Where there is smoke, there is fire.
It is important to note that he has had related injuries in the past. Sheets had his 2007 season cut short after tearing tissue surrounding a tendon in his middle finger (the A4 pulley, which controls and restrains tendon motion). He was sent to the DL in July and missed a course of 40 games with the injury. Interestingly enough, the middle finger tendons course up the forearm (where it’s muscle belly resides) and originates at the medial elbow - the site of his upcoming surgery. Basically, excessive force through the tendon equals more force through the pulley.
While rest sometimes helps tendon tear injuries, rarely does it fully fix the problem. An MRI taken in late September 2008 showed a tear in a muscle at the medial elbow - reportedly not to a tendon. Muscle does heal much more readily than tendons do, so if this was the information they were working with, it would have been feasible to think that rest and rehabilitation could help. Could it be that the MRI was wrong? Sure it could - and it probably was - especially in light of what we know now. He will be out at least the next 4 months for sure (prior to starting his pitching program).
He will have to be immobilized postoperatively with a cast initially, only to be soon transitioned into a splint. At about 3 weeks post-op, he will likely be allowed some form of active movement of the hand and fingers while in the splint. The next step will be removing the splint and gradually increasing active motion over the next few weeks. Typically, splint use is discontinued at around week 5-6, as this is when the tendon remodeling begins (and hence scar tissue formation). It can, however, be common for the splint to be worn longer if needed.
Strengthening of the wrist, fingers and elbow usually starts around week 8 post-op, and continues over the next few months. Most all of the tendon healing should be complete by 3 to 4 months post-op. Then there’s the thing called pitching. This takes time to work back into game shape, allowing the elbow time to respond to the valgus force that caused the problem to begin with. Dr. Andrews’ throwing program protocol (for example) can have as many as 30 steps - each of which is typically is performed twice, without pain, prior to progressing to the next step (this is usually followed strictly, but there are probably instances in which it is modified depending how the player is progressing). Between each throwing day, there is a day of rest. So you can see how this process will take a few months. Following simulated games, he would then need to throw live innings.
With what we know now, it is likely that he will be out for the entire ‘09 season. If he somehow manages to progress ahead of schedule to return around August, it would likely be in a relief role. For fantasy purposes, it is obviously a situation where you can safely cross him off your draft lists.
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