Michael Pineda's labrum tear doesn't bode well for his future, but it's not the death sentence it used to be.
On Wednesday, the Yankees revealed that Michael Pineda had suffered a torn labrum, a devastating turn of events both for the 23-year-old righty and for the team that acquired him from the Mariners for top prospect Jesus Montero back in January. Pineda will miss the entire season and part of 2013, thinning the Yankees' surplus of starting pitching—and underscoring the fact that you can never have too much—while raising the question of whether they will ever get much value out of him.
Taking a look at an injury being treated in-season more often thanks to improvements in surgical techniques.
Among major-league players, treatments for torn labrums in the hip are on the rise. In our database, only eight major leaguers underwent surgery on their hips from 2002-2006. From 2007-2011, 33 players had a hip procedure performed. Improvements in surgical technique and technology have significantly shortened the rehabilitation, making surgery a viable option in the middle of the season.
While hip arthroscopy has been around for many years, it has been only relatively recently that its role in treatment for athletes with femoroacetabularimpingements and/or labral tears has significantly increased. Nevertheless, much like other conditions seen in baseball players, its frequency will continue to rise in the near future, perhaps limiting the severity of acquired osteoarthritis later in life.
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The skinny on an elusive injury that increasingly plagues pitchers.
Superior Labrum Anterior to Posterior (SLAP) tears are an increasingly common injury in baseball players. Much more common in throwing athletes than non-throwers, SLAP lesions have gained a lot more attention as baseball pitchers have been studied in greater detail.
Anatomy As we described in a previous article, the shoulder is made up of three bones but many different soft tissues. The clavicle, scapula, and humerus serve as attachment sites for the various muscles, ligaments, tendons, and nerves in order for proper function to occur. In the case of SLAP lesions, we are most interested in the labrum and the tendon of the long head of the biceps.
A rotator cuff tears isn't a death sentence for a pitcher's career, but it's far from a positive prognosis.
Baseball pitchers and rotator cuff problems seem to go hand-in-hand despite the rotator cuff being much smaller than other muscles about the shoulder and upper back. The four small muscles that make up the rotator cuff are vital to the shoulder’s health and to a pitcher’s playing career. In fact, at one time, rotator cuff surgery was considered a career-ending sentence. That isn’t the case any longer, but it still hasn’t reached the level of relative certainty of ACL surgery or even Tommy John surgery. Without a healthy rotator cuff, a significant cascade effect culminating in shoulder instability and/or tears of the labrum is possible, if not inevitable. In today’s episode of Collateral Damage, we will be looking at the rotator cuff and ways of treating it in all of their complexity.
The rotator cuff is made up of four muscles that attach at different sites on the scapula, a.k.a. the shoulder blade. These four muscles are known as the supraspinatus, infraspinatus, teres minor, and subscapularis. The main function of the rotator cuff as a group is to ensure that the humeral head stays centralized in the glenoidfossa. This cannot be emphasized enough. Two of the muscles—infraspinatus and teres minor—assist in external rotation of the shoulder, while the subscapularis is the only rotator cuff muscle whose role is as an internal rotator. The supraspinatus also assists in abduction, especially early in the motion. Without that rotator cuff, the humeral head would slide all over the place and tear up the labrum, articular cartilage, and other tendons in the area.
Peter Moylan can't catch a break, Denard Span gets into a car crash and emerges with a headache, Daric Barton and Miguel Cairo undergo shoulder surgery, Tim Hudson gets dehydrated, and Scott Atchison strains his groin.
Peter Moylan, ATL (Right shoulder torn labrum and rotator cuff) [AGL: 10 (93 DL), ATD: TBD (-.092 DL)] (Explanation) Moylan can’t seem to catch a break in 2011. After missing four months following surgery on a troublesome disc in his low back, his shoulder started to click on him during normal next day throwing after last Monday’s appearance. Clicking can be indicative of several different problems, ranging from swelling to full blown cartilage tears. However, over this past offseason, he underwent an MRI that revealed tearing in his rotator cuff and labrum.
