The SPH 2010 Shoulder Surgery Survey (a.k.a. More Bad News For Mets Fans)

Due to my hectic summer, I haven't made an S.S.S. update for several months, but with one of the game's most prominent pitchers, Johan Santana, going under the knife, I thought it was probably an appropriate time to renew our discussion.  (To track how this all began, you can go here.)

I'm going to start with the good news.

The 2010 poster-child for shoulder rehabilitation has to be Ted Lilly.  Lilly was back on a major-league mound approximately seven months after having his "frayed labrum" repaired and before long he was again among the most dependent, durable, and underrated pitchers in the National League.  His record for 2010 is just 8-11, due in large part to playing on a pair of teams (Cubs & Dodgers) which seem to be coming apart at the seems.  Lilly's overall numbers are solid (3.83 ERA, 1.10 WHIP, 141 K, 172 IP) and very similar to what he posted immediately preceding the operation (3.10 ERA, 1.06 WHIP, 151 K, 177 IP).  Lilly may be showing a little fatigue.  He began his tenure with the Dodgers by winning his first five starts, but is 0-3 with a 7.47 ERA in his last four.  One could speculate that this is a result of a diminished strength-building routine following the surgery last offseason, but it could also merely be the result of natural tendency towards indifference bred of being a veteran on a team that no longer has a shot at the postseason.  This rough stretch aside, however, Lilly has done plenty to prove that the injury should not effect his bargaining position when he hits the free agent market this winter.

There have also been positive developments from Jeremy Bonderman.  Bonderman missed well over a year following his surgery, in part because he re-injured the shoulder trying to make too quick a return.   A note of caution to Santana and the Mets: Bonderman's injury was not unlike that which Johan recently suffered and, in general, there is a tendency toward re-injury following these surgeries.  Bonderman struggled getting back into sync following his long layoff, posting a 6.97 ERA in April, but has steadily improved over the course of the season.  Since May 1, he's 7-8 with a 4.75 ERA.  That's still a far cry from the pitcher who helped the Tigers get to the World Series a few years back, but there have been glimpses of that former glory.  Last week he shut down the White Sox for eight innings, allowing only three hits and striking out eight.  Perhaps this is a flash of what we can expect from a fully recovered Bonderman in 2011?  If not, he has still proven himself to be capable of being a back-of-the-rotation innings-eater.

Freddy Garcia played a similar role for the White Sox this season, his first full year since having his labrum repaired way back in 2007.  Garcia posted a strong record, 11-6, for the ChiSox, but with modest overall numbers (4.88 ERA, 1.43 WHIP, 83 K, 144 IP) before being shut down earlier this month due to an unrelated back injury.  It's apparent that, at 36, Garcia will never be the Ace he was earlier in his career, but he did manage sixteen quality starts (62%) in 2010.  You might be surprised to find that's more than All-Stars like Johnny Cueto, Yovani Gallardo, Andy Pettitte, and Phil Hughes.

Nagging injuries were a prevalent issue for our survey participants, perhaps no surprise considering the long period spent away from the game following their operations.  Not only could it effect their endurance, but also potentially their mechanics.  Reports out of Colorado this preseason suggested that Jeff Francis was having to completely relearn his delivery.  Francis continued to feel "tightness" in his pitching shoulder even after his return in mid-May, which forced him back to the D.L. after about half a season of work.  In his 17 starts he has been, much like Bonderman and Garcia, respectable but unspectacular (4-5, 4.61 ERA, 1.29 WHIP, 61 K, 96 IP).  He's mixed in a couple of gems (for instance, seven innings of three-hit ball against Florida in July), but also failed to get past the third inning on two occasions.  The Rockies are expecting him to take over Aaron Cook's spot in the rotation for the next two weeks.  We'll see whether he can rise to the occasion following a month of rest.

