It sure seems like the Royals wildly mishandled Salvador Perez’s thumb injury

Salvador Perez—future Royals Hall of Famer, highest paid member of the 2022 Kansas City Royals team, and starting catcher—just had surgery on his thumb. Manager Mike Matheny told reporters that the club estimates an eight-week recovery time from the surgery and that, if all goes well, Perez will return later this season.

This is unfortunate for the Royals for multiple reasons. On and off the field, Perez is a vital member of the team. He is a legitimate power hitter and one of the best defensive catchers in the game if you don’t give credence to pitch framing data (which you should not, but we can all get into that another time). Furthermore, he’s a leader, the connective tissue between the Second Golden Age Royals and, hopefully, the guys on this team who will lead the next Royals playoff team.

It is also unfortunate because the information we currently have suggests that the Royals severely mishandled his injury. In all likelihood, this surgery didn’t need to happen, and is frustratingly another piece of evidence that calls the competence of the organization into question.

Salvador Perez Injury Timeline

On May 17, Salvador Perez left the first game of a doubleheader against the Chicago White Sox with an injury. To date, Perez had played in all 34 of the Royals’ 34 games as either the catcher or the designated hitter, but he didn’t quite look the same. That day, the Royals placed Perez on the 10-day injured list with a left thumb sprain. Perez had been hitting .206 with a .636 OPS.

Perez returned on May 28 after missing 10 games. After returning, he played every day, again either as catcher or as the DH. Over the next 23 games, he hit a respectable .218/.277/.471 with five home runs, five doubles, and even a triple.

On June 21, Perez re-aggravated his thumb injury in the Royals’ wild 12-11 overtime win over the Angels. Perez had surgery to repair his thumb sprain the next day, which was announced on June 24th. Again, the club estimates an eight-week return time.

What are thumb sprains?

Tendons and ligaments are the connective tissue of the human musculoskeletal system. Ligaments connect bones together, while tendons connect bones to muscle. Both can be injured, and the injury to either is called a sprain. Sprains can be minor or severe, and a severe sprain can also be called a tear. The Cleveland Clinic does a great job of defining the specifics of a thumb sprain:

A thumb sprain (sometimes called skier’s thumb or gamekeeper’s thumb) happens when a ligament (tissue that connects bones at a joint) in your thumb stretches too much or tears. Most thumb sprains involve your ulnar collateral ligament (UCL), which is located on the inside of your thumb at the first metacarpophalangeal (MCP) joint. Your MCP joint is located at the base of your thumb near your palm, in the webspace. Thumb sprains usually happen when your thumb forcefully stretches too far backward away from your palm or in another awkward direction. Thumb sprains, and other types of sprains, can range from a stretch or small tear in your ligament tissues to a complete tear through your ligament or a detachment from your bone.

As The Cleveland Clinic explains, there are different types of sprains. These sprains are categorized by a grading system, and sprains are categorized as Grade 1, Grade 2, or Grade 3. The amount of ligament torn determines which grade it is. Again, from The Cleveland Clinic:

Healthcare professionals use a grading system to classify the severity of sprains. The three different grades include:

Grade 1: A grade 1 thumb sprain is a mild sprain. The affected ligament is overstretched but not torn.

Grade 2: A grade 2 thumb sprain is a moderate sprain. The affected ligament is partially torn.

Grade 3: A grade 3 thumb sprain is a severe sprain. The affected ligament is completely torn or separated from its attachment to your bone. Severe sprains require medical and/or surgical care.

Teams don’t always tell us what kind of sprain a player has, forcing guesswork. That is fortunately not the case here.

Thumb sprain recovery time

Perez has a Grade 2 thumb sprain, which we know because he and the team released that information after the second game of the doubleheader against the White Sox on May 17.

[Perez] underwent tests, which showed a Grade 2 thumb sprain. The club immediately placed him on the 10-day injured list. That night, Perez spoke to reporters and added context on the severity of the injury.

“It’s on the inside of my thumb,” Perez said. “I just need some time. Hopefully, it’s only 10 days. (Head athletic trainer Kyle Turner) told me maybe it’s going to be four to six weeks, at least 21 days. It’s Grade 2. With Grade 3, I maybe would have to have surgery. So, hopefully, I can get better soon and get back to the field. You guys know how much I love to play. It’s kind of hard, but it’s something I know I don’t have control of.”

While there is no tearing on Grade 1 strains, Perez’s injury was severe enough to be classified as a Grade 2 strain, which involves a partially torn ligament. The good news is that, as a mild or moderate sprain, those injuries can heal on its own without surgery. The bad news is that it takes time. Again, per The Cleveland Clinic:

If mild (grade 1) and moderate (grade 2) thumb sprains are treated properly with rest and immobilization of your thumb, they usually heal well without long-term complications.

A mild sprain usually heals within four to six weeks if you wear a splint or cast to immobilize your thumb and refrain from activities that irritate it.

The Royals’ medical recommendations from head athletic trainer Kyle Turner line up with The Cleveland Clinic’s description of best practices: four to six weeks, with a three-week minimum for a more mild Grade 2 sprain.

Conclusion

Here’s what we know:

• Perez suffered a Grade 2 thumb sprain on May 17. He might have been playing through a Grade 1 sprain before that either knowingly or unknowingly, but that is impossible to verify.
• Turner and the medical staff told Perez that the minimum recovery time for his strain was 21 days with a more realistic time from four to six weeks.
• Perez returned to full baseball action 11 days after suffering the Grade 2 sprain, somewhere between 10 days to 17 days before he should have done so per the Royals’ own medical team.
• Less than a month after returning, a period of time in which he received no games off, Perez fully tore his ligament on June 21. Unlike a Grade 2 strain, this Grade 3 strain required surgery. Recovery time is now eight weeks.

Even considering that professional athletes often play through pain and do not always recover completely before coming back from an injury, it’s hard to come away from the information at hand without thinking that the Royals badly screwed this up. Sprains do not go away on their own; a Grade 2 sprain, which is a partial tear of a ligament, can only heal with rest and treatment. Otherwise, the tear will remain, making a larger tear more likely. This is precisely what happened.

Who is at fault here? A lot of people. Perez should probably not have tried to rush back, but he’s tough and extremely competitive so it’s hard to expect him to be patient. And while it seems that the medical staff was doing their due diligence, Alec Lewis’s article on The Athletic—posted on June 6 and linked above—has a tidbit that suggests the medical staff didn’t see Perez’s re-injury coming:

At the moment, the situation harkened back to Hunter Dozier’s thumb injury in 2021, which wrecked his swing and his season. But Turner, the head athletic trainer, told The Athletic the two injuries are different, and the club is not fearful that Perez’s presence in the lineup will lead to a worsened injury.

Of course, manager Mike Matheny ought to share a large part of the blame. He’s in charge of who plays when, and it’s up to him to tell Perez “no” when he says he wants to play but the medical staff says otherwise. Unnervingly, mishandling injuries is part of why the Cardinals ended up firing Matheny before he came to Kansas City.

Ultimately, Perez underwent another surgery and the Royals lost a vital member of their team for at least two months when it probably didn’t have to be that way. If there’s a good explanation, I sure haven’t heard it. But we’re not stupid: the onus is on the Royals to defend why they sent their star catcher back on the field way before medical best practices suggested it was safe to do so. At least they have a great attitude about it.