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Nathan poised for another Tommy John surgery

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Mark Cunningham/Getty Images

Devastating. Or at least that’s how it seems it would feel to receive the news Detroit Tigers pitcher Joe Nathan did on Wednesday. Nathan has torn the ulnar collateral ligament (UCL) in his throwing arm for the second time and, along with it, his flexor pronator tendon.

He faced just one hitter in the 2015 regular season -- throwing four pitches total -- before he was sidelined with the original injury. He notched a save in that sole outing but was placed on the DL with a flexor strain. After a period of rest and rehab, Nathan was poised to return this Friday as long as Wednesday's rehab outing went well. It did not. He exited after feeling a “pop” in his forearm on his 10th pitch (of a planned 25) and later acknowledged he was fearful something serious had happened. Athletes know.

Even if he had returned, there were going to be concerns as to whether Nathan’s throwing arm could hold up to the workload of another season. After all, he is now 40 years old with extensive mileage on his throwing arm, a player in the twilight of his career with a significant “elbow” history.

That history is most notable for a UCL tear suffered during 2010 spring training, which led to Tommy John surgery. The season-ending operation could also have been described as career-extending because Nathan, a 12-year major leaguer at the time of his injury, who might have walked away from the game had he played in an era before this procedure, successfully returned one year later.

Within weeks of his return, however, Nathan developed what he described as “tightness” in his forearm and was diagnosed with a flexor strain. Soreness, stiffness or tightness in the forearm muscle group as one progresses through the phases of recovery following TJ surgery is not uncommon, but it does warrant close monitoring since the flexor muscle group (which controls the bending and stability of the wrist) attaches just above the medial (inner) elbow, in the region of the infamous TJ ligament, or its replacement graft. Nathan went to the DL for just over a month but felt the setback actually did his elbow some good overall. “During that time we were working on the forearm, I felt some scar tissue break up,” Nathan said. “Then my arm felt amazing.”

Late in 2012, while with the Texas Rangers, Nathan dealt with an episode of arm fatigue that cost him a few days, but he still racked up 37 saves. After another All-Star appearance and 43 saves in 2013, Nathan moved to the Tigers. This year, despite changing up his offseason workout program to counter the effects of turning 40 (“We added a lot of agility work, which has completely eliminated the joint aches and pains I had started to get,” Nathan told me this spring), he was again dealing with a flexor strain.

Recovery from any muscle strain depends on the degree of injury and the quality of the soft tissue at the injury site. While the most significant strains (complete tears) may warrant surgical repair, minor injuries, as this one was reported to be, often respond to rest and rehabilitation. However, a history of repeated injuries at the same site translates to an increased likelihood of scar tissue in the area and healing may not be as comprehensive. Aggravation of the injury may also be easier.

Joakim Soria has been filling in as the Tigers' closer since Nathan went on the DL, but Soria, as good as he looks at the moment, is not without risk of his own. He is himself a two-time recipient of TJ surgery and has clearly met the measure of success as far as returning to prior level of performance. In fact, his season thus far (five saves, just one earned run) would hint at an improved performance over his collective numbers since his second surgery in 2012. No one can say Soria is destined for an inevitable breakdown, but the longevity of success following two TJ surgeries is difficult to project, given the small sample size.

In the meantime, the Tigers have indicated Nathan “will undergo season-ending surgery at a later date.” On Thursday, Nathan told reporters he is “preparing to come back and be a major league player again.” Interestingly, last month, before there was a hint of discomfort in his forearm, Nathan (considering the arduous process of rehab) told me he would not undergo a second TJ surgery unless it was going to improve his life after baseball. The severity of the injury -- with the accompanying flexor-pronator tear -- likely influenced his decision to have the surgery. And, maybe he’s not quite ready for life after baseball.