There have been a couple of monumental advances in sports injury medicine over the past few decades that produced surgical procedures that have saved the careers of untold numbers of players, stars and journeyman alike, from the pioneering work of Dr. Frank Jobe in developing the ulnar collateral ligament transplant, commonly referred to as “Tommy John Surgery”, that reconstructs the elbow and in 90% of instances returns the player to his former elbow strength, to micro-fracture surgery, developed by Dr. Richard Steadman, a surgical process that for the first time enables the actual repair of knee cartilage, as opposed to traditional surgical procedures that could only remove damaged cartilage. As with “Tommy John Surgery”, micro-fracture surgery has resurrected and extended the professional careers of significant numbers of athletes, from baseball players to football players and to others around the world.
But when it comes to significant injuries to other areas of the body, and in particular to professional baseball players and among them to pitchers, medical advances over the years
have been far less successful, and most significant among those where success is yet to be found involve injuries to the shoulder. It was back in the late 1960s and early 1970s that sports’ injuries to the rotator cuff first began to be diagnosed, and the immediate medical response was surgery, surgery to repair tears to any of the four muscles that attach at different sites on the scapula, a.k.a. the shoulder blade, either the supraspinatus, infraspinatus, teres minor or the subscapularis. Back in the 1970s, guinea pigs such as star right-hander Steve Busby, diagnosed with such a tear were rushed into surgery and the results for him, for others of that day, and still for pitchers today, are all the same, and none are good. I do not believe there has ever been a single major league pitcher to undergo rotator cuff surgery and then return to being or to become a successful major league pitcher.
With the record of unsuccessful rotator cuff surgeries, conservative treatments were developed, and the standard treatment for all but total muscle tears quickly became physical therapy and other rehabilitate treatments, and the success rate increased exponentially, returning injured pitchers to their prior level of success on a regular basis, through not with the success rate of “Tommy John Surgery”.
Unfortunately, pitchers who incur other serious shoulder injuries suffer the same fate as those with rotator cuff tears, and that is decent success and return rates where conservative treatment is indicated, but a reality of total failure where the only available course of treatment is surgery. As with such star pitchers before him as Johan Santana, the anterior capsule tear suffered by the Dodgers’ Julio Arias falls directly into the category; it is the same career-ending injury suffered by Santana and from which he never recovered, despite not one but two surgeries to repair the damage. Other pitchers’ whose careers were ended by the same injury include Mark Prior, John Danks and Rich Harden. Chris Young also suffered the injury and had surgery, and did return to the major leagues, becoming perhaps the single most successful pitcher to have suffered the injury and then undergone surgery. Never a star before the injury, Young, just this week Designated For Assignment by the Kansas City Royals, has a post injury 26-24 record with a 4.30 ERA over 112 appearances.
Urias may have one advantage over other pitchers who have suffered such an injury and this is the manner in which the injury occurred. Tears to the anterior capsule of professional pitchers are most frequently wear and tear injuries suffered over time, such as with the long time veteran Santana, who had pitched close to 2,000 major league innings before his diagnosis (and exactly 117 after surgery, going 6-9 with a 4.85 ERA). With Urias, they say his injury was a single event traumatic injury, occurring on a single pitch.
Whether it’s wishful thinking or whether there is actual medical evidence in support of the theory, it is being said, at least among Dodgers’ executives, that the difference could be significant for Urias, for his recovery, and for a return to form.
Shoulder injuries for which there were no successful medical treatments ended the careers of Dodgers’ Hall of Famer Don Drysdale, long-time Dodgers’ stalwart Pete Richert, and one-time top Dodgers’ prospect Rich Rodas, as described in a recent post about Mike Trout and injuries incurred in head-first slides.
I hope that I am wrong, that medical advances have progressed in the years since Santana and Young and the rest had their surgeries, and that Urias will fully recover and resume his road to major league stardom, but the odds are significantly against him.