On the afternoon of March 31, just more than 24 hours before the start of the most anticipated season in San Diego Padres history, Fernando Tatis Jr. was asked about his goals for 2021, a year when many wondered if he might solidify himself as the predominant face of his sport. Tatis, 22, provided a basic answer -- that he simply hoped to remain healthy enough to play an entire six-month regular season, a feat that had previously eluded him.
"If that happens," Tatis said in Spanish, "I know good things are going to happen."
Five days later, in the bottom of the third inning in Petco Park, Tatis swung violently through an Anthony DeSclafani breaking ball and crumpled to the dirt, remaining on the ground for 35 seconds before being helped to his feet. The head of the humerus in Tatis' left shoulder had slid far enough out of its position in the socket to stress the adjacent soft tissues, causing an excruciating pain that forced Tatis to exit immediately. The Padres diagnosed him with a shoulder subluxation, which is when the shoulder essentially slips out of position but doesn't fully dislocate. It was the third reported incident with that shoulder in a 23-day span.
The following day, Padres GM A.J. Preller provided an update so optimistic it triggered skepticism from people within the medical community and throughout Major League Baseball. Preller called the MRI "uneventful," reported that Tatis had regained full range of motion, stated he would rehab his way through the ailment and volunteered the possibility that Tatis could return to the lineup once his 10-day stint on the injured list expired, which coincides with the opening game in a budding rivalry with the Los Angeles Dodgers.
That day has arrived, and Tatis is expected to return, but two critical questions beckon:
Can he prevent this from happening again?
Can he manage it without changing the essence of what makes him great?
The Padres have spent some of these last 10 days talking with Tatis about the high-risk moments within a game that might leave his shoulder vulnerable and working with him on ways to at least minimize them, if not altogether avoid them. It's a difficult balance to strike, particularly for a young man who plays with such noticeable aggression on the bases and in the field. Padres manager Jayce Tingler admitted it's "a fine line."
"Look, things are gonna happen in the game because it's game speed and he's just a natural at a lot of things," Tingler said. "So I think the main thing is: Can we put some focus in some of the practice work and try to minimize that? He's a really quick learner, he's super sharp, ton of baseball IQ. The more he practices that, guys like that, they can usually quickly transition their work into the game. Those are some of the things we've been talking about. He's been doing great."
Tatis jarred his left shoulder on a headfirst slide into home plate on March 13 and returned to the lineup five days later. On March 23, he felt that shoulder pinch while backhanding a grounder and returned to the lineup two days after that. He was asked how long that shoulder had been causing problems when he addressed the media before Opening Day and chuckled.
"Since rookie ball," Tatis estimated.
Through the Padres' first four regular-season games, Tatis amassed only three hits in 16 at-bats, striking out six times and committing five errors -- two more than his total in 437 1/3 more innings in 2020. Scouts who watched him closely believe Tatis was favoring that left shoulder, worried that it might slide out of its socket once again, which made him tentative while swinging and throwing. Two scouts who watched the Padres' opening series against the Arizona Diamondbacks came away thinking the shoulder woes from spring training were affecting Tatis both physically and mentally.
The Padres hope that 10 days off will be enough to not only strengthen the area, but also restore some confidence.
"I think the first time [a subluxation is diagnosed], everyone would agree that the right thing to do is shut him down, let things settle down, rehab him, build up his rotator cuff a little bit, and let him go back to swinging a bat to see how it feels, let him go back to throwing and see how it feels, and try to nurse him back off the injured list," said Dr. Alan Beyer, an orthopedic surgeon in Orange County, California, who has practiced in the field for 40 years. "If that fails, he's looking at having the shoulder stabilized. If it fails soon, in a month or six weeks, he's gonna have to have it fixed this season, and basically the season is over. If he has surgery, the season is over."
The recovery time for that surgery, Beyer said, is four to six months. It's typically an effective long-term fix, but Preller doesn't believe it's an inevitability. He pointed to the relatively large variance of the ailment, which was evidenced by the 2019 season.
