The sight of David Ortiz standing in front of his locker yesterday afternoon, clad in a green T-shirt and hard black cast, gave those in the clubhouse a glimpse of just how long this summer might be. While it is possible that doctors will remove that cast in two to three weeks and find Ortiz pain-free and ready to resume baseball activity, it is also possible that Ortiz will require season-ending surgery.
"They're going to get it off in two weeks just to see how I feel," said Ortiz, who injured himself swinging at a pitch Saturday night in Baltimore and has been placed on the 15-day disabled list. "If I have no pain, then they're going to start getting me swinging and see how I feel. 'Cause the problem right now is the pain. Every time I move my hand around, I feel pain.
"Because it's kind of loose, every time I move my hand, the tendon just pops, so with this [cast] right here, it won't allow me to move my hands around. So it will probably give the tendon the opportunity to go back to where it's supposed to be."
There was optimism around Fenway Park yesterday. The plan is to keep Ortiz in his cast for two weeks. If there is no pain by then, he will work toward returning to the field. If there is no pain but the "clicking" in his wrist continues (the tendon coming in and out of the sheath), he might be able to get through the season before needing surgery. If there is still pain, then in-season surgery might be necessary.
"The tendon itself is unaffected; it's completely intact," general manager Theo Epstein said. "It's not in jeopardy. What is partially torn is the sheath that holds the tendon in the groove.
"You remember Curt Schilling's ankle - it was the sheath that ruptured that meant the tendon was flapping back and forth. That was a full rupture of the sheath that held the peroneal tendon. In this case, it's a partial tear of the sheath that holds the tendon in place, the ECU tendon. So the integrity of the tendon hasn't been compromised at all.
"So that's why the doctors are pretty confident that if it's immobilized in this hard cast for a period of time, there's a significant chance it will heal itself in that time period, and we'll know it has because if David is pain-free and it's not tender when he gets out of the cast, then it will have resolved itself and he can start a progression."
While a comparison also has been made to Nomar Garciaparra, his 2001 wrist injury was far more severe. Garciaparra suffered a split tendon in his right wrist, which required surgery to repair, as well as the tendon sheath, and a piece of bone at the bottom of the sheath. The more apt comparison likely is Nick Johnson, the Nationals first baseman. Johnson tore the tendon sheath in his right wrist last month and is expected to be out 4-6 weeks.
Dr. Philip Blazar, an orthopedic hand surgeon at Brigham and Women's Hospital who has not examined Ortiz, cautioned that even without pain, it would likely take longer than two weeks for full rehabilitation to begin. Blazar, relying on experience in the absence of direct knowledge of Ortiz's injury, said that in general, this kind of injury is not something that significantly affects the motion of the wrist. He also said the preferred course of action is to treat it nonsurgically.
"The way the tendons on the back of our wrist are grouped, they are grouped into six compartments," Dr. Blazar said. "This is a tear of the compartment of the restraining structures of this tendon, not the tendon itself.
"There is a tendon that runs along the bone on the pinky side of the wrist. That tendon normally runs through a little tunnel that makes the tendon mechanically better able to do its job. What happened is there is a tear in that tunnel or a partial tear in that tunnel and the tendon is not staying 100 percent within the tunnel."
While Ortiz indicated that if the clicking does not stop, he might need surgery in the offseason, Blazar said many people experience clicking and continue to function - though a baseball player, who uses his wrists a lot, might need to be monitored more. But he also said the confidence shown by Epstein and manager Terry Francona in the possibility of Ortiz's return without surgery is likely warranted.
"If they can get the swelling down, yeah," agreed Dr. Bill Morgan, who reconstructed Schilling's ankle in the 2004 postseason, and also has not examined Ortiz. "If it looks like he still has pain and a feeling of instability, they'll repeat [the MRI]. If it looks like a marginal or partial tear, get him back. If not, [surgery] might be necessary."
Everyone from Ortiz to the front office to his teammates is hoping that won't be an issue. But for now, there are few certainties.
"It's just like it's a little frustrating," Ortiz said. "It's not like you injured your hand doing something you normally do not do. I was swinging. I swing every day. This is a little crazy."
Amalie Benjamin can be reached at firstname.lastname@example.org