After all the hand-wringing about Michael Pineda‘s velocity this spring, and his subsequent sidelining with shoulder pain/weakness, we finally have a resolution. Unfortunately, the resolution was not a positive one, as a dye-contrast MRI found that Pineda had a torn right anterior labrum (a ligament that goes around the socket of the shoulder). This injury (as I learned in researching this piece) is also known as a Bankart Tear. This injury would require arthroscopic surgery, sidelining Pineda for the entire 2012 season, and possibly jeopardizing his future. Shoulder injuries tend to be considered more difficult to recover from than elbow injuries, so it appears likely that Pineda will have a long road to recovery ahead of him.
This injury certainly provides ample opportunity for criticism and second-guessing. Despite the Yankees’ (and Mariners’) assertion that Pineda wasn’t injured at the time of the trade (since he passed his physical), this injury does raise the possibility that the Yankees may have acquired damaged goods in Pineda. Even if the Mariners had no knowledge of the injury, perhaps Pineda’s second-half struggles in 2011 could be linked to some health problems. There will also likely be criticism for trading a top hitting prospect in Jesus Montero for a young power pitcher like Pineda, because the injury risk for pitchers is so much higher than for hitters. There will be plenty to discuss on this front, but for the moment, I’m going to leave that topic behind.
Instead, I want to take a look at what the potential likelihood was for Pineda to make a full recovery, by looking for comparable historical cases. The existing perception regarding labrum tears is that a torn labrum is one of the worst injuries that a pitcher could suffer, and recovery is unlikely. In a 2004 article in Slate, Baseball Prospectus’ Will Carroll referred to a labrum tear as “baseball’s most fearsome injury.” He mentioned that of 36 pitchers who suffered a torn labrum between 1999 and 2004, only 1, former Expos closer Rocky Biddle, was able to get back to his previous level of performance. ”If pitchers with torn labrums were horses they’d be destroyed” Carroll wrote ominously.
While Carroll’s take on the chances of recovering from a torn labrum was exceptionally pessimistic, a 2010 article by Larry Stone of the Seattle Times had a more of an optimistic outlook. Stone was examining the possibility of recovery for then-Seattle lefty Erik Bedard, and looked at 5 cases to see the range of possibilities. Of the 5, 3 (Chris Carpenter, Jon Rauch and Trevor Hoffman) recovered and were able to go on to further major league success while Jason Schmidt was never the same. The 5th pitcher, Casey Janssen was too recent of a case for Stone to assess, but has come back to be a serviceable (1.7 bWAR) pitcher in a relief role in 2011.
Since Stone’s article, we can add a few more data points that may provide additional information. Diamondbacks ace Brandon Webb had surgery for a torn labrum in August 2009, this after a strong 2008 season in which he finished as a runner-up for the Cy Young Award. Webb’s recovery process was slow, as he demonstrated diminished velocity. After exercising Webb’s 2010 option, a year in which Webb did not make a major league appearance, the Diamondbacks did not attempt to resign Webb, who was now a free agent. Webb wound up signing a 1-year deal with the Rangers, as he attempted to work himself back into form (he was reportedly throwing in the mid-80′s). Webb pitched 12 mediocre innings for Texas’ AA club before undergoing another shoulder surgery (this time to fix a torn rotator cuff) in August of 2011. Webb has been rehabbing and will attempt to latch on with another team when he is ready, but after his second surgery, his chances of regaining his Cy Young form (or anything near that) look remote.
Kelvim Escobar is a similar situation to Webb. Escobar went under the knife in 2008 to repair a torn labrum, and looked to work his way back in 2010 with the Mets. However, Escobar tore a capsule in his right shoulder while he was working his way back, and did not pitch a game for the Mets. He is still working his way back and hopes to return to the majors, but as with Webb, the chances are slim.
Erik Bedard had labrum surgery in 2009, but unlike Webb and Escobar, he was able to make it back to the major leagues. After missing the entire 2010 season, Bedard re-signed with the Mariners and was traded to the Red Sox in 2011. Bedard missed time in 2011 due to a knee injury, limiting him to 129 innings on the season, but it was a major step for a guy who didn’t pitch in 2010. Bedard actually pitched pretty well in 2011, striking out nearly a batter per inning and posting a 3.64 ERA, good for 1.8 bWAR. He is off to a good start to as the Pirates’ nominal ace, and this will be a big test to see if he can hold up over a full season.
In addition to Bedard (so far), Rauch, Hoffman, and Carpenter, is at least one additional success story. Curt Schilling apparently had a torn labrum repaired way back in 1995, but went on to toss 183 innings with a 3.19 ERA in 1996 (and to have a phenomenal career afterward). I am assuming this was a very minor tear compared to some of the others based on the quick recovery and apparent lack of long-term problems, though it is possible that Schilling is just a freak (or maybe it was just ketchup on his shoulder).
What does all this mean for Pineda? It still seems that the odds are stacked against him fulfilling his potential as a future ace for the Yankees, but it is not completely out of the question. Carpenter and Schilling were both able to recover from their surgeries and win Cy Young Awards, while others such as Escobar and Webb saw successful careers sidetracked. Making predictions is difficult because there is very little information available on the type and severity of tear suffered by the other players, so it is difficult to know who would be the best comparable for Pineda.
Pineda’s injury, if it is in fact a Bankart Tear seems to typically be the result of a shoulder dislocation (though throwing and other overhead motions have also been associated with these injuries). Typically, the purpose of repairing the torn labrum would be to prevent further dislocations, and the success rate for this procedure is believed to be over 90%. However, preventing a shoulder from dislocating and getting a pitcher’s shoulder strong enough to throw 95 mph heat are entirely different, and presumably the latter would be much harder to achieve.
Despite all the doom and gloom, there may be room for optimism. That Pineda is undergoing arthroscopic surgery, rather than the more invasive open surgery, is a good sign, as the recovery time tends to be shorter. Mark Feinsand got a good quote from the Yankees’ team physician, Dr. Christopher Ahmad, who observed that Pineda’s prognosis was better than it could have been because there was no tear in his rotator cuff. With rotator cuff damage on top of the labrum injury, long-term velocity would be at greater risk.
Dr. Stephen Fealy of the Hospital for Special Surgery in New York wrote on the hospital website regarding labrum tears: “If fixed properly, most athletes should be able to return to at least 80 percent of their pre-injury level of play.” Eighty percent of Michael Pineda could still be a pretty good pitcher, but certainly not what the Yankees hoped to get when they dealt Jesus Montero. Pineda does have youth on his side, which could increase his chances of making a full recovery (just speculation on my part here). He certainly won’t be back any time in 2012, and could very well miss some time in 2013 depending on his progress. It will be a long and arduous road back to the majors for Pineda and Yankee fans, but I’ll be hoping that he can follow in the legendary footsteps of “Big Carp” and become an impact pitcher again.
Addendum: A few other names of pitchers who have come back successfully after having some kind of labrum surgery: Anibal Sanchez, Roger Clemens, Kerry Wood, Ted Lilly, and Jeff Francis.
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