Indians duo struck by rare middle finger sprain

CLEVELAND -- Of all the dangers that come with pitching, a sprain to the middle finger on one's throwing hand is not high on the list of concerns. It is an injury that rarely presents itself, which is why so many were both surprised and confused when two pitchers on the same staff were shelved because of it during the same season.

For about seven weeks between June and July, the Indians were forced to replace Zach McAllister in the starting rotation because the right-hander had sprained the middle finger on his throwing hand. Two weeks after McAllister's return, the Tribe placed fellow righty starter Corey Kluber on the disabled list with the unusual injury.

"Whereas it's not the most common of pitcher injuries," Indians head athletic trainer Lonnie Soloff said, "it's not completely uncommon either."

Finger sprains are much more likely to happen in an activity such as rock climbing than in baseball -- where ailing shoulders and elbows are most widespread among pitchers -- but the Indians have seen firsthand that they do occur, and they can be dangerous. The specific problem for both McAllister and Kluber correlated with the middle finger's pulley system, which allows the appendage to bend.

This season's middle finger sprains called to mind those of former Indians pitching prospects Alex White and Adam Miller, a pair of first-round Draft picks from 2009 and '03, respectively, whose disappointing careers were hampered by similar injuries. The Indians hope McAllister's sprain is firmly behind him, with Kluber soon to follow suit.

"We're exploring every variable to see if we can find anything that would predispose them to the injury," said Soloff, who is in his 10th season as the head of Cleveland's training staff. "But as it stands right now, there's nothing in the literature that would suggest that there's a variable that would predispose a pitcher to the injury."

In the cases of McAllister and Kluber, discomfort in the middle finger was primarily a result of throwing a curveball.

"It's just bad luck," Kluber said. "I would say most guys that throw a curveball probably throw it the same way. It's just a coincidence. Something really rare just happened to happen to two guys on the same team in a matter of a couple months."

Kluber sensed something wrong on his 99th of 105 pitches against Detroit on Aug. 5, when he threw an 0-1 breaking ball to leadoff hitter Jose Iglesias in the eighth inning. After Iglesias went on to ground out, Kluber allowed a single to Ramon Santiago, and his outing ended at 7 1/3 innings.

When Kluber woke up the next day, his finger felt jammed. An MRI was ordered, a sprain was diagnosed and he was placed on the 15-day DL. Shortly after, the Indians announced that Kluber was expected to miss four to six weeks, which means he'll likely return to game action sometime in early-to-mid September.

"They basically said, just, 'It can happen,'" Kluber said. "Nothing necessarily caused it. There's all those little intricate parts in the finger. It just happened."

Kluber's loss was difficult to bear for Cleveland because of how well the 27-year-old has pitched this season. After starting the year at Triple-A Columbus, Kluber was recalled on April 10, optioned down two days later and recalled for good on April 17. In 21 games (19 starts), Kluber has gone 7-5 with a 3.54 ERA. Over 16 outings before his trip to the disabled list on Aug. 6, Kluber had a 5-3 record and a 3.07 ERA.

"[Kluber has] always had well-above-average stuff," Cleveland general manager Chris Antonetti said. "I think we've just seen the maturation of a pitcher who's worked very hard to put himself in this position."

Kluber's symptoms have resolved to the point where he's allowed to throw again. On Tuesday, Kluber played catch from 60 feet while wearing tape over his right middle finger. According to Tribe manager Terry Francona, Kluber will throw from distances of 60, 90 and 100 feet with the tape and then repeat the process without that protection before resuming mound workouts.

That progression is similar to the one McAllister followed in his comeback.

Kluber's sprain is thought to be less severe than that of McAllister, who first felt something in a May 28 start in Cincinnati. The Indians monitored McAllister and sent him to see Dr. Thomas Graham, one of the top hand specialists in the country. Graham works at Cleveland Clinic and oversees all of the Tribe's significant hand or wrist injuries.

McAllister, while still not feeling 100-percent confident about throwing his breaking ball, pitched on June 2 against Tampa Bay.

The 25-year-old McAllister entered that outing riding a streak of 12 straight starts with at least five innings logged and no more than three earned runs allowed. That impressive stretch came to an end when the Rays tagged him for five runs (four earned) in 4 1/3 innings, taking advantage of the fact that the right-hander avoided curveballs altogether.

Cleveland then placed McAllister on the disabled list on June 8, retroactive to June 3.

Across 11 starts before the DL stint, McAllister was 4-5 with a 3.43 ERA. In five appearances since, he has gone 1-2 with a 4.56 ERA. McAllister said one of the most challenging hurdles in his recovery process pertained to believing in his curveball again.

"It's something that early on you really don't, at least for me, I didn't want to throw it at all," McAllister said. "That rest was definitely much-needed. When it came time for the curveball, it's something that you just got to know that … [it] had healed it up and you're ready to go. And once that process is done, it's time to see what happens.

"If you have any doubt in your mind, you're going to not be able to pitch the way that you want or execute that pitch the way that you want."

