I usually don’t watch spring training games, but I did catch a bit of the Nationals-Mets game on Saturday afternoon. Zack Wheeler was scheduled to start for the Mets, but he was scratched due to soreness in his elbow as well as having developed a blister on the index finger of his pitching hand.
The Mets’ announcers were downplaying the significance of the elbow and didn’t think an MRI would be necessary as Wheeler had already undergone two MRIs – one in November and one in January neither of which showed structural damage to his elbow.
But Mets GM Sandy Alderson did an about face the following day and Wheeler undergo an MRI which revealed a torn UCL. Wheeler will require Tommy John surgery and miss the entire 2015 season.
I was struck by something that Adam Rubin of ESPN New York wrote about the two MRIs. Rubin wrote, “Still, Alderson noted Monday, a compromised-but-not-yet-torn ligament may not appear to be injured on an MRI.”
It got me to thinking. Back in 2007, I was experiencing intense pain in my chest. I would be woken up by it in the middle of the night and would have to go to the emergency room. The medical personnel at Mass General thought I had acid reflux disease. But when the pain recurred on Christmas Eve and persisted for nearly 24 hours, the medical staff couldn’t figure out what was wrong even after I had undergone an MRI. Then someone suggested I get a sonogram. This illicited some laughter.
As you are probably aware, sonograms are generally used on pregnant women. But I was willing to try anything to alleviate my pain. As it turned out, I did not have acid reflux. My gall bladder was disintegrating and the MRI did not pick that up. A few hours later, I went into surgery and had my gall bladder removed. It was a Christmas I will never forget.
I can’t help but wonder that if Wheeler underwent a sonogram or some kind of ultrasound procedure that perhaps it could have better detected the condition of his UCL. There was a study published in The North American Journal of Sports Physical Therapy back on 2010 on the merits of musculoskeletal ultrasound rather than MRIs on pitching elbows as well as one published last year in The American Journal of Sports Medicine making the case for stress sonograms. Both studies made the case that these respective techniques would better diagnose elbow injuries in pitchers and perhaps reduce the need for Tommy John surgery.
I wonder why MLB clubs aren’t more open to using stress sonograms or musculoskeletal ultrasound if they are a more effective diagnostic tool and result in more rehabilitation and less surgery. If stress sonograms or musculoskeletal ultrasounds can more effectively detect, as Alderson put it, “a compromised-but-not-yet-torn ligament” and do so at a lower cost than with an MRI then why wouldn’t MLB clubs make that investment?