By Jay Jaffe
April 20, 2014

Brian BlancoIvan Nova will likely become the latest major leaguer to undergo Tommy John surgery. (Brian Blanco/Getty Images)

As they were in 2013, the Yankees have been bitten by the injury bug this year, with both Mark Teixeira and David Robertson hitting the disabled list during the first nine days of the season. Just as those two problems appeared to be behind them — with the former activated on Sunday and the latter on pace for Tuesday — they've suffered a more serious loss, as Ivan Nova could need Tommy John surgery.

Nova left his Saturday night start due to an elbow injury, and a postgame MRI revealed that he had suffered a partially torn ulnar collateral ligament. While he'll be reevaluated by the Yankees' team physicians in New York before a course of action is decided upon, the likelihood is that he's headed for surgery, which would cost him the remainder of this season and part of next year, given the typical 12-18 month rehab. If that's the case, he would be the 14th major league pitcher to undergo Tommy John surgery this season.

Given the uncertainty that surrounded CC Sabathia, Masahiro Tanaka and Michael Pineda as they came into the season, the Yankees were counting on Nova to be a stabilizing force in the rotation. After two shaky starts to begin the year, the 27-year-old righty threw 7 1/3 innings of two-run ball at the Red Sox last Sunday, but on Saturday he was rocked by the light-hitting Rays for four home runs and eight runs in four-plus innings. Even so, it wasn't until the last of his 80 pitches that he felt pain or discomfort, according to postgame reports. After Nova served up a double to Matt Joyce, manager Joe Girardi and assistant trainer Mark Littlefield came out to the mound, concerned that they had seen the pitcher shaking his arm after delivering a pitch (check this video at the 1:18 mark), a common sign of elbow trouble. Nova later told reporters he felt "kind of a little pop, like when you feel a friction or something" on that pitch, but believed he could stay in the game.

As has been noted several times in this space and elsewhere at, Tommy John surgeries are up all around baseball, to the point that Dr. James Andrews, the industry's leading orthopedic surgeon, recently called the increase "an epidemic." Via the disabled list data at, 21 professional pitchers have undergone or will undergo TJ surgery this year, after 28 did last year. Brandon Beachy, Corey Luebke, Kris Medlen and Jarrod Parker are among those needing the surgery for the second time. This year's count includes the Rays' Matt Moore, who is scheduled to go under the knife this Tuesday after exiting an April 8 game due to elbow soreness. The last Yankees major leaguer to need the surgery was Joba Chamberlain, who had it in June 2011. The Yankees have had better luck than most at avoiding the procedure in recent years; the four their major league pitchers had undergone since the start of 2004 was tied for sixth in the majors, and even if Nova winds up going that route, they'd still be tied for 10th.

While teams have gotten more conscientious about protecting young arms via pitch counts and innings limits, the reality is such measures — which don't have a whole lot of hard science behind them anyway — can't undo the damage that's done to even younger arms due to overuse at the amateur level. Pushing the numbers higher is the fact that in the past, pitchers have generally tried to rehab UCL strains, but few have successfully done so while avoiding surgery; that tack can work only if the tear is relatively minimal. With increasing frequency, pitchers appear to be foregoing months of rehab and opting for surgery sooner rather than later in order to get on with the arduous but generally predictable course of working their way back.

Which doesn't lessen the Yankees' pain of losing a pitcher who had intermittently shown signs of becoming a mid-rotation staple, but had yet to make more than 28 major league starts in a season. After debuting in 2010, Nova went 16-4 with a 3.70 ERA in 165 1/3 innings in 2011, a performance that enabled him to finish fourth in the AL Rookie of the Year voting. He suffered a Grade I flexor strain during the Yankees' Division Series loss to the Tigers, and while that injury healed over the winter, Nova was erratic in 2012, pitching to a 5.02 ERA in 170 1/3 innings and spending time on the disabled list due to rotator cuff tendonitis. He put up a 3.10 ERA in 139 1/3 innings last year, but spent four weeks on the DL early in the year due to a triceps strain.

With Nova out, the strong likelihood is that 26-year-old lefty Vidal Nuno will remain in the Yankees' rotation after throwing five scoreless innings in a spot start against the Rays on Sunday afternoon. His outing was necessitated by the team's rain-induced doubleheader on Wednesday, since the alternative would have been bringing back Tanaka or Pineda on three days' rest. Nuno made three starts and two relief appearances for the Yankees last year, and competed for the fifth starter job this spring, ultimately losing out to Pineda. He had made three appearances out of the bullpen since then, striking out the side in one, issuing a walk to the only batter he faced in another, then getting pounded for seven runs in 3 1/3 innings by the Orioles in his most recent one on April 8. He looked a whole lot better on Sunday, holding the Rays hitless into the fourth inning and needing just 69 pitches to get through five; relying primarily on a fastball/slider/curve combo, he netted seven swings and misses and struck out six.

If Nuno can't live up to that success going forward, the Yankees could turn to 27-year-old righty David Phelps, who made 23 starts with a 4.39 ERA for them in 2012-2013, though they may be reluctant to move him out of the late-inning role into which they placed him once he too lost out in the fifth starter derby. Adam Warren, a 26-year-old righty with three major league starts under his belt and another fifth-starter-candidate-turned-reliever, is another option on the major league roster, and the team does have 31-year-old Alfredo Aceves and 35-year-old Brian Gordon stashed in Scranton. Aceves has never made more than six major league starts in a season; last year, he was roughed up for a 4.86 ERA and 6.35 FIP in 37 innings for the Red Sox. Gordon made two starts for the Yankees in 2011, the culmination of a 15-season odyssey that began with a decade spent as a minor league outfielder before converting to the mound; he spent 2012 in Korea and 2013 with Oakland's Triple-A Sacramento affiliate before re-signing with the Yankees in December.

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