When pitchers are young, they are generally told to wait to begin throwing curveballs until they reach 14 or 15. It's a pitch often associated with injury -- but to elbows, not fingers. The fact that two Indians starters each sustained a sprain to the middle finger of their throwing hand -- with curveballs being the most challenging pitch to throw in both cases -- has some wondering if Cleveland's pitchers are utilizing an unpopular or little-known grip.

Francona, in his first season with the club, seemed to think the occurrence was as strange as everybody else.

"Yes, it is," Francona said. "Believe me, we've asked. Everybody in the clubhouse has probably asked the same question you have. It's poor luck of the draw. We're not teaching them any delivery that is putting them in danger. It just happened."

Antonetti said the club's research indicated that Major League Baseball averages about 12-15 cases of similar finger injuries each season, meaning each organization would experience one instance every two years on average. According to Soloff, Graham alone sees about 12 cases per year.

"We happen to have two in one year," Antonetti said, "which is a little bit above average, but not completely out of the norm."

Kluber is somewhat lucky in that he has McAllister's experiences upon which to draw.

When McAllister's finger sprain put him on the shelf, there were no teammates in Cleveland's clubhouse who had suffered similar setbacks. So, Soloff reached out to former Indians pitcher Jake Westbrook, a member of the same St. Louis rotation as Adam Wainwright, who missed time in 2008 with his own finger sprain. Westbrook helped McAllister get in touch with Wainwright.

"Wainwright was kind enough to let me talk to him for a little bit," McAllister said. "To me, that was really nice -- to be able to do that and get some info from it. Because, like I said, it's an injury you don't hear [about] too often. But when you're able to talk to other guys about it, it kind of gets a little bit more reassuring that you're going to be OK."

Five years ago, Wainwright tweaked his middle finger on a curveball during a bullpen session in Houston. He still started the game, and with every new inning, the pain got worse. In the sixth, Wainwright felt a snap in his finger, which then went numb. When his next pitch, a fastball, reached the backstop, Wainwright knew it was time to come out.

"More guys have had it than you think," Wainwright said. "There's been several guys that have had that injury and several guys have called me about it. The one thing I tell them is, 'Trust the process. You'll come back strong, come back and everything will be as it was.'

"It's just a freak injury that happens on guys who throw a certain way or throw a curveball or whatever it is. It can happen to anyone, really. But it's something that I haven't even felt at all or dealt with since that situation, so luckily it helped and healed right. It looks like Zach's pitching great again."

If McAllister continues to perform without pain and Kluber returns to do the same, the Indians will have secured a best-case scenario, given the circumstances. Within the past seven years, however, decidedly less fortunate outcomes fell on Miller and White.

While pitching for the Indians in 2011, White felt a pop during an outing and went on the disabled list with right middle finger soreness in May. He didn't make another appearance until August, by which time Cleveland had dealt him to Colorado as part of a prospect package for righty Ubaldo Jimenez. In December, the Rockies traded White to the Astros. And in April, he underwent Tommy John elbow surgery.

But at least White is still part of a Major League organization.

Miller's finger ordeal began in 2007, when he twice injured the middle digit on his throwing hand. At first, he thought it was nothing. When it hurt, he and the Indians took care of it. When it felt fine again, he pitched. In all, as the finger continued to deteriorate, Miller would undergo four surgeries on the finger, which now contains ligaments taken from his left wrist and left calf.

Adam Miller was drafted No. 31 overall in 2003. (MiLB.com)

The Indians cut ties with Miller following the 2011 season. He spent the next year as a member of the Yankees' organization, but currently pitches for the Sugar Land Skeeters, the same independent club in Texas that Tribe left-hander Scott Kazmir played for in 2012.

"The first one I had wasn't that bad," Miller said. "The only time I ever felt it was throwing. I could pick up a ball and be fine. But when it was time to release it, I would feel it. It was just like one sharp pain in that one area, not like the whole finger. Just one area, one specific area. And obviously, it led to worse."

The pain in Miller's finger was such that, when acting up, it prevented him from ever getting to curveballs. Fastballs were as challenging for him as breaking pitches were for McAllister and are for Kluber. Through it all, Miller never found out exactly what it is about him that made his right middle finger more vulnerable than those of other pitchers. His only regret from the process is that he didn't spend more time off following the first surgery.

"[Miller's] injury was a little more involved than a finger sprain," Soloff said. "[It was] a very uncommon scenario and outcome."

Like Miller, the Indians are left with more questions than answers when it comes to these middle finger sprains. Until the organization figures out what causes pitchers to sustain them, it cannot determine precisely how best to prevent them. Maybe it's simply a matter of overuse, a culminating effect from countless pitches that have left a player's hand.

The Indians don't know for sure.

Either way, Cleveland knows that such injuries are not something that ought to be taken lightly. That's why the Tribe had McAllister take his time, and that's why the club will act with similar caution with Kluber.

Perhaps more than any other team, the Indians are fully aware of how detrimental a middle finger sprain can be for a pitcher.

"I think the positive thing," Soloff said, "is that the lion's share of the pitchers who sustain this injury around the league, they return to competition and they return to their prior level of performance. While there's no question it's unfortunate for any pitcher to miss time, the good news is that with some patience and a well-defined rehab program, these guys do come back and perform."