Brian Cole MD of Midwest Orthopaedics at Rush & Steve Kashul discuss Chicago Cubs’ Yu Darvish’s season ending injuries due to stress reaction in elbow.
Michael Kopech, the White Sox’s new Superman, has been cut down by a pitcher’s version of Kryptonite. He is believed to have torn the ulnar collateral ligament in his elbow, which could force him to undergo elbow reconstruction surgery and be sidelined until 2020.
It’s the same diagnosis that forced the Cubs’ Kerry Wood to undergo surgery after his Rookie of the Year season in 1998. More recently, the ligament transplant procedure known as Tommy John surgery has sidelined a long list of active major-leaguers, including Stephen Strasburg, Jacob deGrom, Yu Darvish, Johnny Cueto, Carlos Carrasco, Michael Pineda and Adam Wainwright.
“Unfortunately, in this day and age, it’s a regular part of the game with pitchers,’’ Kopech said Friday. “Personally I never thought it would be something I would be going through. But it’s part of it.’’ Kopech becomes the fifth right-handed prospect ranked in the preseason top 100 by MLB Pipeline to suffer a serious elbow injury. He joins the Angels’ Shohei Ohtani, Cardinals’ Alex Reyes, Ray’s Brent Honeywell and Reds’ Hunter Greene in having their development delayed by Tommy John surgery.
The success rate of the surgery is good, especially for pitchers who haven’t had a previous elbow reconstruction, and the White Sox are confident Kopech will remain a major part of their future despite the specter of major elbow surgery. “This is by no means the last we’ve seen of Michael Kopech,’’ Sox general manager Rick Hahn said. “This is the last we’ve seen of him for ’18 and very likely for ’19, but he’s still going to play a significant role on what we project to be some very, very good White Sox teams in the future.”
Kopech experienced his first rough start in the major leagues on Wednesday night, giving up four home runs to the Tigers. It was seen as a minor blip until Friday, when orthopedic surgeon Nikhil Verma examined him and found a torn ulnar collateral ligament. Hahn said an exam Friday “revealed a rather significant tear in his ulnar collateral ligament.’’ He will receive a second opinion next week but it seems the only question is who will perform the surgery.
This development comes as a shock to both the team and Kopech, who at 22 has been one of the most intriguing young pitchers in baseball. “It has been a whirlwind of emotions for me in the past couple of weeks obviously,’’ Kopech said. “From just about my absolute peak to the absolute rock bottom. To say it’s unexpected would be an understatement.’’
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This regular segment of ‘Ask the Doctor’ addresses questions sent in by Sports Medicine Weekly followers. In this segment we have Dr. Gregory Nicholson from Midwest Orthopaedics at Rush, addressing questions about the causes, symptoms and treatment of shoulder and elbow injuries along with a discussion of alternatives to anti-inflammatory (NSAIDs) medication for people with kidney issues.
Dr. Nicholson specializes in shoulder and elbow surgery, utilizing state-of-the-art arthroscopic and open surgical techniques to treat sports-related, traumatic, arthritic, and occupational conditions of the shoulder and elbow.
A graduate from Indiana University School of Medicine, Dr. Nicholson completed his internship and orthopedic residency at University Hospital of Cleveland and completed a fellowship in shoulder and elbow surgery at the New York Orthopaedic Hospital at Columbia-Presbyterian Medical Center in New York City.
Dr. Nicholson is involved in the design of an advanced shoulder replacement system. He is a consultant to differing orthopedic companies and has designed instruments and implants for shoulder and elbow surgery. He is the principal investigator for funded studies on rotator cuff repair augmentation, and shoulder arthroplasty.
Baseball is a huge part of life for Millikin University sophomore Ben Jacobs. And he doesn’t take his ability to play at the college level for granted.
Just a few years ago while playing in a high school summer travel league, Ben was afraid his plans for a college baseball career might be derailed. He felt a tingling sensation in his arm and pain with throwing. What he didn’t know was that he was developing a type of throwing overuse injury.
When the feeling in Ben’s arm changed from tingling to pain, he knew he had to see a specialist. Ben’s father had been a patient at Midwest Orthopaedics at Rush, so they sought help right away from that group. They were introduced to Dr. Gregory Nicholson, an expert in shoulder and elbow surgery.
Dr. Nicholson diagnosed Ben with ulnar neuritis (also known as cubital tunnel syndrome), an inflammation of the ulnar nerve, which passes behind the medial epicondyle of the elbow down through the forearm and into the hand. The ulnar nerve is more commonly thought of as the “funny bone” nerve and inflammation can cause numbness or weakness in the hand.
Because of the position of the nerve, it is stretched when the elbow is bent. Thus, with the throwing motion it can become inflamed. In some cases, a splint or brace that keeps the elbow straight can be enough to relieve the pressure on the ulnar nerve. In Ben’s case, Dr. Nicholson recommended surgery to decompress the nerve and relieve Ben’s symptoms.
“Ulnar nerve decompression and transposition (moving the nerve to the front of the bend of the elbow) is a low-risk, outpatient procedure with a relatively high success rate. If patients are diligent with their physical therapy and follow the course of treatment, most regain full function,” Dr. Nicholson explains.
Ben and his family agreed to the surgery and he completed it while still in high school. During the procedure, Dr. Nicholson made an incision along the inside of Ben’s elbow. Once the nerve was fully explored, decompressed and moved slightly, Ben’s connective tissue and skin were closed with small stitches.
The surgery was successful and Ben soared through his physical therapy. Now, a few years post-surgery, Ben says he “feels 100 percent,” and has had no pain recurrence.
However, in order to avoid another overuse injury, he has changed positions from pitcher to catcher.
“To err on the side of caution, I decided to primarily play catcher. That way, I’m not putting too much strain on my arm, but can still be involved in every pitch.”
To commemorate his positive outcome, Ben had a “smile” face tattooed over his surgery scar as a reminder to persevere and stay positive.
“At first my arm felt a bit strange after surgery and it took me awhile to adjust. But now I’m lifting weights and throwing with no problem and I feel stronger than ever.”
To schedule an appointment with Dr. Nicholson to discuss your shoulder or elbow pain or condition, call 877-MD-BONES.