The Los Angeles Dodgers are currently flush with two things: cash and starting pitching. With a collection of starters that includes two elite talents in Clayton Kershaw and Zack Greinke; a highly touted Korean import; and four veterans ranging from capable to once great in Chris Capuano, Aaron Harang, Ted Lilly, and Josh Beckett, it’s somewhat surprising that the club is taking such a liberal approach to Chad Billingsley’s elbow problems. Billingsley falls somewhere between the elite hurlers and the capable ones, although he shades closer to the top of the rotation guys when he pitches like he did over the course of six straight starts between July 23rd and August 19th last season.

As Mike Petriello detailed extensively in a post on his excellently named Mike Scioscia’s Tragic Illness blog, Billingsley was shutdown in August of last season with a partially torn UCL in his throwing arm. Petriello links to an update on Billingsley’s rehab from Kevin Gurnick of MLB.com, essentially stating that the right hander’s progressing well and reports to be pain free. Skeptics all over probably scoffed at such a claim, especially given the recent history of starting pitchers who failed to rehab such an injury successfully without surgery.

Whether it’s Jesse Litsch, Drew Hutchison, Cory Luebke, or Billingley’s Dodgers teammate Capuano, most pitchers who have opted for rest and rehab over surgery when dealing with a partially torn elbow ligament have eventually gone under the knife. Elbow ligaments are not akin to lizard’s tails; regeneration is not a viable avenue for healing.

Of course, baseball bloggers are not privy to Billingsley’s health records, so perhaps we’re way off in questioning the Dodgers’ approach here. A common refrain when discussing such issues is “well, you’re not a doctor…” and fair enough. For the purposes of this post, I leaned on a doctor with a sound knowledge of sports related injuries.

Doctor, Backhand Shelf injury “smartass”, and all around swell person, Jo Innes on partially torn UCLs:

“The UCL’s job is to keep the elbow stable by protecting it from valgus stress. Pitching a baseball is the exact motion that puts that exact stress on the joint. So every single time you throw that ball you’re stressing that ligament. In shocking related news, repetitive throwing motions are the #1 cause of UCL injury.

You can treat the injury with conservative therapy first, which is a minimum of 3-6 months of NSAIDs, physio, and no pitching. If you opt for surgery, it’s 4-6 months before you can throw and 9-12 before you can play. Here’s the fun part: one of the indications for surgery (aside from being a pro ball player who has a clue and wants to get that fixed ASAP) is failing two rounds of conservative therapy. Do the math – that would take 6-12 months, and then you’d STILL lose a year from the surgery.

If it was a minimal tear I could see trying to rehab it. Except if you were an MLB pitcher in which case I’d think you might want the peace of mind of knowing your elbow wasn’t about to fall apart.”

Given what we know about the healing process for a partially torn UCL, and given what Petriello has outlined in terms of pitchers dealing with the injury in the past, it’s increasingly surprising that the Dodgers wouldn’t have pushed for surgery. This raises several questions regarding the situation, including the accuracy of the initial diagnosis, and the rehab process if it was in fact a tear in Billingsley’s elbow, just to highlight a few. Again, with the absence of team medical records to provide clarity, we’re left to trust the player and the team here.

A best-case scenario for Billingsley is a successful recovery while avoiding surgery. Petriello cites examples of Adam Wainwright in 2004 and Ervin Santana in 2009 as pitchers who eschewed surgery and managed to recover and continue pitching. For what it’s worth, Wainwright eventually underwent Tommy John surgery in 2011. A worst-case scenario is a setback in his recovery, or being shutdown again while surgery and a minimum year-long layoff loom. We can only presume that the Dodgers and Billingsley know best. In which case, they’ve weighed the risks involved and charted their course based on information that’s beyond our reach.

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