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Friday, February 26, 2010

The Sporting Hippeaux's 2010 Shoulder Surgery Survey

I've recently been participating in some preseason roundtables over at Inside Pulse Sports.  Our discussion of the Arizona Diamondbacks, specifically Brandon Webb, prompted a little debate about the effectivity of shoulder surgeries.  The conversations got me thinking, 2010 is going to be an important season for surgeons.  Webb is just one of several notable pitchers who are returning to work after a major reconstructive surgery cost them the better part of the 2009 season.

In recent years, even the casual baseball fan has become familiar with "Tommy John surgery," the elbow operation which hundreds of major-leaguers have undergone.  The procedure has become so effective that are even cases of pitchers increasing their velocity upon returning.  Tim Hudson, Jake Westbrook, and Shaun Marcum are among the Tommy John recoverers who should be ready at the beginning of 2010.

Major shoulder injuries, on the other hand, are viewed as the death knell for pitchers.  Randy Johnson's discovery that his rotator cuff was going to require surgery may well have been what prompted his decision to retire.  Mark Prior had a shoulder replacement in 2007 and still hasn't made his way back to a big-league mound.  Mark Mulder has been trying to make his way back from a 2007 operation, but has managed only a dozen innings (and not good ones, either).  Shoulder injuries which required surgery also cut short the relatively promising careers of Matt Clement and Kris Benson.  The list is goes on.

There have, however, been a few instances of full recovery.  Pedro Martinez had to have his rotator cuff repaired in 2007 and while he struggled in 2008, his return to the mound last season with the Phillies was very successful.  Chris Carpenter had his labrum repaired in 2002 and has since been one of the best pitchers in all of baseball, winning a Cy Young in 2005.  Al Leiter had both Tommy John and shoulder surgery in 1989, at the age of 23, and proceeded to have an excellent career.  This experience helps lend a little credence to Leiter's prediction, as an MLB Network analyst, that Webb would be able to make a full recovery because he relies mainly on a sinker and has never needed an overpowering fastball (Leiter had a similar arsenal).    

A 2008 study of orthopedic surgeons found that only about a third of professional players were able to achieve their pre-injury level of production following a major shoulder surgery.  More than a third not only were unable to regain their former glory, but were forced into retirement.  Elbow surgeries faired much better, with slightly more than half of the players returning to full strength or even improving.  Sadly, it was still true that 30-40% of players were permanently effected to an extent that they were unable to continue to play.  More recent surveys have the specific ulnar collateral ligament reconstruction, known as "Tommy John," succeeding at a much higher rate, perhaps as high as 80-90%, though not every player gets a full recovery and the rehabilitation and strengthening process can be very lengthy.

Two years is a long time in terms of 21st-Century medical technology, so perhaps it's time for another look.  Eight noteworthy pitchers with be returning from shoulder operations early in 2010.  Throughout the season I'll be closely monitoring their progress and providing updates and analysis in hopes of understanding a little more about the long-term effects of this difficult and unpredictable procedure.

Here's our roster:
Erik Bedard, Seattle Mariners

I'm on the record about Bedard's recent re-signing with Seattle.  Part of his contract was, of course, a physical, so the Mariners brass must be fairly optimistic about the work of Dr. Lewis Yocum, who's been rooting around in Bedard's shoulder for a couple of years now.  In September of 2008, Bedard wrapped up an injury-riddled campaign by having Yocum remove a cyst from inside his throwing shoulder.  He came back strong in the first half of '09, going 5-2 with 2.47 ERA in his first eleven starts before pain sidelined him again in early June.  He returned for four painful starts in July, pitching well enough (2-2, 4.15), but clearly suffering.  He was unable to make it past the fifth inning in three of the four outings.  In August, Yocum went back in and found a torn labrum and an inflamed bursa, which he proceeded to repair.  The Mariners do not expect Bedard to be back for Opening Day, but the rough timetable for his return gets him back on the mound sometime between late April and the All-Star Break.  One of the more interesting things about Bedard is that, much like Rich Harden, though he has been dogged by injuries throughout his career (making 30+ starts only once in six seasons), when he takes the mound, he's very, very good, in spite of whatever discomfort he may be feeling.

Pitching Style: Bedard's out pitch is his curveball, which some rank among the best in baseball.  He has an average fastball (90-93 MPH) and a mediocre changeup, but makes the most of them, maintaining  a very high strikeout rate (he led the league in 2007).  He still suffers from fits of wildness, but his control has improved considerably over the course of his career.

Jeremy Bonderman, Detroit Tigers

Bonderman made his first major-league start at the age of 20.  He averaged 30 starts a season in his first five years in Detroit, but in the last two, he's managed a total of only thirteen.  He had a blood clot removed from his pitching shoulder in June of 2008.  He was perhaps too eager to rejoin the team and re-injured himself in an attempt to make the Opening Day roster in the spring of 2009, although luckily an additional operation was not required, just rest and rehabilitation.  The Tigers tested him out gingerly as a reliever last September and plan to have him back in the rotation this April.  The early reports out of Tigers camp have been very positive.  

Pitching Style: Bonderman is a classic power pitcher.  Prior to his injury, his fastball sat in the high 90s and was complemented by a vicious hard slider.  He possesses good control for a strikeout pitcher and last year was reportedly working to add a splitter to his repertoire.   

Jeff Francis, Colorado Rockies

The former Rockies Ace, who won 17 games for the NL Champions in '07, has not pitched since September of 2008.  He attempted to work his way back without surgery, but succumbed to its inevitability in February of 2009.  Dr. Thomas Noonan fixed his torn labrum and gave him a recovery timetable of six months to a year.  Francis showed up to Spring Training early and claims to be pitching without pain.  The Rockies expect to insert him into the backend of the rotation and hope for the best.

