What to know about Bryce Harper’s elbow injury: Treatment, surgery outlook and can hitting make it worse?

LOS ANGELES — When Phillies manager Joe Girardi announced that Bryce Harper had a small tear in the ulnar collateral ligament of his right elbow and would be receiving a platelet-rich plasma (PRP) injection to treat it, he emphasized that there would be a wait-and-see element to this process.

Harper has never dealt with an elbow injury before, let alone received a PRP injection. This is new territory for him, and how his body will respond to the treatment remains to be seen.

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Harper received his PRP injection from the Kerlan-Jobe Institute on Sunday morning in Los Angeles. He was in the Phillies clubhouse Sunday evening, and said the injection went well and he felt good, albeit a little sore. Harper will not throw for four weeks, at least, so we won’t know immediately how effective the PRP injection is, and whether surgery will be required.

While we wait for answers, The Inquirer consulted two experts — Dr. Orr Limpisvasti, an orthopedic surgeon at the Kerlan-Jobe Institute in Los Angeles, and Dr. John Kelly, an orthopedic surgeon at Penn Medicine — about what we can expect to see as Harper navigates his injury this season. Neither doctor has treated Harper and they spoke in general terms about this type of injury.

Both doctors believe that if Harper feels no pain while hitting, he should be fine.

“The fact that it’s the opposite arm is the big thing,” Limpisvasti said. “There are lots of UCL injuries that we’ve seen where if you’re injured, then not only can you not throw, but it hurts when you’re hitting as well. But because it’s his opposite arm, it’s arguable that he could hit indefinitely on that side, hitting left, and not have even a functioning UCL.”

Opinions vary on this one. Kelly said because Harper is not a pitcher, there is a “great likelihood that he will avoid surgery.” Limpisvasti said it depends on the severity of his injury.

“It comes down to the complexion of the actual tear,” Limpisvasti said. “How much is chronic and how much is new, and is it at the top of the ligament, the bottom of the ligament? The fact that he’s an outfielder, yeah, he’s going to have huge loads on his arm, but not like a pitcher or a catcher.

“The experience and the research, even in the major leagues, for PRP for UCL injuries is super variable. You’ll see guys who say, ‘Oh, yeah, I did totally fine.’ But then there are also studies showing that with a partial UCL, you can actually get back without PRP, just from giving it time to heal, and rehabbing it appropriately for an adequate amount of time. So your guess is as good as mine.

“I would say that the odds of him continuing to hit through the season, feeling great at DH, are fantastic. But if you’ve got a guy signed for many, many, many years, a fielder’s got to do some other things to be as meaningful as you otherwise would, then that’s going to leave way bigger question marks.”

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Yes, but it depends on the severity of the tear and the quality of Harper’s tissue. This would require surgery, but would lead to a far shorter recovery period than Tommy John surgery, which involves reconstructing the UCL by transplanting a tendon.

Phillies first baseman Rhys Hoskins had an internal brace put in his throwing arm in October of 2020. His situation isn’t the same as Harper’s — Harper injured his arm while throwing, and Hoskins injured his when a runner ran into him while he reached for a wide throw — but it could be an option for Harper that would allow him to miss less time. Or Harper could even wait until the end of the season, and have the brace put in then (more on that below).

“We talked about it a little bit [Saturday],” Hoskins said. “He was just asking about timeline stuff, and my perspective on it. I didn’t miss a ton of time, and it didn’t affect me next season. From the time of surgery to back in the game was about five months. I was swinging probably 10-11 weeks after surgery. So, I guess when compared to Tommy John, it’s relatively short. But it was something I got taken care of in the offseason and hasn’t been an issue since.”

“Tommy John should be last resort in a non-pitcher,” Kelly said. “Rehab, injections of PRP and a brace while batting will be the fastest path to recovery. If surgery becomes necessary, an internal brace [synthetic ligament] will afford a faster recovery than Tommy John.”

Said Limpisvasti: “I guess one way to look at it is that it’s a solvable problem. You can still hit, and if the PRP rehab doesn’t work, then you do Tommy John and the success rates are really high. I think if we’re sitting here in May, and you’re talking about PRP now, then you’re usually four to six weeks of letting the PRP do its thing. Let it start to heal, and work a little better, and then you start a throwing progression. And sometime along the throwing progression, you’ll have a sense of whether it’s working or not, because that usually progresses over weeks as well.

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“Some players do a PRP and the second they pick up the ball, and they’re out 40 feet on the line, they can’t do it. Others can progress and all of a sudden they’re at 120 feet and they’re pretty good, but they still don’t feel quite right. Their velocity drops, their accuracy changes, something changes in their abilities or they have some sort of a ceiling on their throwing, and so then that may be another fork in the road as well.

“It all depends on the quality of the tissue. Let’s just say the whole ligament looks great and it’s torn right off the top or right off the bottom. Then in that case, you could get away with not replacing the whole thing, which would be maybe a shorter timeline for the recovery. But if the tissue itself is very attenuated, there’s a lot of chronic wear, then clearly just repairing that doesn’t make a lot of sense.”

“Yeah, I think that’s a very reasonable and commonly used avenue, especially if there’s something else they can do to stay meaningful,” Limpisvasti said. “If you weren’t able to hit, you don’t want to prolong his convalescence and his time out of the lineup. It may not be what he’s accustomed to doing, but if it’s really meaningful for the team, he and the team would have to decide. It would come down to, ‘I can’t throw, the PRP didn’t work, but I’m just going to get through the season.’ But then you have to think about the downtime, because if he needs Tommy John, that can take quite a while to heal. It varies, but it’s north of a year.”

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It shouldn’t because Harper bats left and the injury was to his right arm.