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 (May)

In honor of Jeff Francis's return to the mound, I'm providing the fourth installment in my 2010 Shoulder Surgery Survey.  The cast of active participants increased by one this afternoon, as Francis squared off with the Nationals.  It was Francis' first start since September of 2008.

Much like Brandon Webb, Francis entered Spring Training with the intent of being ready for Opening Day.  Unfortunately, his progress stalled and was complicated by an unrelated injury to his back, thus delaying him by about six weeks.  The Rockies were cautious with his rehab, so he arrived in Colorado prepared to throw around 100 pitches.

Although it's been twenty months since his last appearance, in this start it looked like he'd never left.  He allowed a couple hits, a walk, and a run in the first inning, but Francis, like many soft-tossing lefties, has always tended to struggle in the opening frame (6.37 career ERA, his highest for any inning).  Thereafter, he settled in and allowed only five hits, a walk, and no runs over the next six.  He also struck out six.  Francis mixed in all four of his pitches (fastball, changeup, sligder, curve) and touched 91 MPH, although he was more consistently in the 88-89 range.  In the seventh, possibly tiring, Francis gave up two singles to start the inning, but was able to strand them by getting a pair of strikeouts and a pop-up.  He induced nine groundballs, including a key double-play to end the sixth.

The Rockies need Francis to pitch like he did today, as they are still without their #2 starter, Jorge De La Rosa and haven't gotten much from either Aaron Cook (1-3, 5.80 ERA) or Jason Hammel (1-2, 7.71 ERA).  If Francis can eat some innings, it will help take the pressure of Ubaldo Jimenez, Jhoulys Chacin, and the bullpen, which has been among the best in the NL (117 IP, 3.08 ERA).

This afternoon also featured the fourth start of the season from Ted Lilly, another member of the S.S.S. roster.  Lilly managed seven strong innings, allowing six hits, three walks, and three earned runs.  Like Francis, he took a no-decision, but his team did end up with the win.  It clearly took Lilly a couple outings to shake off the rust, but he's been building up his pitch counts and has quality starts in each of his last two games.  There's little reason to believe that he isn't prepared to be the same dependable top-of-the-rotation starter he has been for the Cubs since they signed him.

A very similar scenario is developing across town, as Freddy Garcia has started to really round into form.  He's 2-0 in May with a 2.77 ERA, after going 0-2 with a 5.87 ERA in April.  He'll be tested a little this coming week, as he'll take the mound against the division rival Tigers and the Florida Marlins, who have some thunder and are on a bit of a hot streak (swept the Mets in a four-game series, won six of their last seven).  Ozzie Guillen has been a little conservative with Garcia, who has only thrown 100+ pitches once so far, but he's still be able to go at least six innings in five of six outings, which speaks well for his efficiency.

Jeremy Bonderman has also shown a dramatic improvement since the calender turned.  He's had bad luck in terms of decisions (0-1), but has posted a 2.08 ERA in his last fourteen innings and has clearly regained his control, giving up just one free pass over that span.  The Tigers are no doubt a bit concerned with his velocity.  His average fastball speed so far this season is 89.5 MPH, significantly lower than his career mark of 92.5 MPH.  In his last start, an excellent seven-inning outing against the Yankees, Bonderman topped out a 93 MPH and pitched consistently in the 89-90 range.  This, coming from a guy who at one time could occasionally reach the upper nineties.  Certainly, Bonderman has enough movement, control, and variety in his pitches to be effective even with lowered velocity, but the Tigers have pushed back his next start, perhaps partly to see if his arm will be at all rejuvenated by a full week of rest.

Of the eight members of our survey, those are the only four who have pitched in the majors thusfar in 2010.  Of the guys remaining on the D.L., Erik Bedard is probably the closest to joining a rotation.  He has progressed much faster than expected and the Mariners expect him to start throwing off the mound within a week, which still puts his return date somewhere around a month away.  Brandon Webb is throwing from flat ground, but as yet there's no timetable for rehabbing him into pitching shape, so an All-Star Break return seems optimistic.  The Nationals have set a tentative date for Chien-Ming Wang debut at July 1st.  Finally, Dustin McGowan, the Blue Jays youngster, who had perhaps the most serious injury of any of our participants, is still working primarily on a strengthening program.  No timetable has been set, and with many young Jays pitchers performing well, there seems no reason to rush him.  It seems to me only about 50/50 that McGowan pitches this season.      

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:

Offseason Prospectus #17: The Colorado Rockies

In the fall of 2007, the Rockies used an eleven-game winning streak and an extraordinary extra-innings win against San Diego in game 163 to surge into the postseason and eventually to the World Series. They had five players with 90 or more RBI - Matt Holliday (137), Brad Hawpe (116), Garrett Atkins (111), Troy Tulowitzki (99), and Todd Helton (91) - and looked like a team built to win for several years to come.

Unfortunately for Colorado, like so many teams who make unexpected journeys deep into October, they had trouble duplicating that success, managing only 74 wins in '08 and beginning '09 by going 18-28, a performance bad enough to lead to the firing of long-time skipper, Clint Hurdle.

To everybody's surprise, soon after Hurdle was dismissed, the Rockies regained their swagger under Jim Tracy and '09 turned out to be the best regular season in the team's history (92 W, .568). They got manhandled by the Phillies in the NLDS, but there is once again optimism among the Coors Field faithful, as the team proved it could win without Matt Holliday.

In recent years, Colorado's front office, led by Dan O'Dowd, has made a consistent commitment to drafting, developing, and retaining their own players, and keeping themselves away from big free agents who haven't proven themselves in the distinctive environs of Colorado, like the ones that hamstrung the team earlier in the decade (Mike Hampton and Denny Neagle, most famously). Of the dozen men who got 100 or more at-bats for the Rockies in 2009, only Carlos Gonzalez and Yorvit Torrealba have ever played for another organization (in Gonzalez's case, that tenure was very brief). The starting rotation is also led by two pitchers who are career Rockies: Ubaldo Jimenez and Aaron Cook.

So far this offseason, O'Dowd has stuck to his guns. The Rockies offered arbitration to set-up man, Rafael Betancourt, but have otherwise been silent. In the early months of 2010, O'Dowd may look for a part-time catcher and minor bullpen or bench reinforcements, but the Rockies remain convinced that they already have the major pieces necessary to get them back to the promise land. And, with nobody in their division getting noticeably better so far this winter, they can make a pretty convincing case for being the preseason favorite in the NL West.

Free Agents:

Garrett Atkins (30) 3B/1B [Signed w/ Orioles]

Joe Beimel (33) LHRP

Jose Contreras (38) RHRP

Adam Eaton (32) RHSP

Alan Embree (40) LHRP

Josh Fogg (33) RHRP

Jason Giambi (39) PH

Matt Herges (40) RHRP

Jason Marquis (31) RHSP [Signed w/ Nationals]

Matt Murton (28) OF

Joel Peralta (34) RHRP [Signed w/ Nationals]

Juan Rincon (31) RHRP

Arbitration Eligible:

Clint Barmes (31) 2B

Taylor Buchholz (28) RHRP

Jorge De La Rosa (29) LHSP

Jason Hammel (27) RHSP

Chris Iannetta (27) C

Ryan Spilborghs (30) OF

Huston Street (26) RHCL

ETA 2010?:

Jhoulys Chacin (22) RHSP

Samuel Deduno (26) RHSP

Edgmer Escalona (23) RHRP

Shane Lindsay (24) RHRP

Michael McKenry (25) C

Chaz Roe (23) RHSP

Esmil Rogers (24) RHSP

Eric Young (25) 2B/CF

While I think O'Dowd is an exceptionally competent GM, I see one area in which his conservative strategy might prove dangerous. While none of the free agent arms Colorado is losing were among the best pitchers in their bullpen, Alan Embree, Josh Fogg, Joel Peralta, Juan Rincon, Jose Contreras, and Joe Beimel did combine for over 150 innings. Down the stretch Contreras was among the Rockies most dependable relievers.