A recent repeat MRI on Thursday revealed that the tearing has worsened and may require surgery. He will see noted surgeon Dr. James Andrews down in Birmingham for a second opinion, and it sounds like he will need surgery. Surgery will almost certainly put him out for most of the 2012 season, barring some unexpected good news. He doesn’t have to have surgery, but he is risking significantly more damage in his shoulder if he chooses to pursue the rehab route.
Hunter Pence attempts to stay in play for the playoffs, Pablo Sandoval continues to battle a strained shoulder, Cody Ross hits the comeback trail, Asdrubal Cabrera fends off the end of his season, and Kerry Wood gives up the ghost.
Pablo Sandoval, SFN (Left shoulder strain) [AGL: 3 (29 DL), ATD: -.002 (+.031 DL)] (Explanation) When Sandoval strained his shoulder in mid-August, few were expecting him to be limited for the remainder of the year as he has been. Still unable to hit from the right side because of the left shoulder pain, Sandoval may end up needing surgery after the season is completed. Typically, this mechanism of injury—Sandoval injured the left shoulder batting right-handed—is more indicative of instability or a partially torn labrum than a partial muscle tear.
In some cases, the ligaments and capsule are stretched and can be painful, while at other times the capsule and ligaments can be torn and end up needing to be stitched or anchored to bone for proper healing. The labrum can tear with a similar mechanism of injury and lead to deep pain and “something not feeling right” inside the shoulder itself.
Frank McCourt's team is hurt physically almost as much as financially as Rubby is rubbed out, Hanley and Kyle Davies hurt their shoulders, Cliff Pennington can't close his eye, and Buchholz fights to get back.
Rubby De La Rosa, LAN (Right elbow surgery—Tommy John)[AGL: 121, ATD: -.004] (Explanation)
The hits just keep on coming for the Dodgers, who have now suffered 23 disabled list entries this season. The injuries haven’t been limited to older players like Casey Blake, and the causes haven’t all been as simple as muscle strains. De La Rosa left the game on Sunday after throwing over 100 pitches in just four innings of work and was almost immediately placed on the disabled list with right elbow inflammation. He had been wild recently, and his elbow was likely contributing to his lack of control. The inflammation was just a harbinger of things to come, as De La Rosa was diagnosed with a sprained UCL, and reports came out yesterday that he was slated for Tommy John surgery. He's going to miss most, if not all of 2012 as a result.
Hanley Ramirez, FLA (Left shoulder sprain) [AGL: 8 (38DL), ATD: -.005 (-.019DL)]
Ramirez came out of Tuesday's game in the sixth inning with a left shoulder sprain, but given his history, there is obvious concern about further injury. It's been four years since he had surgery to fix a torn labrum after partially dislocating the shoulder while swinging. More commonly, a player dives for the ball with his arm extended and out to the side, which puts the shoulder in a prime position to dislocate. As a result, connective tissue and ligaments inside the shoulder (glenohumeral) joint will invariably become sprained in a failed attempt to stabilize the shoulder.
Rickie Weeks goes down with an ankle injury and takes Milwaukee's playoff odds with him, Dustin Moseley tries to make his way back, Clay Buchholz's back gets mysterious, and Craig Gentry suffers his fourth concussion.
Rickie Weeks, MIL (Left ankle sprain) [AGL: 29, ATD: -.003] (Explanation) The Brewers' chances took a serious hit on Wednesday night once Weeks went down. In the midst of one of the top offensive seasons among NL second basemen, Weeks was lunging for first base trying to beat out a grounder when he injured his ankle. It rolled inward significantly into inversion (he was lucky that he did not suffer a concurrent injury with that mechanism). After the medical staff ruled out a major fracture at the stadium, Weeks went to the hospital for further specialized imaging and was diagnosed with a sprained ankle.
In reality, any sprain, even the mildest one, does ligament damage. When potential ligament damage is discussed in the various news and media outlets, it’s implied that it involves partial or complete tearing of the ligament. Grade II sprains include anything from 20 percent to 80 percent or more of the fibers torn, leaving a wide range in the prognosis that isn't very helpful to most of us trying to plan our fantasy trades approaching the wire.