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The Blue Jays just announced that Dustin McGowan will have arthroscopic surgery to repair fraying of his labrum, next Thursday in Cincinnati.



McGowan Surgery | 35 comments | Create New Account
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Original Ryan - Saturday, July 26 2008 @ 02:44 PM EDT (#189518) #
A torn labrum is a nasty injury for a pitcher, but generally what is the success rate for pitchers who undergo surgery for a frayed labrum?
Gerry - Saturday, July 26 2008 @ 02:52 PM EDT (#189519) #
Bad news, I believe a frayed labrum is the same as a torn labrum.  Here is some medical input on the labrum.  The article suggests that the level or degree of the tear is the most important issue.
Smithers - Saturday, July 26 2008 @ 03:24 PM EDT (#189523) #
This is obviously bad news for both McGowan and the Blue Jays, and pretty much is what we feared the most when news of his sore shoulder surfaced.  Basically we went one for two in the starting pitcher injuries, Marcum's turned out well, McGowan not so much.

It is however good news for a few guys, as it opens up an opportunity for an extended audition in the rotation.  Namely, John Parrish and David Purcey could be around (and cheap) for a while, and Jesse Litsch might have the rails greased for his return to the big club earlier than expected. 

It seems we go through a discussion of the chances of recovery from labrum surgery every time it happens.  It is essentially the same operation that has recently been carried out recently on Jays starters Casey Janssen and Gustavo Chacin.  According to a 2004 article by Will Carroll that is continually referred to by naysayers, the odds of coming back are not good at all.  But in recent years the success stories have become more commonplace, see Chris Carpenter's Cy Young award and Gil Meche's recent pitching and monetary resurgence with Kansas City.

greenfrog - Saturday, July 26 2008 @ 03:24 PM EDT (#189524) #
I would be surprised if McGowan is ready for spring training, especially given that both the labrum and rotator cuff are potential red flags. And doesn't shoulder surgery typically require a year or more of recovery time?

This issue typically gets glossed over in the media, but I wonder whether McGowan's big innings jump in 2007 had anything to do with the injury (101.1 innings in 2005; 111.1 innings in '06; 191.2 innings in '07). Isn't there some correlation between big leaps in innings pitched for a young pitcher and injuries, especially when that pitcher has a history of arm problems? The same thing occurred to me with Janssen's heavy relief workload last year (70 appearances in his first year as a reliever).

Of course, this is all speculation. It may be that both pitchers' shoulders would have given out eventually, even with a lighter workload. But I would be interested to see a comparative analysis of the way McGowan and Janssen were handled. The Jays might also want to rethink how they manage Marcum going forward.
timpinder - Saturday, July 26 2008 @ 03:26 PM EDT (#189525) #
So Dustin McGowan has already had Tommy John surgery and now he has a torn labrum and also a rotator cuff tear.  If he ever makes it back my hope is that the Jays put him in the bullpen and try to get the most out of him.  I don't see McGowan ever being a reliable (health wise) starter in the majors.  This is a big blow to the Jays who now must hope that Purcey and/or Cecil are ready next year.
Schad - Saturday, July 26 2008 @ 03:30 PM EDT (#189526) #
Fraying indicates that it's a minor tear, which offers hope that McGowan might be fully rehabbed by Opening Day. The real worry, though, is that this will permanently lower his velocity; I'm not sure how effective he could be pitching in the 91-93 range, and trimming his labrum still leaves him open to re-injury.
rtcaino - Saturday, July 26 2008 @ 04:42 PM EDT (#189529) #
I had a bad feeling about Cito coming back...
92-93 - Saturday, July 26 2008 @ 05:02 PM EDT (#189530) #
This one can't be blamed on Cito - he averaged 83 pitches over 4 starts under his watch, the most being 104. If anything, it was the complete game he tossed against Seattle on June 10th when Gibbons rode him for 125 pitches. Since then, it's been downhill.
Schad - Saturday, July 26 2008 @ 05:42 PM EDT (#189533) #
If anyone is looking for a smoking gun, it is probably late 2007. Through August 21st, McGowan had thrown 144 innings between AAA and the majors, and acquitted himself nicely. However, he had thrown 95 or more pitches in eleven consecutive starts; his workload was piling up, and the Jays were all but out of the hunt.

