The conservative approach to Adam Miller's finger issues hasn't worked, so the next step probably is surgery.
Injuries have created nothing but grief for the promising Indians right-hander for more than a year. For the past two months, he has tried to learn a new grip on the ball to avoid putting pressure on his middle finger, which has two damaged pulleys (bindings that hold the ligament to the bone).
"Adam experienced pain in the finger when he threw on Monday,'' head trainer Lonnie Soloff said Friday. ""He will visit Dr. (Tom) Graham on Monday, and there will be a decision whether to use surgical options.
"When Adam increased the intensity (of his throwing), his symptoms returned. So there is a very good chance he will have surgery on Tuesday.''
Graham, a noted hand surgeon in Baltimore, has already seen Miller at least twice.
Even if the surgery is successful, Miller's career might be in jeopardy. Scar tissue inside the finger can result from this type of an operation. If so, there is no guarantee it can be removed permanently.
"The projected recovery and rehab time is six to nine months,'' Soloff said. ""But because space is limited in the finger, there is a high possibility of a secondary surgery to limit or remove the scar tissue.''
The presence of scar tissue could seriously limit the finger's range of motion and strength. And surgically removing the scar tissue might lead to the forming of more scar tissue.
Despite the hazards of the operation, Miller has come to the conclusion that it's the only chance he has to continue his career.
"Adam is the one who reached the decision,'' Soloff said. ""He gave the conservative approach his best effort. Undergoing surgery is something he's given a great deal of thought to. He feels he has to do it to return to a high level of performance.''
Miller's middle finger problems began early last year, when Graham performed surgery to prevent infection in the finger, which had developed a fistula (kind of a hole). At that time Graham knew of the current damage but was unable to operate because of the risk of infection.