Doctor explains Tarik Skubal return to Detroit Tigers from surgery

What are loose bodies in the elbow?

"A loose body happens when you have damage to the joint. A piece of cartilage or a piece of bone breaks off inside the joint, and over time, it can gradually get bigger – and that's a loose body. Sometimes, it stays in one of the recesses in the capsule, and it doesn't cause any problems, but sometimes, it can cause problems. It can get stuck inside the joint all of a sudden, and then you can get locking, pain, inflammation. That's the way it works when it gets stuck in the joint. Sometimes, it can be big enough that it stays in one part of the joint, like the front or the back, and when that happens, it can block your flexion and extension, and that's called impingement."

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How are loose bodies removed surgically?

"Most of the time, we can take them out through arthroscopy. We make a small incision around the joint, and then we put a camera in, and under direct vision from the camera through the small hole, we can remove the loose body. Sometimes, on top of the loose body, there can be extra bone on the edge of the joint, and at the same time, we can remove that. When arthritis in the joint is more advanced, we do something called debridement and capsular release, and what happens is we cut the capsule to release the joint and give them more motion."

What is the rehab process as a player returns from surgery?

"After the operation, we want to restore range of motion right away. Otherwise, the patient can get stiff. We start physical therapy right away. Initially, they do range of motion, and then they do strengthening, and then they gradually go back to sport activity. In terms of how fast it can go, it depends on the extent of the problem. If somebody has a couple of small loose bodies, not much arthritis in the joint, not much stiffness, then it'll be a quick recovery. When it's more extensive, it will be a much, much longer recovery."

What does the recovery timeline typically look like?

"It is a spectrum. You can't just put it in one category. If they have a few loose bodies, not much joint involvement, and you don't need to do any capsular release, the recovery can take anywhere from six to 12 weeks. If the joint is more involved with more capsular release, more extensive arthritis, more loose bodies, that can take anywhere from three to six months to go back to sports. The minor one can be six to 12 weeks, and the major one can be three to six months."

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How does prior elbow surgery – Tommy John surgery (in 2016) and flexor tendon surgery (in 2022) – impact this situation?

"If the medial collateral ligament [also known as the ulnar collateral ligament] that was reconstructed starts stretching over time, that can be another reason for damage in the joint because the elbow goes into more of a position called valgus, which puts stress on the joint. There can be bone-on-bone impingement in the posterior part of the elbow in full extension, and the bone spurs can potentially cause loose bodies in the joint. If you remove them, and that instability is there, unfortunately, the problem is not going to be solved because that residual instability over time can cause the same problem again. That can make the rehab longer because they have to recover and do more strengthening. But if they have no instability, the Tommy John is solid and the flexor repair is completely healed, that should not affect recovery."

Could another Tommy John surgery be required?

"If the medial collateral ligament has insufficiency, the player may need another Tommy John down the road. Before the operation, through imaging and physical exam, we can get enough information to see if it's unstable or not, but in the operation, we can get more information by stressing the elbow and seeing how much gap there is, how much instability we get."

Contact Evan Petzold at epetzold@freepress.com or follow him @EvanPetzold.

This article originally appeared on Detroit Free Press: Tarik Skubal return to Detroit Tigers? Doctor says 6 weeks or 6 months