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.  

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: