Grade 2 teres major strain sounds like something Ferris Bueller would diagnose himself with to get out of class and galavant around Chicago on a spring day. Alas, this happens to be the injury Joe Ryan suffered against the Chicago Cubs on August 7.
The Twins placed Ryan on the injured list on August 9 after an MRI showed damage to his right shoulder. Initial reports after the MRI were far-ranging, stating that Ryan could be out for only weeks, unavailable for the rest of the season, and perhaps even missing time in the playoffs.
To understand Ryan’s injury, we must answer three questions: What is a teres major? What does Grade 2 strain mean? And what does this mean for Twins and Ryan?
The teres major is a small muscle that attaches at the scapula (shoulder blade) to the top of the humerus (upper arm bone). The muscle is relatively small but facilitates almost all shoulder movement. Specifically, it helps with shoulder rotation and lifting of the upper arm. Needless to say, the muscle is imperative for an MLB player, let alone a pitcher.
Injuries typically occur from repeated stretching or use of the muscle, and they often get worse as people use the muscle. To use an analogy, think about folding a piece of paper longwise (hotdog style) and then unfolding it before folding it and unfolding it repeatedly. Eventually, the paper will get a visible crease, the edges may begin to tear, and the paper will eventually rip apart due to repeated folding. The same is generally true with muscles. The more a player uses them, the more damage they incur. Once a muscle begins to tear, it’s too late. Every movement puts more stress on a damaged muscle.
After a player injures the teres major, more activity will likely further injure it. Pain is typically the main symptom of this injury. There is usually a sharp, immediate pain at the time of injury, followed by a dull pain for weeks to months that intensifies with movement or lifting.
That leads to the second question: What is a strain? Contrary to popular belief, anything above a Grade 1 strain is a tear. The number associated with the strain reflects the extent of the tear. Grade 1 is overstretching of the muscle, but not a muscle tear. Think back to the folded paper; a Grade 1 would be the visible crease. Grade 2 is a minor tear of the muscle fibers or the beginning of the tears along the crease of the paper. Grade 3 is the complete tear of a muscle, or the folded paper is in half. Below is a diagram explaining the different grades in hamstring tears that can be used to visualize the differences in grades.
The frustrating part about Grade 2 strains is that they can be anything from a minor muscle tear to an almost complete tear. That’s often part of the problem with recoveries and why there is such a wide variety of timeframes for the injury. A smaller tear could theoretically heal in weeks. Meanwhile, a major tear can linger and last months even if it isn’t completely through the muscle.
The Grade 2 injury is more frustrating because it rarely needs surgery. Physical therapy and rest are the best ways to promote muscle healing. Since everyone heals differently, this adds further ambiguity to the timeframe for recovery. Some athletes heal faster than others, which is why the range of weeks to months is often used and why one athlete could return from a strain significantly faster than another with the same injury.
Unfortunately, Ryan will have to take a page out of Ferris Beullers’ book and spend time resting over the next weeks to months. There’s likely no real timetable for when he will be back in action for the Twins. Hopefully, luck will favor Minnesota, and Ryan will be back anchoring the rotation for a postseason run.