Does Gibbons -- or, to spread out the blame, the organization as a whole -- recognize that it might be wise to cap the workload of a young pitcher who had not thrown over 110 innings since he was a 21 year old kid split between A/AA (after which he required Tommy John surgery)? Of course not; McGowan finishes the season by throwing an average of 106 pitches in his last seven starts, including 112 in a meaningless 5 IP six days after he threw a complete game. When most teams would be easing things down to protect a valuable asset, Gibby was proving that his pitcher abuse scale goes up to 11.
greenfrog - Saturday, July 26 2008 @ 05:47 PM EDT (#189534) #
The Jays' rotation next year could look something like: Halladay, Marcum, Purcey, Cecil, Litsch. Yikes. And there isn't much backup in the system (Parrish? Romero?). The young pitchers might be ready to step up by spring '09, but on paper this looks like quite a drop-off from Halladay, AJ, McGowan, Marcum, Litsch.

I wonder if the Jays are rethinking their stance on extending Burnett (I doubt it--too expensive, and the injury risk is still there--but having AJ would help stabilize the rotation). This whole situation highlights the idiocy of the opt-out clause in his contract.
Jimbag - Saturday, July 26 2008 @ 07:20 PM EDT (#189538) #
One thing that often gets overlooked when a pitcher suffers a "progressive" injury like this is how well informed the training staff are of the soreness as it continues. And by that, I'm referring to the unwillingness of the pitchers themselves to inform the medical staff, for fear of being used less. There is still a bit of a "walk it off, Nancy" attitude across all pro sports - not simply for the "tough-guy" aspect, or even for the potential financial impact - but simply because these guys know they have a short career and really want to make the most of it.

The usual reaction in a situation like this is to blame the manager / coaching staff / medical staff. I'm not implying that this is anyone's fault - that would require information that none of us have. I just wanted to remind everyone that the players bear some responsibility for their well-being as well.

Having said that, all I can add is I hope the surgery is successful and McGowan comes back in the same form he had last season. I looked forward to his starts almost as much as Halladay's last year, and this season, too - until the injury.

TamRa - Saturday, July 26 2008 @ 07:54 PM EDT (#189539) #
According to a 2004 article by Will Carroll that is continually referred to by naysayers, the odds of coming back are not good at all.

Carroll himself has recently commented on that article:


The reason the article is “essentially obsolete” is that techniques in both surgery and rehab have changed so significantly. Whether it’s newly constructed bone anchors, changes in surgical methodology, or having far too many pitchers to practice on, it’s not a death sentence for pitchers any more. It’s not good by any stretch, but it’s not as bad as it was just a few years back.


Also...

So Dustin McGowan has already had Tommy John surgery and now he has a torn labrum and also a rotator cuff tear.

Where does it say he has a torn rotor cuff? Saying they are going to look at it while they are in there is not saying he has damage to it.


timpinder - Saturday, July 26 2008 @ 08:05 PM EDT (#189540) #

WillRain,

There was never any question that McGowan had a tear in his rotator cuff.  The Jays acknowledged that, but were hopeful that the tear hadn't worsened and that it was still the same size as it was when it was revealed in an MRI last year.  So yes, he has had TJ surgery, he has a tear in his rotator cuff, and now he has fraying of the labrum.  This does not bode well at all for his future as a starting pitcher.

Here's the most recent article on bluejays.com:

http://toronto.bluejays.mlb.com/news/article.jsp?ymd=20080726&content_id=3199411&vkey=news_tor&fext=.jsp&c_id=tor

The_Game - Saturday, July 26 2008 @ 08:06 PM EDT (#189541) #

McGowan's MRI from a few weeks back is what said he had a torn rotator cuff.

http://toronto.bluejays.mlb.com/news/article.jsp?ymd=20080709&content_id=3100999&vkey=news_tor&fext=.jsp&c_id=tor

The_Game - Saturday, July 26 2008 @ 08:13 PM EDT (#189542) #

Seems like I was beaten to the punch.

And yes, this doesn't bode well for his future as a starting pitcher in this league at all. I did enjoy watching both Burnett and McGowan, two "stuff" pitchers the last few years. Looks like we may not see either of them next year in that form.

Ryan Day - Saturday, July 26 2008 @ 09:00 PM EDT (#189545) #
I'm not sure anyone fully understands why pitchers get hurt, so it's hard to lay blame anywhere. Casey Janssen got hurt, and he wasn't worked very hard. And people spent five years predicting Livan Hernandez's breakdown before they finally gave up.

