Boston Red Sox medical director Dr. Thomas Gill on Friday reiterated his belief that the fractured rib discovered in medical tests on Jacoby Ellsbury this week showed a new injury and was not related to the four fractured ribs the Red Sox outfielder sustained in an April 11 collision with third baseman Adrian Beltre.
Gill, in a conference call arranged by the team to discuss Ellsbury's condition, said the team took an "extremely conservative" approach with Ellsbury and that his pain was "completely resolved" from his initial rib injury before he returned to the lineup on May 22, nearly six weeks after he was hurt.
When Ellsbury came off the disabled list, Gill said, Ellsbury was medically cleared because he showed no signs of pain or tenderness, was able to participate in full batting practice and was symptom-free.
"In our medical opinion it was safe to have him come back," said Gill. "It was very clear at that point. His pain was completely resolved before he returned to play. He had absolutely no symptoms anywhere. In my physical exam he was completely clear and not tender.
"The player himself said he felt so good he did not want to continue his [minor-league] rehab assignment. He wanted to get right back to playing. We are fully confident he was fully healed and fully ready to get back."
Ellsbury collided with Beltre on April 11 while both players were pursuing a foul fly down the left-field line. The injury was initially diagnosed as bruised ribs, but tests later that week showed a hairline fracture of four ribs, according to the team. The Red Sox outfielder played in just three games upon his return, eventually landing back on the disabled list after experiencing pain, the player said, that radiated along his rib cage to the back.
An examination by Dr. Lewis Yocum in Los Angeles on Wednesday revealed another fractured rib on the posterior side of Ellsbury's rib cage, which according to Gill was not present at the time of the original injury. This newest injury, according to Gill, likely occurred when Ellsbury dove for a ball in Philadelphia in his second game back.
Ellsbury remained in the game and played the next day, and told reporters that he felt no negative after-effects from his catch, which would seem inconsistent with a diagnosis of a newly fractured rib. Gill acknowledged that it was relatively rare for a player to sustain such an injury while diving for a ball.
But after the Red Sox left Philadelphia and traveled to Tampa for its next series, according to Gill, Ellsbury told the team's training staff that he was experiencing pain in a different area (behind the armpit) than where the original trauma had occurred. Within two hours of Ellsbury's complaint, Gill said, the Sox arranged for another MRI and CT scans. A Tampa-area radiologist and the team's radiologist read the reports and concluded there was no new fracture.
Earlier this week, Gill said, Ellsbury indicated to the medical staff that his pain and discomfort moved again and now was in the rib area near his spine. The Red Sox were on the road, so Ellsbury came back to Boston to meet with Gill. At that point the Red Sox learned that Scott Boras, Ellsbury's agent, requested an independent examination by Yocum.
Yocum examined Ellsbury on Wednesday and found "just a very small non-displaced injury on one of the sixth ribs and that's where we are right now," Gill said.
Gill, in an e-mail to ESPN Boston on Thursday night, said that the team had taken medical scans of the posterior side of Ellsbury's rib cage prior to the tests administered by Yocum on Wednesday.
"I don't know what to do differently," added Gill. "He's had three MRIs and three CTs. He's seen two opinions from his agent and three from an orthopedist and a thoracic surgeon at Mass General, so that's probably more sub-specialty care than you can imagine. I think he's had every detail checked, not once, but four times. We're on the right path and I think he'll be productive for the rest of the season."
There is no set timeline for when Ellsbury will return to action, though Gill said he "would guess from the two-week point until the All-Star break, but we will support any pace he needs to recover at."
"We obviously want to do what's best for Jacoby both mentally and physically so he can be fully comfortable and confident like he was when he came back the first time," Gill said. "[Jacoby] will really dictate, based on his symptoms, it won't be less than two weeks because we want to give him a good two weeks away and let him do some rehab."
Gill explained that Ellsbury needs more rest than rehab at this point. He will be re-evaluated at the two-week point by Gill and if everything looks good, Ellsbury will begin to progress in his rehab. Until that point there will be no baseball activities.
At the suggestion of Boras, Ellsbury will rehab at Athletes' Performance in Arizona for the next couple of weeks.
"Sometimes when a player is working hard to get back on the field, has some bad luck, or not getting back as quickly, sometimes getting a change of scenery can help both mentally and physically," said Gill. "I think he's had some encouragement from his representation that he might be good to have a little change of scenery. Jacoby has worked out at API in the past, he lives down there and this is something we fully support."
Gill also explained having Ellsbury away from the daily grind of the schedule and someplace where he can focus on his rehab is best. But it was clear Gill would rather have Ellsbury stay in Boston under the watchful eye of the team's medical staff.
"We don't have to sign off on pretty much anything," said Gill. "If we think it's not in the player's best interest, I would say we don't typically send our players elsewhere. We think we've got probably the best situation in baseball where we are right now from an expertise standpoint. I think it was suggested by the representation and in this rare situation, made a lot of sense to us. It's something I fully support and I know our training staff does and the front-office staff does as well."
Joe McDonald covers the Red Sox and Bruins for ESPNBoston.com.