Tristan Beck

Doctor details Beck's right arm aneurysm, possible recovery timeline

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The Giants could be without young right-handed pitcher Tristan Beck for a while.

Beck was on track to earn a spot in San Francisco's starting rotation this season, but was diagnosed with an upper right arm aneurysm earlier this week and told reporters on Friday, after seeing a vascular specialist in San Francisco, that he will undergo surgery Monday to address the issue.

What exactly is an arm aneurysm, and how long could Beck be out? Stanford Medicine’s Associate Professor of Orthopedic Surgery, Michael T. Freehill, MD, answered those questions in an interview with NBC Sports Bay Area on Friday.

"In elite-level pitchers especially and in your professional throwers, they throw with such forces and at such speeds that you can put a lot of stresses across the blood vessels of the arm," Freehill explained. "And although it's relatively uncommon in those higher levels of throwers, we certainly see this. And what happens, is you can start to get some intimal tearing, or some tearing of the blood vessel wall, and as that thins, it starts to balloon out a little bit, hence what we call an 'aneurysm.'

"Now it's not something you think about rupturing like you think of aneurysms in the head, but what happens with the ballooning is the body tries to heal that by laying down what we call thrombus, clotting into that area to let the body heal. And that's a good thing normally, but in the throwers, with that continued repetitive forces and tensions across that, it can allow some of that thrombus to basically shower out of the injured area and into the greater arteries that end up going down the arm and they can become lodged and that's how you can get this myriad of symptoms."

Freehill wears many hats, including the role of head team physician for the Stanford baseball team, the assistant team Orthopaedic surgeon for the Oakland Athletics and teaches in the Department of Orthopaedic Surgery at Stanford University School of Medicine.

While the Giants have not released any official details regarding Beck's upcoming surgery and his timeline for a return to the mound, Freehill estimates the 27-year-old could miss quite some time this season.

"If it is an aneurysm, where is that located? Once that is identified, you're going to have a repair involved with a blood vessell," Freehill said. "That's going to probably require up to four weeks of just letting it heal. Probably after those first four weeks, you're going to go into at least four weeks of physical therapy if you will, starting to build up the motion back, then introducing the strength, and now you're probably at two months before you start what we would call an interval throwing program.

"And then that would build out and those can go upwards of two-and-a-half, three months. So generally speaking, something like this you can probably expect up to five months before you're throwing competitively in a game."

If Beck is sidelined for up to five months, his potential return to the mound could line up with injured veteran pitchers Alex Cobb and Robbie Ray, who are expected to miss most of the first half of the season with their respective injuries.

Outside of relief pitcher-turned-starter Jordan Hicks, the Giants have not added a healthy arm to their rotation this offseason. If all three of Beck, Cobb and Ray miss most of the first half, San Francisco's rotation could be pretty thin to begin the 2024 MLB season.

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