You can quibble with some of McGowan's usage, but I don't see anything that clearly says "abuse."  (in the same way that, say, Mark Prior's 2003 says "what the hell were you thinking?") The Jays could have been more cautious with him, but he might have gotten hurt anyway. It happens.

King Ryan - Saturday, July 26 2008 @ 10:09 PM EDT (#189546) #
Heartbreaking.

There is a non-zero chance we never see McGowan or Aaron Hill on the Jays again.

greenfrog - Saturday, July 26 2008 @ 11:07 PM EDT (#189547) #
"I'm not sure anyone fully understands why pitchers get hurt, so it's hard to lay blame anywhere. Casey Janssen got hurt, and he wasn't worked very hard."

I agree that no one fully understands why pitchers get hurt, but I think it's a question worth looking into. And teams know a lot more than they used to. I think BP posted an article at one point arguing that young pitchers (possibly with a history of injuries, I can't remember) experience a significantly higher injury risk when their workloads are suddenly upped from one year to the next. This was the case with McGowan, whose innings nearly doubled from 2006 to 2007. And although Janssen's total IP in 2007 weren't that high, I think a case can be made that his workload was fairly heavy: in his first year as a reliever, he pitched in almost half the team's games, many of them high-leverage situations (not to mention all the times that Gibbons had him up and throwing).

I'm not saying that the Jays are to blame for the McGowan and Janssen injuries. But I would be interested in seeing if there is any research in this area, rather than simply dismiss it as something no one will ever understand.
Ryan Day - Sunday, July 27 2008 @ 01:19 AM EDT (#189548) #
I don't mean to dismiss the question itself - I'm always surprised that some team hasn't commissioned a $20 million study into pitching mechanics, having a bunch of minor league guys MRI'd after every game or something.

But here, on a message board, no one really knows anything. It's not a question that can be answered by monitoring pitch counts or statistical analysis.

PeteMoss - Sunday, July 27 2008 @ 08:27 AM EDT (#189549) #
If they say he can be back by spring training, then it is definitely not the same as a torn labrum.  If it was torn he would be out at least a full calendar year and likely more before he started pitching again.  Obviously what the Jays say about injuries isn't to be taken as gospal.

One guy who will likely be back in the next 7-10 days from a torn labrum is Annibal Sanchez of the Marlins, he of the no-hitter and the 2nd piece of the Josh Beckett trade. 

nanook - Sunday, July 27 2008 @ 11:40 AM EDT (#189551) #
I hope you'll excuse me, but I go back to four-man rotations and an era when 200 innings wasn't a big deal. Neither was 100 pitches.
It's a long time ago, but if I remember correctly guys were mostly fastball/curve/change-up types.
So I'm wondering if the seemingly high incident rate for pitcher injuries might be a result of pitches like the cutter, or if steroid use might have something to do with it.
From what I've read 'roids do tend to make people more brittle.
I'm not trying to cast aspersions, just throwing out some food for thought/

Geoff - Sunday, July 27 2008 @ 12:54 PM EDT (#189552) #
I would say that today's pitchers are finding all kinds of ways to get stronger than pitchers in years past, as well as finding ways of how to throw the ball harder, and with more movement at high velocity, than pitchers in years past. Drugs are only a part of the system and removing them I don't believe would cure the system of all these injuries.

I'd like someone to point out all the pitchers who throw very hard who have not experienced arm trouble, because I don't imagine the list is very long. Today's pitcher is so focused on conditioning and strength and mechanics to achieve the best possible velocity, movement and location that he is pushing his body to the limit of how much stress it can handle. Pitchers from bygone eras did not subject their bodies to such high stress levels. Granted, I have no empirical proof of such a claim nor have I any other evidence or established opinion. And this whole theory hinges on that claim. That pitchers from previous eras, by and large, did not experience the same pressures to increase their strength, mechanical performance and the velocity and break of their pitches, as do pitchers of this era.

For that reason we have a greater incidence of pitchers with bad shoulders, elbows, backs, knees, and any other possible joints. The higher stress levels they put on their bodies makes them more brittle because they are wearing themselves down. PEDs I would say are but a minor ingredient in the overall problem. I expect the only solution to this problem may be for teams to invest heavily in studies on genetics, or bionic enhancements. Human bodies are simply falling to the greater pressures as naturally constructed.

