Within the Fanball family, we’re lucky enough to have a resource like Rick Wilton on our staff. Wilton has long been one of the more recognizable names to fantasy baseball players as a premiere source of information on baseball injuries. Before joining Fanball, Wilton ran the Baseball Injury Database site that tracked injury history and trends for baseball players; that database is now part of the suite of products Fanball offers to its OwnersEdge subscribers. Wilton also writes a weekly column updating injuries at OwnersEdge.com but he was nice enough to take my questions concerning J.P. Howell directly.
(DOTR): Labrum injuries on pitchers tend to come from usage issues rather than a pinpoint incident. How much do you think that fact Howell pitched in the World Baseball Classic and was used heavily in the 2009 in a variety of bullpen roles affected this situation?
For the most part labrum issues can be traced to usage but poor pitching mechanics can put undue strain on the pitching shoulder. Do you remember Roger Pavlik who used to pitch for Texas? He pitched across his body and that really put stress on both his elbow and shoulder. Usage AND mechanics can contribute to a labral tear. Heck, you can attempt to pick up a 100 pound suitcase and if your mechanics are not correct, tear the R/C or labrum at that time.
(DOTR) Will Carroll wrote an article for Slate (linked in our previous story) in 2004 that covered just how tough it was to come back from a torn labrum back then as only Rocky Biddle had been able to return to form at that time. Since 2004, how many pitchers have had labrum surgery and who are the success stories these days?
Will has backed off the Slate article in recent years. I’ve looked at labrum injuries as a group but not as a study for First Pitch Arizona. Because there are several types of labrum injuries and we rarely get the whole story medically speaking it is difficult to breaking down each category. Plus pitchers may have inflamed tissue removed, the rotator cuff repaired, shoulder capsule repaired or the bursa sac repaired.
Simply put, a frayed labrum usually is a bit easier to come back from but as we are seeing from Chris Young of the Padres, a pitcher can still struggle trying to return from that injury. I went through the DL lists in 2006/2008 a while back and could not find a clear cut case of the pitcher making a full recovery yet. In other words, they did not pitch as well as they did before they developed the shoulder injury. Until I start seeing some clear cut examples that they had labrum surgery to repair a tear and they make it all the way back I will continue to project a difficult return from this injury/surgery.
(DOTR) Ben Sheets and Jeff Francis both had labrum surgery in 2009 and we’ve seen them pitch with less velocity in 2010 than they displayed in previous years. Will they regain the 3-5mph on their fastballs they have lost or is that gone for good?
Sheets actually had surgery in February 2009 to repair a torn flexor tendon near his elbow. The big muscle in your forearm has a tendon that connects near the elbow, that is the tendon he tore and had surgically repaired.
Francis had surgery February 25, 2009 to repair both his labrum and rotator cuff. The problem in using Francis is the fact he also had R/C surgery means we cannot use him as a success or failure from labrum surgery. Also, the description does not say he had a frayed labrum or a tear. To me this is important in determining how soon he can come back. Again, add the R/C injury and it complicates matters.
(DOTR) Howell was shut down in late August 2009 when he was obviously tired and complained early in camp in February for a tired shoulder that the club went the rehab route with until deciding on surgery this week. Is there a reason why the club would not do a precautionary MRI (perhaps dye-enhanced) early in camp when Howell was complaining of a tired arm? Can a pitcher rehab his way through this injury or is surgery always the final outcome?
If they did not do a MRI it may be because the attending physician you have done a physical assessment of his shoulder and determined his shoulder was ‘stable’ thus he did not need to have a MRI. He may have had a MRI done on the shoulder but we were never told about it. It could have been a contrast media type too. HIPPA has messed up injury information reports so much we just are not getting the same quality news we were a few years ago. Pitchers can rehab a labrum injury, build up the muscles around the shoulder area to strengthen it and help protect the labral area. Lastly, labrum injuries almost never heal on their own. The patient may be able to tolerate the pain or the pain subsides and he avoids surgery but that is very rare.
Wilton also recommended readers visit this site for more information on labrum surgeries and rehabilitation methods. Thanks again to Rick for taking the time to answer our questions about Howell’s surgery.