Red Sox medical director Dr. Thomas Gill defended the team's handling of Jacoby Ellsbury, using the forum of a conference call with reporters to address what he called "misconceptions."
According to Gill, Ellsbury was "given the absolute standard of care and the best possible treatment from the time this injury occurred."
Gill said that rib injuries are treated the same way whether there are fractures or not and that the Red Sox were "extraordinarily conservative" with their treatment of Ellsbury.
"These are, quote, unquote, fractures that you can't actually see on an x-ray. They're very stable injuries. They happen all the time in football, they happen all the time in hockey. We obviously have a huge wealth of knowledge and experience treating these injuries," Gill said.
According to Gill, Ellsbury was injured April 11 in Kansas City when he collided with Adrian Beltre. While the fractures were not discovered until about a week later, Gill reiterated that the treatment would not have been different and that the team was proceeding under the assumption that there were fractures.
"We always take the worst-case scenario," Gill said.
Ellsbury, Gill said was not cleared to play until he was comfortable. "The criteria for his return to play was having no pain, no tenderness. He would take full batting practice ... let him run, he had to do everything he needs to do without symptoms. What he said to us was, 'I feel fine now.' "
However, on May 15 in Detroit, Ellsbury seem disgruntled about starting his rehab assignment.
“Not really,” said Ellsbury that day when asked if he was ready to play. “It’s not do-or-die or anything."
Ellsbury played three games in the minors, going 4 for 10, before playing three games for the Red Sox. Ellsbury, Gill said, made the decision to end his rehab assignment, saying he felt great.
"At his own saying and in our medical opinion, it was safe to have him come back. It was safe, very clearly at that point," Gill said. "That pain was completely resolved at that point. He had no symptoms."
A second injury apparently occurred in Philadelphia on May 23 when Ellsbury dove to make a catch. When he complained of pain in Tampa Bay on May 25, Ellsbury was given a CT scan and MRI in Florida within two hours.
Gill said fracturing a rib on such a play, particularly close to the spine, was "very rare."
According to Gill, the radiologist in Florida did not detect any fracture. Nor did Gill or team radiology consultant Dr. William Palmer of Massachusetts General Hospital. Still, Ellsbury went back on the disabled list
Ellsbury told the training staff this week that the pain had moved closer to his spine. "He had an acute onset of more pain," Gill said.
At the request of agent Scott Boras, Ellsbury was seen by Dr. Lewis Yocum of the Kerlan-Jobe Orthopaedic Clinic in California. It was then Ellsbury was found to have what Gill described as a "very small, non-displaced injury on the sixth rib."
According to Gill, Yocum reviewed the tests done in Florida and agreed that no fracture could be detected.
"It's simply not there," Gill said. "But whether it's there or not is not medically relevant. You treat it exactly the same."
According to Gill, Ellsbury will essentially rest for at least two weeks in Arizona before starting baseball activities. Gill said Ellsbury could return around the All-Star break.
"It's been a more prolonged recovery," Gill said. "We want to do whatever's best for Jacoby both mentally and physically. ... We'll support whatever pace he needs."
Gill said Ellsbury would largely determine when he returns and that his availability would be based on his symptoms.
On several occasions, Gil said the Red Sox had taken a conservative approach and would continue to do so.
"I don't know what else there is to do differently," Gill said. "He had three MRIs, three CTs ... He's seen three orthopedists and a thoracic surgeon at Mass General. That's more sub-specialty care than you can imagine. He's had every detail checked not once but four times. I think we're on the right path."
At one point during the call, Gill said the entire situation has been vexing.
"This whole [thing], the length of his symptoms, everything is different. Everything is different in this case. It's really been different," Gill said. "The key to thing to keep in mind is that it's really not a question of was it there or when it was there. The key thing is we always treat people for the worst-case scenario from Day 1. ... We always treat them as if there is that hairline fracture there."