Magpie - Sunday, July 27 2008 @ 12:58 PM EDT (#189553) #
I go back to four-man rotations and an era when 200 innings wasn't a big deal.

So do I, but those of us who do always forget a couple of things. Mainly it wasn't like every team actually had four guys who were doing that for them. Most of them didn't, in fact - we tend to remember the ones who did have that kind of pitching, generally because they often played in October, which makes a team more memorable. Plus there were barely half as many teams anyway. There are probably more pitchers now who can handle that workload than there were in 1938 or 1978 (the talent is coming from a much larger pool) but there still wouldn't be enough to go around. There never was, there never will be.
Magpie - Sunday, July 27 2008 @ 01:07 PM EDT (#189554) #
I'd like someone to point out all the pitchers who throw very hard who have not experienced arm trouble

Good luck. For one thing, all of these guys throw hard. The ball may not  get there as fast, but the guy on the mound is generally throwing about as hard as he can.

And of course, the vast majority of pitchers who ever lived have experienced arm trouble. The vast majority. At least 98%. The guys who have successful careers are the ones who overcome their arm troubles, the ones who recover from the torn labrum (Curt Schilling, 1995), the torn rotator cuff (Jim Pamer, 1967)..
Schad - Sunday, July 27 2008 @ 01:08 PM EDT (#189555) #
Four-man rotations and 200 innings wasn't a big deal (200 IP still isn't a big deal...250 is, though), but it was pretty common for pitchers to be worked into the ground by their 30th birthday. For the heck of it, the career arcs of the top-2 workhorses in the AL for 1955, 1960, 1965, a golden era for pitcher abuse:

1955:

Frank Sullivan: five very good seasons between 24-28, went into a tailspin and was quite bad at age 30 and beyond.

Whitey Ford: one of those rubber-armed guys, Ford probably could have thrown until he was 50. Worth noting that with the exception of this season, his inning totals (while high) weren't as extreme as some other pitchers noted until after his 30th birthday.

1960:

- Frank Lary: became a regular at age 25, throwing 220 innings or more in seven straight seasons, culminating with 274 and 275 IP at 30 and 31, respectively. Basically cooked at age 32.

- Pedro Ramos: hit the bigs at 21, threw 2100 innings by his 30th birthday. Pitched for two more seasons as a useful reliever, done at 32.

1965:

- Mel Stottlemyre: almost 2500 innings between 23-31, retired at 32 with a complete mess of a rotator cuff.

- Sam McDowell: bad at 29 and finished at 30, two years removed from throwing 300+ innings. Alcohol was a factor as well, though.

Magpie - Sunday, July 27 2008 @ 01:31 PM EDT (#189557) #
Craig Burley made the point that Casey Stengel didn't work Ford nearly as hard as you would expect a top team's ace to work. Craig noted that Stengel didn't need Whitey Ford to beat Kansas City, but he wanted Ford fresh and strong for the World Series. Ford never started more than 33 games for Stengel.

Ralph Houk took over in 1961, when Ford was 32, and Ford started 39, 37, 37, and 36 games over the next four seasons. And then, in the first game of the 1964 World Series, the arm problems began. He had one last effective season in 1965, two more years badly disrupted by injury before calling it quits early in the 1967 season.

Geoff - Sunday, July 27 2008 @ 01:45 PM EDT (#189558) #
Anything you can say about pitchers of the past and how much effort they would put into everything? My thinking is that a lot of guys didn't know, mechanically, how to exert the maximum effort that today's guys do. And a lot just didn't care to push themselves hard every pitch, particularly because they wanted to spread out their energy over the entire game.

Nowadays, because those specialists we all love in the bullpen -- who are going to take the ball in any case-- are resting in the back of pitchers minds as they consider how much to put into each pitch, and the pressure to perform is then greater because you aren't going to be in the game long enough to do well now, and the hitters realize this and are smart to work the pitcher to throw as often as possible to wear him down. Then eventually the guy from the bullpen comes in and he experiences much the same trouble and if he does his job well enough, he may be called on to do it again tomorrow. Maybe even the next day. At maximum effort. There's only so much a human can take, and thousands of folks out there guessing at how to detect the breaking point, which is usually detected after the guy is broken. Not at 100 pitches a game, or x days of rest.