Pitching Style: Francis is a crafty left-hander.  His fastball rarely touches 90 MPH, so he lives on the corners and features a good curveball and changeup.

Freddy Garcia, Chicago White Sox

Garcia was able to make nine starts during the waning weeks of the '09 season, which was enough to convince the White Sox to pick up his option for 2010.  Garcia had his surgery way back in August of 2007, when he was with the Phillies.  Dr. James Andrews repaired his torn labrum, but the rehabilitation process was particularly long and Garcia didn't make a start until September of 2008.  He had hoped to be at full strength from the beginning of '09, but he strained the should during winter ball and had to rehab all over again.  The Mets became inpatient and released him, after which Chicago jumped on the opportunity to sign him to a cheap, incentive-laden deal.  Garcia was a big part of the White Sox 2005 championship.

Pitching Style:  Garcia's fastball, never particularly overpowering, now clocks in the high 80s, but Garcia throws a four-seamer and a two-seamer with pinpoint control and plenty of movement, and his repertoire might as well include the kitchen sink: slider, curve, changeup, and splitter.  

Ted Lilly, Chicago Cubs

The Cubs got moderately good news this week when an x-ray revealed no structural damage to Lilly's recently-repaired shoulder, but he's still experiencing pain and the timetable for his return is iffy.  The surgery, performed by Dr. Yocum, was done shortly after the '09 season and treated a frayed labrum and "debris."  Since the injury was less severe, the Cubs expected him to make a full recovery by Opening Day, but that's now seeming less likely.  Lilly has pitched very well for the Cubs, going 44-26 with 3.70 ERA in the last three seasons.  He hadn't missed a start prior until last July and he still managed to pitch very well down the stretch (2.00 ERA in 8 starts after coming off the DL).  One wonders, in fact, whether the operation was necessary.  

Pitching Style: Lilly is another typical lefty soft-tosser.  He relies on his command and a wicked looping curveball.  He'll also mix in a decent slider and an occasional changeup.  His control is imperfect, making him prone to the long ball, but he's a gamer who remains unfazed by bad outings and rarely misses a start. 

Dustin McGowan, Toronto Blue Jays

McGowan is the least established player on this list, but he very well may have the best "stuff," at least he did, prior to his injuries.  McGowan had a particularly ugly series of injuries, including a torn rotator cuff, a frayed labrum, and cartilage damage in his knee.  Dr. Steve Mirabello performed the shoulder portion in July of 2008.  His long rehabilitation process was made even longer by his diabetes.  The Jays have been very cautious with McGowan.  They have no reason to push him and have not declared a firm timetable for his return, but Opening Day is not out of the question.

Pitching Style: McGowan has an unconventional delivery, which some speculate could have led to his injuries.  He had (or had) power everything - power fastball (95+ MPH), power sinker, power slider, power curve - and a changeup.  Like most young players who boast that kind of arsenal, McGowan doesn't possess great control.

Chien-Ming Wang, Washington Nationals

You probably heard about Wang's precipitous decline.  It was one of the most-bandied stories in the early part of 2009.  Wang had surgery in July to repair "a tear in the capsule."  Dr. Andrews performed the operation.  Wang recently signed with the Nationals for $2 Million plus incentives.  He's trying to re-establish his market after his disastrous '09 campaign, prior to which he looked headed for a megadeal.  Wang had an incredible .729 winning percentage in the first four seasons of his career.  It didn't hurt, of course, that he played with the Yankees.  His 3.79 career ERA probably won't be good for 19 wins on the lowly Nationals, but it could net him 12-15, assuming he's fully recovered, as predicted, by sometime in May.

Pitching Style: Wang leans heavily on a Grade-A sinker, throwing it around 90% of the time.  He throws it hard (low 90s) and with great lateral movement.  His straight fastball can reach the mid-nineties.  He also features a good slider and occasionally a splitter.  Like most sinkerballers, Wang lives on the grounder, but his stuff is good enough to get a K when he needs it.   

Brandon Webb, Arizona Diamondbacks (Shoulder)

I think you'll agree that this is a pretty impressive roster of pitchers, but Webb is undoubtedly the least he was.  Webb took home a Cy Young in '06 and finished second in the voting in each of the next two seasons.  He won 22 games in 2008.  From '05 to '08 he averaged 18 wins, 230 innings, and 180+ strikeouts a season, with an ERA of 3.23.  Webb's shoulder started barking last spring.  He tried to push through it and was Arizona's Opening Day starter for the fourth consecutive season, but that was his final appearance of 2009.  In August he finally resigned himself to surgery and Dr. Keith Meister treated him for bursitis.  The D-Backs must be fairly confident Webb is on the path to a full recovery, because they picked up his $8.5 Million option for 2010.  The D-Backs are cautiously optimistic that Webb will be ready to be in their April rotation, but Dan Haren has already been tabbed for Opening Day.

Pitching Style: Like Wang, Webb is a renowned for his sinking fastball.  He rarely breaks 90 MPH, but his sinker has incredible movement.  Webb induces a ton of grounders, but he also strikes hitters out in bunches.  On the rare occasion he doesn't throw his best pitch, he uses a pretty good curveball and a mediocre changeup.     


Anonymous said...

FYI, Webb had what is known as a "Debridement", which is essentially a cleanup of fraying and loose material. It's far less invasive than most of the shoulder surgeries performed on the other pitchers reviewed here. There were no repairs done to tears of the labrun or rotator cuff. The doctor described it more like "getting gravel out of your shoe".

Anonymous said...

That shoe seemed to work out well.