Nathan's Elbow Injury Leaves Twins With Questions

The results of Joe Nathan's CAT scan and MRI came back on Tuesday and they arrived with devastating news. The elite closer has a "significant" tear in the UCL of his right (pitching) elbow and he will likely need surgery to repair the team. In terms all can understand, unless a modern medical miracle occurs between now and two weeks, Nathan will need Tommy John surgery and will miss the entire 2010 season.

As LEN3's article linked above details, Nathan is one of baseball's most reliable closers, recording an MLB-high 246 saves since becoming the Twins' closer in 2004. He is 30 of 30 in save opportunities against the Detroit Tigers and has recorded an ERA of 0.85 against the Kansas City Royals over his career. Last season, Nathan recorded a Twins-record 47 saves in 52 save opportunities. He allowed just 42 hits in 68.2 innings. Although his five blown saves represent two months worth for many closers, they were the second-highest total for Nathan's career. The importance of Nathan's injury cannot be overstated.

Nathan will rest his arm for two weeks to allow the swelling to subside and then decide if surgery is an option. The Twins have been down this road before over the past few seasons with Pat Neshek and Francisco Liriano, who each attempted to rest the arm before delaying the inevitable surgery. However, with a significant tear in Nathan's case, it looks to a non-medical professional that surgery is the only option.

The loss of an elite closer puts a temporary damper on the sky-high expectations of this Twins team heading into 2010. The team will need to find someone to step into Nathan's shoes and close games in 2010. Internal candidates may include:

• Matt Guerrier - The righty is a solid set-up man who has recorded one save in each of the past four seasons. He had a fantastic year in 2009, but seems to thrive in the role he currently occupies. Plus, he's a bit prone to the home run ball.
• Jesse Crain - Crain has closer experience in the minors, but has only two career saves since joining the Twins in 2004. He pitched extremely well after his mid-season demotion to AAA, but he just doesn't seem to have the makeup for a closer at this level. He's just fine where he is.
• Jon Rauch - My pick for the closer at the start of the season. The 6-11 Rauch saved 24 games for the Arizona Diamondbacks and Washington Nationals in 2008, so he has prior closer experience at the MLB level. He'll be an intimidating force on the mound in the 9th inning and pitched very well for the Twins after his acquisition from Arizona.
• Jose Mijares - He's young and cocky, but he isn't a closer. Ask Delmon Young about his late-inning maturity level from last season.
• Pat Neshek - He's coming back from his own arm surgery, so the Twins won't ask him to close even though he was a very successful minor league closer.
• Francisco Liriano - This is perhaps the most interesting option for the Twins. Since his incredible 2006 debut and his subsequent arm injury, Liriano has struggled to come back as a starter. He seems to wear down in the middle innings, suggesting that he could be a closer-type who could throw as hard as he wants for one inning, mixing in sliders along the way, and then rest. The issue will be if he can pitch three days in a row, which is something the Twins simply cannot answer right now. He's in the battle for the final starter's position, but may shift to the 'pen.
• Anthony Slama/Rob Delaney - Both have been solid minor league closers, but each has yet to pitch in a major league game. It's simply not the Twins way to ask someone to debut in the bigs in a pressure-packed environment.

With the Twins' payroll already at $95M, there is little chance of the team looking outside the organization for help. Whispers of Heath Bell abound, but it doesn't seem likely at this point. The Twins will circle the wagons and stay within the organization to replace Nathan in the near-term. If things fall apart early, look for GM Billy Smith to make a move. For now, however, the smart money is staying in-house to replace Nathan.

Don't think that Nathan's loss is going to bump the Twins from the pre-season division favorite perch. The Twins still have the best lineup they have fielded in several seasons. However, this is a temporarily devastating blow for the team right now.