Félix Bautista playing catch was ‘strange,’ a doctor says. Here’s what it might mean. – Boston Herald

Twice last week, injured Orioles closer Félix Bautista played catch. But an expert on elbow injuries said that does little to clarify the state of the ulnar collateral ligament in the All-Star’s right arm.

In the more than two weeks since placing Bautista on the 15-day injured list a day after he exited a strike from closing out a victory, the Orioles haven’t gotten more specific than general manager Mike Elias’ initial announcement that Bautista has “some degree” of injury to his UCL. Bautista throwing on the field before Friday’s game at Fenway Park was the first tinge of an update on his status, with manager Brandon Hyde urging that nothing be read into Bautista’s capability of throwing.

“I wouldn’t put any emphasis, positive or negative,” said Hyde, who acknowledged that Bautista also played catch days earlier in Anaheim.

Dr. Mohit N. Gilotra, a University of Maryland Medical Center orthopedic surgeon who treats shoulder and elbow injuries, described Bautista playing catch as “strange.” He said UCL injuries come in three forms: full tears, which necessitate Tommy John elbow reconstruction; partial tears, which depending on the location can be healed with a lesser procedure known as a repair; and what Gilotra described as a “change in the consistency” of the ligament called tendinosis, treated with rest and platelet-rich plasma injections.

Gilotra, who is not treating the Orioles closer, said the UCL is unneeded in most aspects of daily life, with athletic acts such as hard throwing, gymnastic landings and powerlifting being the ligament’s primary applications. Bautista could still perform light throwing even if his UCL wasn’t intact, Gilotra said, though it wouldn’t necessarily make much sense for him to do so.

“If it’s fully torn, he could still do it. But if it’s fully torn, why would you?” Gilotra said. “Like, what are you warming up for next, right? … Usually, you wouldn’t do that if you were preparing for a reconstruction or even a repair.

“If you’re just playing gentle catch, you’re not hurting yourself. But for the high-level athlete, there’s no reason just to stay warm, so I honestly don’t know what that means. Does that mean that he, in secret, had some of these [PRP] injections already and he’s just slowly returning to throw? I feel like that’s unlikely that it would be such a secret, but it is strange. … I think the confusing part then is what’s next, right? Is this in preparation for harder throwing later?”

Elias, asked when the Orioles put Bautista on the IL whether he could return this season, did not answer directly, saying, “I think anyone can go on Google and find the spectrum of outcomes or possibilities that [a UCL injury] might entail.” Twice since Bautista’s injury, the Orioles have opened spots on their 40-man roster by designating other pitchers for assignment when transferring Bautista to the 60-day IL would have had the same effect.

Elias said in announcing the injury that the club is “working on doing the right thing for Félix.” Still, any effort to get him back this season makes sense on the Orioles’ part, especially given their hopes for a deep playoff run. Before the injury, the 28-year-old was baseball’s most dominant reliever and Baltimore’s most valuable pitcher, with a 1.48 ERA, 33 saves and 110 strikeouts in 61 innings in his second major league season. Bautista’s 46.4% strikeout rate is the sixth highest for anyone with at least 60 innings pitched in major league history.

An injury to Bautista’s UCL means the Orioles could be without him not only for the rest of this season, but also possibly part, if not all, of 2024. Tommy John surgery, which several Orioles have undergone, comes with a recovery period of at least a year, replacing the torn tendon with another in the body. The repair process, which features an internal brace on the UCL and is most effective when the partial tear is near either of the bones — the humerus and ulna — that the ligament connects, can result in a six-month timeline; Gilotra offered San Francisco 49ers quarterback Brock Purdy as an example of an athlete who capitalized on that relatively quick turnaround.

But even in the best-case outcome that avoids any surgery, Gilotra said Bautista returning this season would be “really unlikely,” estimating a three-month recovery and ramp-up period. Bautista suffered the injury with two outs and two strikes Aug. 25, walking gingerly near the mound and flexing his right hand after a 102.3 mph fastball and exiting without throwing a warmup pitch. Even a two-month timeline would mean he’s out until the World Series

“You can potentially — doesn’t always work; none of these things are 100% — but potentially avoid surgery altogether,” Gilotra said. “It’s not fast, but you get to avoid an operation. Could this be he’s somewhere in that process? Sure. But it’s just strange that that would never be divulged.

“If it was bad enough that he had to stop, which means it was hurting him to throw, to return, even if it’s the most minor injury, it would be unlikely, even in the postseason. … A lot of these protocols err on the side of caution, especially for someone like him, who’s so young and so good.”

What’s to come?

It’s a big week at Camden Yards.

The Orioles entered Sunday with their magic number to clinch a playoff spot for the first time since 2016 at five. The math is complicated because the teams in the wild-card race have remaining games against one another, but effectively, there’s no scenario a Baltimore team with 95 victories misses the postseason. Regardless of what happens in other series, five wins within their three games against the St. Louis Cardinals — the second of which will feature left-hander John Means’ return from his Tommy John surgery — and four against the Tampa Bay Rays ensure the Orioles will be in the playoffs.

That Rays series carries extra weight, with Baltimore entering the week holding a three-game lead on Tampa Bay in the American League East. By taking one game in the series, the Orioles secure the tiebreaker between the teams, which could prove significant. The club has announced that Friday’s game, before which longtime center fielder Adam Jones will retire with the Orioles, is sold out.

What was good?

When Austin Hays’ season began to crater midway through 2022, he struggled to stop it. But lessons learned from the second half of last year, Hays said, have helped him avoid a repeat in 2023.

Hays hit .180/.217/.250 in his first 27 games after making his first All-Star appearance, dropping his OPS to its lowest postgame mark since April 9 at .754. But he entered Sunday with an OPS of 1.008 over his next 20 games, saying he now has a better understanding of mechanical adjustments he needs to make to get his bat path where he wants it.

“I think the difference is I have things that I’ve had to try, so there’s stuff I’ve realized that doesn’t work, and there’s stuff that has worked, so I can go straight to things that have worked, and I have confidence in that,” Hays said. “I definitely feel like I’ve learned what adjustments to make. … I’d say I’ve grown because of what I went through in the second half last year.”

What wasn’t?

Ryan Mountcastle returned from his vertigo scare and went on a tear, putting up an OPS of .993 across July and August. But he missed the first two games of September with another illness, and in six games this month — all Orioles wins — he’s hitting .214 with no extra-base hits.

On the farm

Colton Cowser was one of the Orioles’ September call-ups, but he didn’t get to stick around long before being sent back to Triple-A once Aaron Hicks was activated from the IL. Back with Norfolk, Baltimore’s No. 2 prospect continued to thrive, batting .333/.367/.625 with two home runs last week. The 23-year-old outfielder is hitting .315 with 14 home runs and a .966 OPS for the Tides this year.


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