It seems inconceivable that a quarter inch decrease in the movement of the tip of the middle finger could put a pitcher's career at risk.
Yet, that is precisely what could happen to luckless Adam Miller, whose right middle finger has created a nightmare for him. And Miller's bad dream is far from over.
Unless he finds a way to pitch effectively ` that is, maintain the velocity of his fastball and command the strike zone ` with what Indians head trainer Lonnie Soloff calls ‘‘his altered anatomy,’’ Miller will be forced to undergo a risky operation that might threaten his livelihood ` even if the surgery is medically successful.
‘‘If he is unable to compensate for his altered anatomy, he is looking at the reconstruction of the long finger,’’ Soloff said Wednesday. ‘‘This is an injury that is career threatening. Right now, the idea is to try and avoid surgery of this magnitude.’’
But that might not be possible.
The long and winding road that led to a dead end for Miller last Friday began in April 2008, when the middle finger of his right hand, his pitching hand, blistered. Eventually, a fistula (kind of a hole) developed, and Baltimore surgeon Tom Graham operated to close the wound and stabilize the No. 3 pulley, a binding that holds the tendon (which runs the length of the finger) to the bone.
At the time, doctors knew that the No. 2 and No. 4 pulleys (on either side of the No. 3 pulley) had undergone some deterioration, but because of the risk of infection from the open sore, repairs could not be made. Nor would they necessarily be necessary.
‘‘The chance for infection was about 95 percent, so there was no other option,’’ Soloff said.
After the finger healed, Miller threw without pain in the fall instructional league and the Dominican Republic winter league. But he came to spring training and felt soreness in the finger early in camp. After being shut down for more than two weeks, Miller resumed a throwing program, playing catch from 60 feet then 75 feet.
During his second throwing session, last Friday, he complained that he could not bend the tip of his middle finger. Why does this matter? The middle finger is the last thing that touches the ball when it comes out of his hand and affects both velocity and his ability to control the pitch.
‘‘From 75 feet, Adam experienced some pain in his long finger that resulted in a decrease of range of motion and a decrease in strength,’’ Soloff said. ‘‘The feel of the ball also was altered.’’
Miller's scheduled throwing session Sunday was canceled, and he was examined by two hand surgeons, one a local orthopedist from Scottsdale and Graham, who had already planned to visit the Tribe's complex long before Miller's discomfort.
In the judgment of the doctors, Miller might or might not be able to get through his latest hurdle. If he can't, another surgery is mandated.
‘‘The question is whether Adam is able to compensate for his new anatomy and pitch effectively,’’ Soloff said. ‘‘He threw today, and his velocity was near normal, but he was unable to locate the ball.
‘‘He threw from 105 feet then he threw 25 pitches off a mound; he was pain free and had no symptoms.’’
Keep in mind, however, that Miller cannot bend the tip of his middle finger normally.
‘‘He lost the ability to do that March 13,’’ Soloff said.
In the next week to 10 days, Miller will throw at least three times to determine whether there is some way he can adapt his delivery and grip to the current condition of his middle finger. If not, surgery provides the only solution, but it is not a sure thing.
Soloff said a delay in undergoing the operation will nullify its effects.
‘‘If we wait too long, the chances for a successful outcome are not as high,’’ he said. ‘‘We had about a three-week window, and there's maybe 10 days left of that.’’
Graham would perform a procedure to replace the No. 2 and No. 4 pulleys with a tendon that is removed from Miller's wrist.
‘‘Pulleys are really ligaments, but they're a little more substantial than ligaments,’’ Soloff said.
Recovery time for such an operation is six to nine months. But that is not the primary issue.
‘‘A complicating factor in this kind of surgery is scar tissue,’’ Soloff said. ‘‘Because it's such a narrow space, there can be a decrease in range of motion and a decrease in strength.’’
Thus too much buildup of scar tissue could keep Miller from pitching permanently. But it is virtually impossible to predict the outcome of the operation, because this type of surgery is rare among pitchers.
‘‘There is no history, no precedent for pitching athletes,’’ Soloff said. ‘‘The tragedy is that Adam is an ultra-competitive player with great stuff, and this is hard to overcome. You can see it in his face. He can't do what he has always done.’’
Miller has been plagued with finger and elbow injuries the past two years but has remained one of the team's brightest pitching prospects, a guy whose fastball has registered 100 miles per hour on a radar gun.
No CAUSE FOR ALARM -- Travis Hafner (shoulder surgery) is batting .182 and seldom drives the ball, but manager Eric Wedge says there is no reason to worry.
‘‘Driving the ball probably will be the last part (of his swing) to come,’’ he said. ‘‘You don't want him to just try and yank pitches. He'll continue to lock in his swing. When that happens, you'll see his power. But it's not important to see it now.’’
TICKET DEAL -- For Northeast Ohio fans who have planned a trip to spring training, the Indians are offering 50 percent off the price of all outfield box and outfield reserved seats at Goodyear Ballpark, with the exception of the Saturday's game against the Los Angeles Dodgers.
Tickets can be purchased at the box office in Goodyear or on Indians.com
MARCHING ONWARD -- The Tribe travels to Maryville this afternoon to play the Milwaukee Brewers. Aaron Laffey will start against Manny Parra, with Zach Jackson, Vinny Chulk, Kirk Saarloos, Greg Aquino, Juan Salas and Jack Cassel available in the bullpen.