That year, Dodgers outfielder Cody Bellinger, Minnesota Twins outfielder Byron Buxton and Kansas City Royals infielder Adalberto Mondesi all suffered what was described as either a subluxation or a dislocated shoulder. Mondesi and Buxton spent a few weeks rehabbing it, returned briefly and ultimately opted for surgery. Bellinger popped his shoulder out on a diving attempt in early May, but he popped it back into place, played the rest of the 2019 season -- becoming the National League MVP in the process -- and played through another dislocated shoulder in the 2020 World Series, finally opting for surgery thereafter.
"We're hoping we can control it and contain it so this doesn't become a regular issue for him and in the future," Preller said of Tatis. "And if it does, and it's something that's becoming more regular, that's when you go the surgical route and try to fix it that way so we put it behind us and can put him on the field regularly."
A subluxation is more common in pitchers, but also in loose-bodied position players with more laxity in their joints, like Tatis.
The shoulder is a ball-and-socket joint like the hip, except more shallow and less stable for added range of motion. The labrum, a cartilage cap that surrounds the cup of the shoulder, is responsible for maintaining stability. Tatis' most recent MRI revealed a partial labral tear that was consistent with a subluxation and, according to Preller, not much different from the tear revealed during the physical exam for Tatis' 14-year, $340 million extension.
But the labrum doesn't get adequate blood supply to heal itself. The rehab program to strengthen it consists of dynamic stabilization exercises which aim to work the small musculature that controls the shoulder and superimpose more effective neuromuscular control. ESPN injury analyst Stephania Bell believes rehabbing the injury is "a reasonable approach" but said the typical strengthening program lasts four to six weeks -- not 10 days.
"If you're really working on neuromuscular retraining and trying to get someone to a point where you're changing something that's been happening for multiple years, I would say that 10 days is optimistic," said Bell, a licensed physical therapist, board-certified orthopedic clinical specialist emeritus and certified strength and conditioning specialist.
Asked if Tatis can effectively manage the issue all season, Bell said: "I hope for his sake that that's the case, but I wouldn't say I have a high level of confidence that that will be the case."
Bell cited the repeated shoulder issues in a short span, each seemingly more serious than the other, and the in-game adrenaline that can't be duplicated in the controlled setting of rehab. But she also cautioned that she hasn't seen the MRI -- reviewed by Drs. Catherine Robertson and Bryan Leek of UC San Diego -- and that the Padres are basing their decision off a much deeper understanding of Tatis' medical history. There's also the element of Tatis being young enough and athletic enough to tilt the odds in his favor.
Tatis batted .301/.374/.582 with 39 home runs, 27 stolen bases and eight triples in his first 143 games from 2019 to 2020, compiling 6.5 FanGraphs wins above replacement. Before the 2021 season began, he had already secured major marketing deals with Gatorade and Adidas, graced the cover of MLB The Show and obtained the third-largest contract in history. Major League Baseball had clearly identified him as its most marketable athlete, largely because of his brash, exhilarating style of play.
Prior to his most recent shoulder injury, Tatis was asked if he had thought about tempering his aggressive approach so as to preserve himself long term.
"No, of course not," he said in Spanish. "Changing the way I play has never crossed my mind. It's something that's inside me, something that runs through me."
But Preller is hoping that a few adjustments can help, like holding the bat with two hands a little longer, staying on his feet a bit more often on defense and being more judicious with the headfirst slide while running the bases. They might seem minor, but they're typically difficult to pull off in real time. And often there's concern that similar adjustments, particularly with the follow-through on a swing, can mess with a player's mechanics.
"Part of it is style of play," Preller said, "part of it is just things he has to do from a positioning standpoint with his body to make sure that he's putting himself in the best position possible to stay on the field."
Preller worked frantically over the offseason to lengthen the Padres' rotation and deepen their position-player group, but the Padres have little to no chance of dethroning the mighty Dodgers in the NL West without Tatis. Given the strength of the NL East, they might struggle to even capture a wild-card spot in that scenario. It's why Tatis seems so determined to play through this -- to, at worst, delay surgery until the Padres' season ends, whenever that is.
Preller is adamant that Tatis won't cause further long-term damage to his shoulder by continuing to play through it. The thought, then, is to at least give him a chance this season.
The question is: Will it work?