Sadly, considering how modest these results are, that's the end of the "good" news.  Of the eight players we began tracking at the beginning of the season, only these four managed to make it back to the mound in 2010.  The Mariners were cautiously optimistic that Erik Bedard would be ready by the All-Star Break, but he also fell victim to the urgency of his rehab and ended up having a "setback" which resulted in yet another surgery, this time to remove a bone spur.  As yet, there's still no timetable for his return.  The same can be said of Brandon Webb and Chien-Ming Wang, two other former All-Stars who may never fully recover from their injuries.  Webb is tentatively hoping to make a couple of relief appearances before the end of the season, but the D-Backs have been slow to confirm that report.  Having now missed almost two full seasons, it is impossible to predict what the former Cy Young winner will look like if he is indeed ready for Opening Day in 2011.  The future of Wang, the former Yankee Ace, is even more uncertain.  Same for Dustin McGowan, the promising young Blue Jays starter, who also had an additional surgery in June and is unlikely to be ready in time for Opening Day 2011.

All told, that's a pretty dismal picture of Johan's prospects.  Of these eight pitchers, seven of them missed a season or more rehabbing after surgery.  Of the four who have made it back to the mound, only one has come anywhere near his previous level of effectiveness.  While Santana isn't dealing with major labrum or rotator cuff repairs, the "torn capsule" is the same thing which Bonderman and Wang were treated for, and both missed well over a season.  It would be wise, based on this track record, if the Mets reconsidered their intentions of trying to have him ready in the first half of 2011.  That seems fairly far-fetched.  And, as we saw with several of these cases, the urgency to return can actually prolong and exacerbate the injury, even to the point to requiring additional surgery.  I would not expect Santana to be ready before August of next year.  Even then it is unlikely he will immediately pitch like an Ace.  Unfortunately, he may never again look like the perennial Cy Young candidate we've come to expect.

SPH 2010 Shoulder Surgery Survey (March)

About a month ago I outlined my intentions to follow the trials and tribulations of eight starting pitchers attempting to return from shoulder surgeries in 2010.  We have gotten off to an auspicious start.  When Spring Training began, at least six of our eight participants were aiming to make the Opening Day roster.  Now, with the regular season about two weeks away, that number is falling fast.

Brandon Webb, the most notable pitcher in the group, complained in early March that he felt "stagnant." Unable to build upon his early progress, he has resigned himself to opening the season on the D.L. and is aiming for a late April return, at the earliest.

Chien-Ming Wang, another former Ace, trying to make a comeback with the Nationals, threw his first bullpen session on Wednesday.  While reports were very positive regarding Wang's control and the movement on his sinker, two concerns following his disastrous '09 season, the timetable for his return has been tentatively set for early May.  With Stephen Strasburg headed to the minors and Wang joining Ross Detwiler and Jordan Zimmerman on the D.L., the Nats are forced to audition guys like Garrett Mock and J. D. Martin for the rotation.

Ted Lilly, whose surgery this offseason was supposed to be "routine," suffered a couple early setbacks and has yet to appear in a preseason game.  He threw off the mound for the first time this week and is optimistic he could be ready by the middle of April.  The Cubs don't need a fifth starter until April 19th.

Dustin McGowan made a Spring Training start on Friday, but as he surgery was more invasive than Lilly's his rehabilitation process is dramatically longer.  Since Toronto is in rebuilding mode and have a number of starting pitchers who they'd like to have a long look at in 2010, they will not rush McGowan, who is certainly one of the most talented in the group.  He was capable of throwing in the high 90s prior to the injury, but hadn't thrown a pitch for about eighteen months.  He will build up his arm strength during an extended Spring Training, likely followed by a long rehab assignment working his way up through the Jays minor-league system.  If all goes well, I'd bet on a June return to Toronto.

Erik Bedard, who the Mariners re-signed with the full knowledge that he was unlikely to return prior to June, has been cleared to throw his first bullpen session this week.  Seattle GM, Jack Zduriencik, even speculates that Bedard may be a little ahead of schedule.  However, I wouldn't put much stock in any diagnosis when Bedard has yet to throw off a mound.  The Marines signed him hoping to get half a season.  Hopefully, they'll stick with that timetable for his return.