Colorado does have a nice selection of quality arms coming up through the system, but they will need to depend heavily on Manny Corpas, Franklin Morales, Randy Flores, and Taylor Buchholz, all of whom struggled with either injuries or ineffectiveness in '09. I wouldn't be surprised if O'Dowd finds one more "insurance plan" among the remaining crop of free agents, perhaps an inexpensive veteran like Guillermo Mota or David Weathers, or an return engagement for Contreras or Fogg.

By not offering arbitration to Garrett Atkins, a player who was once at the center of Colorado's offensive plans, the Rockies have committed full force to Ian Stewart as their everyday third baseman. Stewart was very impressive against right-handed pitching in his first full season (20 HR, 823 OPS), but struggled mightily against southpaws (5 HR, 664 OPS). The Rockies may see this as an avenue to free up at-bats for Eric Young, who is currently without an everyday role. Or, they may still be in the market for a right-handed cornerman who can also pinch-hit, somebody like Mark Loretta or Nomar Garciaparra.

It's truly odd to say it, but going into 2010, one of Colorado's strengths is the depth of their rotation. Ubaldo Jimenez hasn't yet reached the notoriety of a Lincecum, a Greinke, or a King Felix, but he belongs among that class of pitchers, a truly dominant Ace still in his mid-twenties. Ubaldo went 15-12 in '09 with a 3.47 ERA and 198 K in 218 IP. Most importantly, he seems to have harnessed his incredibly nasty stuff, dropping his walk rate from 4.7 to 3.5 every nine innings.

Lining up behind Jimenez the Rockies have the reliable veteran, Aaron Cook, who over the last four seasons has averaged 29 starts, 11 wins, and a 4.11 ERA, and the 2009 breakout lefty, Jorge de la Rosa, who went 16-3 for Colorado from June 1st until the end of the season.

The Rockies are also anticipating the return of Jeff Francis, who was considered their ace before injuries cost him much of 2008 and all of 2009. If Francis shows anything resembling his former talent, the Rockies will possess a front four which is among the best in the National League.

The final spot will go to Jason Hammel, at least to begin the year. Hammel was very solid in '09 (10-8, 4.33 ERA, 1.39 WHIP, 177 IP), good enough to get first dibs, but he will be pressed to perform by the advancement of young guns like Jhoulys Chacin, Esmil Rogers, and Chaz Roe, all of whom look ready for major-league action. O'Dowd may choose to convert one or more of them into relievers, at least temporarily, as he did with Franklin Morales.

The star of the show in Denver will always be the offense. Even as production has decreased in recent seasons, thanks to the humidifier, Coors Field still consistently ranks among the top three parks for run production. What O'Dowd has improved at over the last few years, however, is putting together lineups which are dangerous in any climate and every stadium. He's still got the hard-swinging flyball specialists like Stewart and Chris Iannetta, but they are combined with speedy slap-hitters like Dexter Fowler and Eric Young, all-fields RBI men like Todd Helton and Brad Hawpe, and, most importantly, five-tool talents like Troy Tulowitzki and Carlos Gonzalez.

Especially if Iannetta bounces back from a sub-par '09 campaign that saw him eventually lose the starting role to Torrealba, the Rockies will have a lineup that rivals the depth of those in Los Angeles, St. Louis, and Milwaukee (no lineup in the NL is as complete as Philadelphia's at the moment). And, like each of those teams, they won't be satisfied by anything less than October baseball. No reason why they should be.

Projected 2010 Opening Day Roster:

CF Dexter Fowler (S)

LF Carlos Gonzalez (L)

1B Todd Helton (L)

SS Troy Tulowitzki (R)

RF Brad Hawpe (L)

3B Ian Stewart (L)

C Chris Iannetta (R)

2B Clint Barmes (R)

SP Ubaldo Jimenez (R)

SP Jorge de la Rosa (L)

SP Aaron Cook (R)

SP Jeff Francis (L)

SP Jason Hammel (R)

CL Huston Street (R)

SU Rafael Betancourt (R)

SU Taylor Buchholz (R)

MR Manny Corpas (R)

MR Franklin Morales (L)

LOOGY Randy Flores (L)

SWING Jhoulys Chacin (R)

C Michael McKenry (R)

IF Mark Loretta (R) FA

IF/OF Eric Young (S)

OF Seth Smith (L)

OF Ryan Spilborghs (R)