Injury Breakdown: Jose Bautista's Unstable Tendon; Surgery A Smart Move

By Abby Sims
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Jose Bautista, the 31-year-old hard-hitting Toronto Blue Jays outfielder, faces season-ending surgery to stabilize a tendon in in his left wrist. Bautista suffered the wrist injury on July 16, and though he tried to come back on August 24, returned to the DL the following day, noting that instability of the tendon rather than pain was the overriding factor influencing his decision to undergo the procedure.

Tendons attach muscle to bone. Though I was not able to locate a report that specified the tendon involved, I'll take a guess that it might be the extensor carpi ulnaris (ECU) tendon, which rests on the pinky side of the hand and attaches at the base of the long bone leading to the pinky (the fifth metacarpal). This tendon rests in a tunnel formed by the contours of the bone below and is generally held in place by fibrous tissue (known as a retinaculum) as well as by a ligament that lies above it. The tendon is also encased in a sheath. The ECU muscle moves the hand toward the pinky (adducts), as well as assists with wrist extension. Whether it is Bautista's ECU or another tendon that is involved, an unstable tendon can lead to other problems that can become debilitating chronic issues if left untreated.

The NY Times reported that Bautista opted for surgery after conferring with Sam Fuld, the Tampa Bay Rays outfielder who'd had a similar diagnosis and ultimately required surgery despite a more prolonged period of rehab.

What happens when an unstable tendon is left untreated?

A tendon that is unstable is, by definition, excessively mobile. By sliding over the bony prominences, the tendon sheath can become inflamed (tenosynovitis), as can the tendon itself (tendinitis). A dislocation of the tendon (which may have been the initial insult) can rupture the fibrous retinaculum that helps to secure it. If this is the case, the tendon may exhibit a snapping in and out of its normal position with movement of the wrist.

If left untreated, an unstable tendon is likely to deteriorate from repetitive stress and exhibit wear and tear (tendinosis), An unstable tendon may also lead to other issues because of its inability to act as intended to control movement or assist with stabilizing other structures, such as the lower joint between the two bones of the forearm  -- the radius and ulna -- in the case of the ECU.

Conservative management, like that tried by Fuld, generally entails immobilization followed by rehab to restore joint mobility and muscle strength at the wrist, hand and forearm. Bautista's post-operative rehab will emphasize these areas as well, but opting for surgery sooner rather than later all but ensures he'll have a complete recovery for 2013.

Smart move.

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