Quick thoughts after Gerrit Cole avoids Tommy John surgery

UPDATE: We have a diagnosis and a treatment plan: Cole has nerve inflammation and edema (swelling, basically) and will be shut down 3-4 weeks, he said Saturday. “Three to four weeks no throw, and we’ll go from there. I think we determined that we just got a little too hot a little too quick this spring," Cole told Bryan Hoch. So a month on the shelf then 6-8 weeks of a careful build up? That puts Cole on track for June, assuming all goes well.

ORIGINAL POST: All things considered, the Yankees received good news about Gerrit Cole’s elbow. Multiple reports say that, following another round of tests, Dr. Neal ElAttrache agreed with Yankees' doctors that Cole does not have a tear in his UCL. The recommendation is rest and rehab. Cole will still miss significant time, likely several months, but he’s avoided the worst case scenario and does not need Tommy John surgery.

It’s so easy to be pessimistic with elbows and think this only delays the inevitable, and that Cole will wind up having Tommy John surgery anyway after spending a month or two rehabbing. It happens more often than it feels like it should. It happened with Sandy Alcantara last year. Jordan Montgomery exited his start with elbow pain on May 1st, 2018, spent a few weeks rehabbing, then he had Tommy John surgery on June 7th.

I’m not sure anything I say will ease that concern. Masahiro Tanaka showed Tommy John surgery is not inevitable in these cases, and Cole does not have a tear. The “rehab for two months and then have Tommy John surgery anyway” cases typically happen when there’s a partial tear and/or flexor strain, and as far as we know Cole has neither. Does that mean he’s out of the woods? Of course not. Elbows are finicky.

Dr. ElAttrache is the authority on elbows these days and he, along with several others, say there’s no tear and Cole should rehab. Cole is so thoughtful and analytical and information-obsessed. What is he supposed to do, have Tommy John surgery against the doctors' recommendation so we don’t have to worry about him needing it later? That’s not how it works. Surgery is always a last resort, especially when it’s something as significant as elbow reconstruction. Do what the doctors say and hope for the best.

We know Cole doesn’t have a tear but we also don’t have a diagnosis. Cole is flying back to Tampa today and the Yankees don't plan to give us an official update until they speak to him, so figure we'll hear something Saturday. Is it just inflammation? A muscle strain? Something else? Beats me. With any luck this is just inflammation – welcome to your mid-30s, Gerrit – and it’ll clear out after some rest, and he can build up carefully from there. Best case is what, miss 2-3 months and a return in the second half of June?

The news is good but only relatively speaking. Cole is going to miss significant time and that’s bad news for a Yankees team that plays in a brutal division and doesn’t have the most stable rotation. Nestor Cortes and Carlos Rodón carry no less injury risk now, and Clarke Schmidt’s 60-something-inning increase last year still happened. Cole is the guy who doesn’t get hurt, but he got hurt, and he’s going to be out awhile.

Hal Steinbrenner, Brian Cashman, and the Yankees can either say they dodged a bullet and just need to weather the storm until Cole returns, or they could view this as a wake up call and realize they need rotation help. The Yankees are at a point on the win curve where every win or loss alters their postseason odds significantly. Here’s what ZiPS says about the 2024 Yankees:

• Entering Spring Training: 63.7% postseason odds
• Subtract one win: 59.0%
• Subtract two wins: 54.3%
• Subtract three wins: 49.5%
• Subtract four wins: 45.0%

The difference between Cole and his replacement, whoever it is, could very well be four wins across three months. Cole’s value transcends what he does in his starts because he soaks up so many innings. Aaron Boone can manage his bullpen differently the day before Cole starts and the day after Cole starts, because he could count on Cole to pitch deep. You can’t overstate his importance to the Yankees.

It’s good news the injury is not more serious and it’s bad news because Cole is irreplaceable, and he’ll be sidelined for several weeks even in the best case scenario. Elbows can be cruel too, so there’s no way to know whether this is the end of it either. We’ll just have to keep our fingers crossed like we did with Tanaka. I hope the Yankees get rotation help but I’m not sure they will. Either way, get well soon Gerrit.