the great thing about the staff here at Aerys is that many of our talented writers have backgrounds in fields other than sports writing. If you’re a football fan, you’ve hopefully seen the work of Melanie Friedlander at Aerys Offsides. Her “House Call” pieces are a great example of the infusion of her medical background and her sports knowledge!

So, I decided to tap into that resource and break Melanie into the world of baseball by getting her opinion on Furcal’s injury and recovery. Here’s what she had to say.

Furcal suffered a grade 2 sprain of the ulnar collateral ligament, which attaches the humerus (upper arm bone) to the ulna (one of the two forearm bones).  It’s a common injury in athletes that throw, especially in baseball. The grade (on a scale of 1-3) describes the amount that the ligament is stretched. Depending on how geeky you want to get, here are 2 decent descriptions: http://www.csosortho.com/ulnar-collateral-ligament-sprain.htmlhttp://www.mdguidelines.com/sprains-and-strains-elbow Ironically, the two websites have differing opinions on the preferred treatment (surgery vs physical therapy and rest).

David Aardsma, a relief pitcher for the Seattle Mariners, had the same injury (including same grade) in May 2011.  He tried non-operative management initially but eventually had Tommy John surgery (http://en.wikipedia.org/wiki/Tommy_John_surgery), where a tendon graft from somewhere else in the body is used to replace the injured ligament.  He has since been signed by the Yankees and seems to have had a good recovery.

Boston Red Sox outfielder Carl Crawford had the same injury in April 2012 and tried conservative treatment with platelet-rich plasma (PRP) under the care of Dr. James Andrews (orthopaedic surgeon to the star athletes).  He had the same surgery in August and got traded to the Dodgers 2 days later.

While Takashi Saito was with the Dodgers in 2008, he was able to recover fully from his UCL sprain using PRP.

So what about Furcal’s treatment?  There is no medical data to prove that PRP does or doesn’t improve healing.  There are some studies that show it might, but the results are inconsistent.  It’s been used in several prominent athletes, of course, most notably Tiger Woods (knee), Peyton Manning (neck) and Kobe Bryant (knee).

The process, as described by Scientific American: “For the treatment, doctors take a small vial of a patient’s blood, about 30 milliliters, and spin it in a centrifuge to separate the platelet-rich plasma from the other components. Then they inject the concentrated platelets at the site of the patient’s injury. In theory, the growth factors that platelets secrete (not including human growth hormone) spur tissue recovery.”

I talked to one of my ortho colleagues about this.  She said that it’s entirely possible that Furcal’s elbow might have healed fine even without the PRP.  Ironically, she used PRP to treat her own achilles injury because she figured it couldn’t hurt.  It all depends on his pain level and functional status … but it sounds like he is doing well, and it’s entirely possible that he could be 100% by spring training.  From what I’ve read, it sounds like they usually make a decision about 2-3 months after the injury if they need to switch gears and do surgery, which is about now.  So I think if he still hasn’t undergone the knife, it’s a very good sign.

Okay, so I feel a little better about the time-table issue. It sounds like it was kind of a “hurry up and wait” scenario where they legitimately couldn’t give a prediction until they broke through that 2-3 month barrier.

There are still plenty of questions about Furcal’s ability to remain healthy through an entire season. However, if he can be counted on to have a regular spring training, it does help solve some of the middle-infield dilemma. Actually, the way I see it, Furcal is really a key factor to determine what the Cardinals need to do this offseason. If he’s good to go, the focus can shift to the bullpen and/or second base. If he’s not, there has to be middle-infield help on the way. As good as Daniel Descalso is, I’m not convinced he can play second AND short at the same time!

So, fingers crossed the R&R method of recovery worked like Mo and Company seem to believe it did. Because there’s no denying Furcal’s place on this team!

Special thanks to Melanie for weighing in on the issue and easing my fretting mind … at least for today! Follow her on Twitter @girlsurgeon.

 

Tara is a St. Louis Cardinals reporter for Aaron Miles’ Fastball and a contributor to Around the Horn. Follow her on Twitter @tarawellman.

 

0 thoughts on “The Doctor Says: Rafael Furcal

  1. Laura says:

    What a great article! Like you I was less than enthused with the proclamation that Furcal had a Thanksgiving Miracle and was 100% healed. I think the track record with the Cardinals and misrepresenting injuries may have colored my view of that progress report so it’s great to have an outside expert opinion weigh in who isn’t on the Cardinals payroll. It seems there have been mixed results but let’s hope that Furcal stays healthy. I think regardless Mo should be looking for middle infield help because I’m not counting on Furcal staying healthy, not unless they rest him more than they did in 2012.

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