Minimally Invasive Pitching Solution
New NanoNeedle Scope Procedure Could Revolutionize MLB Pitching Injury Recovery, Starting with Tarik Skubal
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Detroit Tigers ace Tarik Skubal became the first known MLB player to undergo surgery using the NanoNeedle Scope 2.0 — a device roughly the size of a toothpick — to remove a loose body from his throwing elbow. Pantagraph reports the procedure is already being called the "Skubal Scope" around the league, and it could rewrite how teams handle pitcher injuries for years to come.
The device, made by Arthrex, uses a 1.9mm camera — less than half the size of a standard arthroscope — to enter the joint with almost no cutting. Since his return, Skubal has averaged 96.8 mph on his fastball, up 2.5 mph from before surgery, according to Statcast data.
A Toothpick-Sized Tool That Cuts Recovery Time
Traditional elbow "cleanups" — removing bone chips or loose bodies — require 4mm to 5mm incisions and flood the joint with saline. That fluid irritates the tissue lining the joint and can cause scar tissue to form. The NanoNeedle Scope 2.0 uses a 1.9mm tip, roughly the size of an 18-gauge needle, meaning surgeons can work inside the joint without that level of trauma, Crossroads Today reported.
Dr. Neal ElAttrache, the high-profile Kerlan-Jobe surgeon who performed the operation, explained the difference plainly. "We are no longer 'cutting' in the traditional sense," ElAttrache said. "We are visiting the joint with minimal disruption to the surrounding biology." Skubal returned to the mound in 11 months — roughly two to three months faster than the historical average for similar combined procedures, according to Baseball Prospectus.
Skubal's Performance Took Off After the Surgery
Skubal had his final 2022 start on August 1 against the Minnesota Twins, leaving early with discomfort. The Tigers announced surgery on August 17. By July 4, 2023, he was back on the mound and threw four no-hit innings against Oakland. He finished that season with a 2.80 ERA, Kearney Hub reported.
Analysts at Fangraphs noted that Skubal's fastball actually moves more after 80 pitches now than it did before surgery. That "late-inning life" suggests the joint has less internal scar tissue than a typical post-surgical arm. By the 2024 season, Skubal was the leading AL Cy Young favorite, and media reports began naming the device after him.
The Rest of MLB Is Already Taking Notice
Word spread fast. Several MLB agents, including Scott Boras, reportedly began asking team doctors for "Nano-only" options to protect clients from the recovery lag of traditional surgery. Dr. Timothy Kremchek, the Cincinnati Reds' team physician, put it simply: "If you don't have to cut the capsule to see the injury, the pitcher doesn't have to wait for the capsule to heal. That's three weeks of rehab saved instantly," MT Standard reported.
The NanoScope imaging system costs an estimated $2.6 million for a team's in-house medical suite. That price tag gives richer clubs a potential health advantage over smaller-market teams. There is also growing interest in "preventative" cleanups — players asking for the procedure every off-season to remove micro-debris before it causes a major tear, MT Standard noted.
Skeptics Warn Against Rushing Into Needle Surgery
Not everyone is cheering. Medical ethicists caution that calling it a "toothpick procedure" downplays the fact that it is still invasive surgery. Some worry that younger players in high school and college will seek the "Skubal Scope" for minor aches, leading to unnecessary procedures. Sports Health Journal has flagged the risk of over-medicalization when a device gets branded as simple or risk-free.
Some rival scouts and traditionalists have also whispered about "surgical optimization" giving certain pitchers an artificial edge in longevity. The debate is still early, but with the NanoNeedle 2.0 gaining wider FDA clearance for orthopedic use, the league-wide adoption — and the arguments that come with it — is expected to accelerate well before the 2027 season, Crossroads Today reported.
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