Danny Duffy hints at need to address elbow injury this off-season

Danny Duffy pitched a three-inning simulated game today in his attempt to return from elbow soreness that landed him on the disabled list August 26. The Royals are hoping he can return for this weekend’s series against Cleveland.

Following his simulated game, Duffy indicated he was pitching through pain because of the importance of this season, and there may be a need to “address” the injury this off-season.

When asked if “addressing it” meant rest or something more, Duffy was vague, according to audio provided by 610 Sports.

I have what I have. It’s something that is inflaming something in there. We’ll get it looked at when we need to. Until then, right now I could go. Nothing in my elbow is going to compromise my ligament. But you also have to go forward knowing that you could re-aggravate the original injury.

Duffy was diagnosed with a “very low grade pronator strain” in the muscles near the elbow after an MRI back in August. Orthopaedic surgeon Dr. David Geier writes about the assessment of a flexor pronator strain here:

In high-level athletes an MRI is often ordered to ensure that the pain is not coming from an underlying injury to the ulnar collateral ligament, also known as the Tommy John injury. Most of the time, a flexor-pronator strain is treated with rest from pitching for several weeks to give the tendons time to heal. Ice and physical therapy can also be helpful to decrease the athlete's symptoms. As the pain improves, the pitcher will be started on a long toss program prior to returning to full pitching.

The fact that the MRI did not reveal a need for Tommy John surgery, a procedure Duffy already endured in 2012, is encouraging. However, Nationals pitcher Stephen Strasburg was initially diagnosed with a flexor pronator strain before he had Tommy John surgery in 2010. The surgery typically keeps pitchers out 12-16 months. The rate of pitchers who have returned to action following two Tommy John surgeries is lower than after just one, but the performance is generally about the same.

There are, of course, other elbow surgeries that do not keep a pitcher out quite as long, but still require a lengthy rehabilitation, which could put the start of Duffy’s 2018 season in jeopardy. Cliff Lee had a flexor strain that would have required surgery and 6-8 months of recovery had he not opted for retirement. Jonny Cueto and Mat Latos are pitchers who have suffered flexor strains but did not require surgery. Wade Davis suffered a flexor strain last year and avoided surgery, bouncing back this year with an outstanding season with the Cubs.

Danny Duffy signed a five-year, $65 million contract with the Royals before the start of this season. He has a history of injuries, missing time earlier this year with a strained oblique, missing time in 2015 with bicep tendinitis, pitching through a rib injury in the 2014 post-season, and his Tommy John surgery in 2012.