What’s next for Shohei Ohtani and the Angels after his torn UCL?

Shohei Ohtani has an ulnar collateral ligament tear and cannot pitch for the rest of the season.

The latest news was as crushing an on-field blow to The Angels as they have had. And shocking for the baseball world, which has grown accustomed to the superhuman abilities of the two-way star.

What is next for Ohtani and the Angels? Here are answers to some questions fans might have:

What is the ulnar collateral ligament (UCL)?

The UCL is the ligament on the inside of your elbow that provides stability to it and restricts the movement of the arm from going too far to the side when throwing.

How do players injure their UCL?

“In baseball and overhead sports, in general, when you’re throwing, you put a lot of stress on the inside of the elbow,” said Dr. Eric Bowman, an orthopedic surgeon, assistant professor in department of Orthopaedic Surgery at Vanderbilt Medical Center. Dr. Bowman is also the head team physician for the Nashville Sounds and Vanderbilt University.

Dr. Bowman is not Ohtani’s physician and spoke to The Times as an expert on UCL injuries.

“Unfortunately in people who throw, that ligament can develop degenerative changes over time and can eventually tear,” Dr. Bowman said.

Do certain players tend to injure their UCL compared to others?

“The forces that are placed on this ligament during the pitching motion are tremendous. So it’s a ligament that is prone to failure in high velocity pitchers,” said Dr. Alan Beyer, an orthopedic surgeon and executive medical director of the Hoag Orthopedic Institute.

Dr. Beyer is not Ohtani’s physician and spoke to The Times as an expert on the injury. He also offered that taller pitchers can somewhat be more susceptible to UCL injuries.

“A six-foot-something pitcher puts more force on their elbow than a five-foot-ten pitcher because the levers that are delivering the force are longer,” Dr. Beyer said. “So there’s more leverage, more force applied.”

How common are UCL tears?

As it relates to professional players, Dr. Bowman said there has been an increase in UCL reconstruction surgeries — also known as Tommy John surgery — over the years because pitchers are throwing harder. A survey that was sent out in 2018 depicted that 26% of MLB pitchers and 19% of minor league pitchers had UCL reconstructions (published Leland 2019, Orthopaedic journal of sports medicine).

“The numbers have dramatically increased over the past decade or so and in large part because the pitch velocity has gone up,” Dr. Bowman said, before adding: “A lot of pitchers, probably most pitchers at the major league level have some degenerative changes in the UCL and in the elbows, in general. And sometimes they’re able to compensate and protect it. In other situations, that doesn’t occur very well and they can either completely tear the UCL or further injure it.”

Is Tommy John surgery the only way to repair a UCL tear?

Present day, needing Tommy John surgery depends on the severity of the tear, but tearing a UCL at the professional or amateur level almost always leads to surgery, Dr. Beyer said.

Dr. Bowman said more conservative treatments start with rest and rehabilitation. As far as receiving platelet rich plasma (PRP) injections — as Ohtani had back in 2018 after the first time he tore his UCL — there is not strong evidence they help or hurt in patients with a first-time UCL tear, as medical professionals are still collectively reviewing data on the effects of PRPs.

“The idea behind PRP is that there’s some growth factors in there that might stimulate a healing response,” Dr. Bowman said. “That’s the theory behind why it may work.”

What is the typical return for baseball players from Tommy John surgery?

The range is 12-14 months, though some patients have pushed to return after about 10 months, Dr. Bowman said. A return to pitching in games also depends on when a pitcher is injured. A pitcher that tears their UCL today would not be healed by spring training next year.

Will Ohtani continue batting and will he get Tommy John surgery again?

Ohtani traveled with the team to the team to New York, where they will play the Mets in a three-game series, their first stop in a nine-game trip. Ohtani will continue to be the team’s designated hitter, the Angels said. As for whether Ohtani will need Tommy John surgery again, that remains to be seen.

“I know how bad he wants to play, but with that being said,” Angels general manager Perry Minasian said Wednesday night. “I think he needs time to wrap his head around it, talk to the people close to him. We’re in the process of getting second opinions, which are obviously important… Once the information is there, he’ll make the right decision on what he wants to do and we’ll support whatever he decides.”

What does this mean for the Angels rotation the rest of the season?

Ohtani cannot pitch. The Angels rotation was already struggling with him as the ace of staff. Without him, they can perhaps try to continue with the as-needed six-man rotation the remainder of the season with Lucas Giolito, Patrick Sandoval, Reid Detmers, Tyler Anderson, Chase Silseth and Griffin Canning.

Of those pitchers, Silseth had the most recent instances of success, going five or more innings and giving up no more than two runs in four of his last five starts. Though, the “as-needed” element was only necessary to keep Ohtani pitching every sixth or seventh day. Without him, they could weigh the idea of moving someone into the bullpen the remainder of the season to roll out a traditional five-man rotation the rest of the way.

What does the recent injury news mean for the Angels season?

Combined with the news that Mike Trout would be heading back to the injured list — because of the soreness he was experiencing in his hand from playing on Tuesday — and where the team dropped in the standings, it is hard to believe it will get better for the Angels.

Trout and Ohtani were two key pieces of the Angels postseason push. The Angels do not know if Trout will return after the minimum 10 days on the IL. For what it’s worth, what Trout is dealing with will continue to be pain tolerance until the offseason, when he can rest for a longer stretch of time.

Ohtani can still hit, as he did in 2018 when he finished out the season as a designated hitter after tearing his UCL in June of that year.

But the Angels (61-67) are 10½ games behind the Seattle Mariners for the final American League wild-card spot with 34 games remaining.

“No one’s quitting in that room,” Nevin said Wednesday night. “I’m not quitting. No one’s quitting in that room. I won’t allow it. The coaches won’t allow it, the players won’t allow it. We have too many leaders in there. Room hurts, this sucks.”