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Doctor's Take: Tim Cooney

Lefty Tim Cooney is going to be out for at least three months because of an arm injury, and resident IBI doctor Brandon Bowers gives the low down on what the injury is, his timetable for a return and how it impacts his season moving forward...

On Wednesday, February 22nd it was announced that Indians’ left-handed pitcher Tim Cooney incurred a strain of the left flexor digitorum superficialis muscle.  The ball club suspects the injury will keep him out of commission for somewhere in the neighborhood of 10-12 weeks.  Cooney was acquired in the offseason via waivers from the St. Louis Cardinals.

What is it? The flexor digitorum superficialis (FDS) muscle is located on the palmar side of the forearm, palmar referring to the palm side of the arm/hand, and is responsible for bending the fingers.  The term “strain” refers to over stretching of a muscle, and is typically used interchangeably with the phrase “a pulled muscle”.  Strains are typically graded on a scale from one to three, with one being the least severe and three being the most severe.  In the case of Cooney, his left FDS muscle has been overstretched, most likely as a result of something that happened while he was pitching.  However, the Indians did not disclose the mechanism or grade of the injury.  

How is it fixed? A typical course of treatment of a muscle strain usually begins with the most conservative means possible before progression to less conservative treatment if the condition proves to be refractory.  A period of rest/time to manage any inflammation or pain is performed first, followed by maintenance/improvement of range of motion/muscle strength.  In more severe cases where a complete rupture of the muscle belly or muscle tendon occurs, surgery may be indicated.  A return to baseball activities is gradually introduced and comes before full clearance to return to live game action.  Once the player is able to perform all baseball activities without an exacerbation of symptoms/pain he will be allowed to return to unrestricted baseball activities by the medical team.

My take.  Cooney is going to be out for a while.  There are a few things to consider with this injury that will impact the time the southpaw will miss prior to returning to pitch.  First, what I believe to be the most important factor, is the flexor digitorum superficialis muscle attaches to the medial epicondyle (side of the elbow closest to the body) of the upper arm bone.  This is noteworthy because the medial epicondyle is also an attachment site for the ulnar collateral ligament (UCL).  The UCL is the culprit that sends many pitchers under the knife for the dreaded Tommy John surgery.  All things considered, the lengthy return to play following a flexor digitorum superficialis strain could be due to the close association between the muscle itself and the ulnar collateral ligament.  Continuing to pitch with a strained FDS could lead to altered pitching mechanics and increase torque, force etc. on the UCL, thus increasing an individual’s risk for injury and potential Tommy John surgery.  Furthermore, the injury is in Cooney’s pitching arm, so this also increases time missed compared to if the same injury would have occurred in his non-pitching arm.  Finally, the severity, which the club has not provided, also plays into the duration of time until a return to full, unrestricted baseball activities.  As far as how Cooney’s injury impacts the Tribe, it is certainly a hit to the depth at the left-handed reliever spot the Indians stockpiled in the offseason and also their starting rotation depth.  However, I think this injury is more detrimental to Cooney’s chances to land a job in Cleveland at some point during the season than it is to the Tribe’s ability to have success in 2017.

Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio.  He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports.  Follow Brandon on Twitter for more Cleveland Indians injury insight and analysis:  @blbowers12

The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available.  This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.

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