While most of our roster won't make an active roster this April, there is some good news as well.

The Tigers' Jeremy Bonderman has made four Spring Training appearances and is likely to make the Opening Day rotation.  His overall numbers are skewed by a very rough outing in early March, but in his last two outing he's thrown a total of six innings, allowing eight hits and three earned runs, while walking two and striking out four.  Bonderman is struggling to regain his control after missing most of the last two season, which is to be expected, but he's throwing the ball in the mid-nineties, an encouraging sign that he will could eventually regain the velocity he featured prior to surgery.  The Tigers rotation hasn't been set, but Bonderman would probably make his first start against Cleveland in the Tigers first home series, April 9th through 11th.

Jeff Francis of the Rockies is also on schedule for an early April return.  He's thrown nine innings so far this spring and is one schedule to throw 85-95 pitches in his first regular season start, which will likely be the Rockies home opener against San Diego on April 9th.

Finally, Freddy Garcia is on track to make his first start on the 11th against Minnesota.  Garcia was able to make nine starts at the end of 2009 and is now more than two year removed from his surgery, so the White Sox haven't been treating the veteran with any kid gloves this spring, never questioning that he would be their #5 starter.

With the possible exception of Garcia, who the White Sox believe will be capable of pitching deep into games, as he did during his tenure with them from 2004 to 2006, most of these pitchers will be on strick pitch counts during the opening months.  For Francis and Lilly, who have always made their livings pitching to contact, that shouldn't be a terrible problem.  For Bonderman and McGowan, that could be a major adjustment, as both are strikeout artists who tend towards high pitch counts even when they are throwing well.  

My Broke-Ass Ouija Board Says...The Rockies Hang Their First NL West Flag

The Rockies have an NL Pennant (from 2007) and have been to the postseason three time ('95, '07, '09), but they are the embodiment of the Wild Card era, having come into existence only two year prior to its invention, and utilizing it for every one of their playoff bids.  This is the year that Colorado finally surges to the front of the NL West.

I've been putting off making my western division predictions for both leagues, as I there are a number of reasonable contenders in each of west coast division.  In fact, while participating in the Inside Pulse Sports "30 Teams in 30 Days" roundtables, I think I ended up predicting that four teams in the NL West would finish in third place in order to prevent myself from having to make a strong case for any one of them.

Since those roundtables, there have been a few significant developments.  First, Russell Martin went down with a groin pull.  It isn't expected to cost 'Trane more than a couple weeks of regular season play, but knowing Martin's intensity, you have to wonder whether he will be patient with the rehabilitation process.  Groin injuries can dog a player for much longer than they should if not allowed to fully heal.  A bounceback season from Martin is absolutely key for the Dodgers if they hope to make Joe Torre three-for-three in NL West title attempts.

Also, after early progress, Brandon Webb's rehabilitation has stalled.  It now appears certain that he will begin the season on the DL, with no clear timetable for this return.  With Webb and Dan Haren as co-Aces, followed by Edwin Jackson and Ian Kennedy, the D-Backs had a formidable rotation.  It looks much, much different with two gaping holes at the backend.

Most recently, the Rockies closer, Huston Street, has been diagnosed with a shoulder injury, which will almost certainly cost him a couple months, if not the whole season.  Franklin Morales is the early favorite to take over the closer role, but the Rockies also have two other pitchers with considerable closing experience, Rafael Betancourt and Manny Corpas.  There are also reports that the Rockies have been considering re-signing Joe Beimel or trading for Juan Cruz, although neither is likely to enter the competition for saves.

Giants camp hasn't been completely free of setbacks either.  Freddy Sanchez is unlikely to be ready for Opening Day and Mark DeRosa remains somewhat questionable.  Madison Bumgarner, the early favorite for the fifth spot in the rotation, showed a significant decline in velocity in his first couple outings, provoking worry.

All of this suggests, what probably should be assumed from the start, that with four very competitive teams, the NL West will be determined largely by health and depth.

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: