Bondo may be done, and so is our cheerful, dogged optimism

illustration by Samara Pearlstein

Hey, so… rebuilding year? Rebuilding year.

The Tigers won today, but the larger story is that Jeremy Bonderman landed on the DL with a blood clot in his shoulder (!!!!) and might be done for the year. What else could go wrong with this team? Seriously. I guess when the plague of locusts descends on Detroit, you can blame me for tempting them down upon us all.

I usually do the injury thing around here, but there’s really not that much to say about Bondo’s injury, because it’s almost exactly the same thing that happened to Kenny prior to the ’07 season. I don’t believe I’ve seen anything anywhere saying that Bondo is for sure suffering from thoracic outlet syndrome, but it certainly sounds like it to me (insert usual ‘not a medical professional or anything even approaching one but I sure do have a lot of Anatomy for Artists’ books!’ disclaimer here). (ETA: Went back and read some more articles before I published this post, and thoracic outlet syndrome has been more or less confirmed.)

In case you’ve forgotten what happened with Kenny (and I’m assuming most of you have), I’ll go over it again here, as it applies to Bondo. Bondo reported a heaviness in his arm to the trainers, who rightfully assumed that this could be nothing much but had the potential to be Really Bad, so they sent him in to get examined. Turned out that he had a blood clot in his shoulder, in the axillary vein, which carries blood from the arm to the heart.

Kenny’s clot was in the axillary artery, not the vein, but the two run more or less in parallel, so this diagram will still give you an idea of where it is:

Now, a blood clot– which you can see illustrated, in a vein, up at the top of this post– can be dangerous in several ways. If it remains stationary, it can restrict or even completely cut off blood flow in the clotted vessel, which is obviously immediately bad for everything downstream. A stoppage of bloodflow can result in tissue death within the vessel itself, and in the tissues needing the blood that’s been blocked. A clot can also come loose and start moving through the bloodstream, at which point it’s an embolus and is even more dangerous, as it’ll head in the direction of bloodflow and potentially cause a blockage somewhere much worse… if you’re talking veins, you’re talking about blood flowing towards the heart.

Bondo, by all accounts, had a thrombus (a stationary clot), and not an embolus. He immediately underwent thrombolysis (i.e. they pumped him full of drugs that break up the clot) and angioplasty (i.e. he had a tiny balloon inserted into the formerly blocked vein, which was then expanded to keep the vessel open). The immediate danger ought to have passed. Still, thank cats they caught it when they did.

Now we get into the question of WHY Bondo had a blood clot in his shoulder in the first place, and that’s where the thoracic outlet syndrome comes in.

[Tigers trainer Kevin] Rand said the first rib on Bondermanís right side was ìmost likelyî the cause of the compression. If that rib needs to be removed, Bondermanís season will probably be over.

Jon Paul Morosi/Detroit Free Press article

As you may or may not recall (we did go over all of this with Kenny, alas), the thoracic outlet is the space between your collarbone and first rib and bony shoulder, through which a number of nerves and your axillary/subclavian artery and vein run. It’s the space within the circle in this diagram:

You can see the blood vessels running right through it, and I’m sure you can, from that image, work out how the vessels would be compressed if the thoracic outlet was to shrink. This can happen in a couple of ways. Poor muscle tone can lead to a kind of slumping of the collar bone, which compresses the space, for instance. It can also be a bone problem, where the first rib is too close up, or has been forced that way by repeated motion, such as the motion a pitcher makes repeating lifting his arms over his head. Some people also have an extra little riblet up there, which necessarily shrinks the available space in the thoracic outlet.

Kevin Rand seems to think that Bondo’s first rib (the little rib all up in the business of the circle in the diagram) is causing a compression of his thoracic outlet, and it’ll have to come out. If all goes well with the surgery, this is not going to devastate him as a person or even as a pitcher; Kenny had his first battle with thoracic outlet syndrome as a Ranger in 2001, and had his top rib removed at that time. He pitched 210 innings the next season.

So it could definitely be worse, but still is not anything like good. For those of you wondering why Bondo might be out for the rest of the season if Kenny was only out 3 months last year, remember that Kenny was already years removed from the loss of his rib, and was only recovering from artery repairs. They may have caught Bondo’s clot early enough to keep him from needing the kind of extensive blood vessel repair that Kenny needed (and it sounds like they did), and it’s possible to come back pretty quickly from a simple blood clot without vessel damage (Tom Glavine did it in something like 10 days in 2006), but Bondo will have to recover from the rib surgery.

It’s possible that the rib is NOT the cause of Bondo’s shoulder woe, and that it’s just a matter of fixing muscular problems in the area, which would be loads easier, because that would involve getting inflammation down (anti-inflammatory drugs and cortisone shots, I reckon) and doing stretching and other non-surgical things. If this turns out to be the case, he might not be gone for the whole year.

(Of course, just to be paranoid, I’ll point out that it could be some aspect of his pitching motion that caused the inflammation/problematic muscle growth/repetitive motion that compressed his thoracic outlet. If that’s the case, any course of treatment would have to include a change to his pitching motion, which would take loads longer for him to get accustomed to in any useful way.)

It’s not like he was a lights-out ace of the staff before the shoulder shenanigans, but in any event this still throws a serious damper on the season. Pitching was already our weakest point (very closely tailed by an inability to hit at useful times), and this only makes it weaker. The Renteria deal is not looking super hot right now; imagine if we’d had Jurrjens available to slot into this mess of a rotation. I’m not saying it was a terrible deal at the time (the abject and collective failure of the starters, the injuries to everyone, the anemia of Edgah’s bat… none of that had seemed anything like inevitable), but it looks real unpleasant for the Tigers at this moment.

What can you do? This is clearly not our year. Maybe something will happen at the All Star Break, and Fernando/Zoom are on their way back, but it doesn’t seem like any one thing will be enough. Sigh.

Oh, and if ANYONE suggests that we pick up Sidney Ponson, I will e-punch them in the face.

7 responses to “Bondo may be done, and so is our cheerful, dogged optimism

  1. […] the pure medical side of Jeremy Bonderman’s thoratic outlet compression syndrome, but then I saw what Samara had done over at Roar of the Tigers and knew I couldn’t come close to what she put […]

  2. I completely agree about Ponson.
    Where are the diagrams of Guillen’s injury?

  3. ivantopumpyouup

    Sidney Ponson will punch them in the face for you.
    Thanks for the diagrams. I feel 2.34% smarter after having read this post.

  4. pitching is hard. we are cursed. im fully prepared for locusts.

  5. I don’t think any of you really want to see diagrams of Guillen’s, er, injury.
    Roar of the Tigers: slowly improving the minds of readers, and then immediately destroying them again with stupid photoshops.

  6. hey, im 15 and had this exact same thing happen to me. i had the rib surgery about 15 days ago, and the clot removal surgery about 20 days ago. they had to remove the clot in my pitching arm 3 times because it kept coming back before they figured out it was the rib. im out for 6-8months. so man i feel his pain,

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