Murti: Cashman Explains How Luis Severino Got To Tommy John Surgery


When the Yankees announced Tuesday that Luis Severino will need Tommy John surgery and will miss the entire 2020 season, the biggest question for me was this: what test did he have this time that revealed the torn elbow ligament that didn’t show up in the first two MRIs and the CT scan?

“Obviously, in the prior tests were multiple normal MRIs,” Brian Cashman said. “This time he went (to New York) and did a nerve conductor test which was negative, a CT scan which was negative, and a dye contrast MRI, or otherwise known as an MRI arthrogram. And that result was obviously the finding of a partially torn ulnar collateral ligament.”

Severino initially complained of forearm soreness after Game 3 of the ALCS against Houston last October, but the symptoms subsided and he was scheduled to pitch Game 7 if the series had been extended that far, which it obviously was not.

When Severino complained of soreness again in December after he started throwing again, only feeling it on changeups Severino said, the pitcher initially didn’t even want to go to New York for tests because he didn’t think it was serious. But he eventually relented and the Yankees did the first MRI which came back clean. 

The Yankees' Luis Severino pitches in the first inning in Game 3 of the ALDS against the Boston Red Sox on Oct. 8, 2018, at Yankee Stadium. USA TODAY Images

Severino began to throw again in January when the same soreness—he didn’t use the word pain—came back and another round of testing with a second MRI and a CT scan still revealed nothing. And Severino was still pointing to an area of soreness that wasn’t close to the elbow ligament.

When he met with reporters last Thursday, Severino still was not worried about the problem being his elbow or either of the injuries that shelved him almost all of last season.

“(I) just worry about that spot right there (forearm) because my elbow, shoulder, and my whole lat feels pretty good,” Severino said, confidently explaining how he was throwing good hard fastballs in his sessions to that point.

So how did they get all the way from that minor soreness in October to Tommy John in February? 

“My gut is that it’s something that obviously dates back to when he started feeling something (last October),” Cashman said. “In terms of the declaration of the injury with the physical testing, upon MRIs and where his complaints were, it didn’t reveal itself.  But now, as of yesterday in New York, with both doctors (Dr. Chris Ahmad and Dr. David Altcheck) for the first time the physical testing points to the area on the MRI arthrogram that shows a problem. The prior MRIs had no problem, and the point of injury was not around the ligament. So, our athletic trainers, our physical therapists and the orthopedics that evaluated him both in Tampa and New York could not produce anything that would typically give concern of a ligament issue in any way, shape, or form.”

“But yesterday was the first time that those repeated physical testings showed he was getting response, unfortunately a positive, like ‘yes it hurts right here’ which then mapped where that MRI arthrogram showed a partial tear. So, the conclusion with the physical and the MRI arthrogram, the conclusion is Tommy John.”