98% of pitchers are succumbing to injuries because the pressure to perform has ever been increasing. Question to Magpie then would be what kind of incidence of arm trouble there used to be. Is baseball maintaining roughly the status quo of catastrophic pitcher ailments? Is the gloom and doom of the day just an imaginary construct as a new development?

I expected the answer to be that all the guys today are throwing as hard as they can. Were they throwing as hard as they can, as often as they can, in previous eras?

Stories of ol' Jack Morris's philosophy to let up with a lead suggest otherwise, but not to many pitchers today not nicknamed Doc seem to understand how to economize effort in any way. (how great would it be to get him for an interview to discuss this topic?)
Schad - Sunday, July 27 2008 @ 03:25 PM EDT (#189560) #
I gave Ford the benefit of the doubt because I have never heard definitively whether his circulation problem was baseball-related or congenital.

Anything you can say about pitchers of the past and how much effort they would put into everything? My thinking is that a lot of guys didn't know, mechanically, how to exert the maximum effort that today's guys do. And a lot just didn't care to push themselves hard every pitch, particularly because they wanted to spread out their energy over the entire game.

Very true...Jim Bunning ran away with the AL strikeout title in the 1960 season mentioned above, with a K/9 of 7.18. That would be good for 18th in the AL this year, and with pitchers still hitting during that era one can depress those numbers further. The inveterate hackery of the modern game certainly plays its part in K rates, but enough teams throw out seven decent-or-better hitters (or at least guys with power) that an inning pitched today is probably more taxing than an inning pitched in 1960, despite the dilution of talent.
Lefty - Sunday, July 27 2008 @ 07:36 PM EDT (#189566) #

I've never seen the Box so quite as we get to within three days of the trade deadline.

I think this teams fans are spent.

Dave Till - Sunday, July 27 2008 @ 08:17 PM EDT (#189569) #
As I see it, there are three reasons why there are so many arm injuries:

- Pitching is an unnatural motion.
- Every pitcher has a different capacity for work.
- There's often a lag time between when a pitcher hurts his arm and when the damage becomes apparent.

Presumably, #3 happens because injuries don't happen all at once. First, the damaged part frays a little bit, then a bit more, then a lot more, and only then does it start to hurt. At that point, it's too late. This may be what has happened to McGowan.

I wouldn't kick Gibbons in the slats for "abusing McGowan". Not many pitchers are successful for any length of time going only 6 innings a start. And, to go more than 6 consistently, you have to be able to throw 110 pitches every now and again. Look at Halladay: every now and again, even he is pushed to 115 or so.

And monitoring a pitcher's workload is not an exact science, because of point 2. The only way to tell if you've overworked a pitcher is if he goes on the DL. Oops, that's too much. Bing!

MondesiRules - Sunday, July 27 2008 @ 10:21 PM EDT (#189579) #

Jays may offer AJ $14 mill for 09/10:

http://www.mlbtraderumors.com/2008/07/perrottos-lat-1.html

 

*hmm, I'd do it...

 

Magpie - Monday, July 28 2008 @ 01:35 AM EDT (#189585) #
First, the damaged part frays a little bit, then a bit more, then a lot more, and only then does it start to hurt.

What makes it even more confusing is that practically by definition, the arm is already damaged and the arm already hurts. Normally and inevitably. It goes with the territorry, it's the nature of pitching. The problem is trying to distinguish the additional damage and the additional pain from what normally comes with this extremely unnatural act.

"You know what it feels like to throw a baseball 100 miles an hour? It hurts. Everything hurts. Even your ass hurts."
 - Bob Gibson
TamRa - Monday, July 28 2008 @ 07:31 AM EDT (#189592) #
Well, for a minute there I was confusing "labrum" and Rotator Cuff as the same thing...i can't seem to find a good illustration showing the relationship of the two. I suppose I was mixing the previous statements about the RC being torn (and not more torn now than before) with the announcment of surgery to correct "fraying" as being to the same damage.

IN any case, what I was driving at was that the last we heard, there was no new tear and they did not think the RC was an issue and I - mistakenly perhaps - thought the post I was quoting was referring to some new revelation.





Geoff - Monday, July 28 2008 @ 09:28 AM EDT (#189595) #
Hadn't heard a sharp Gibson quote before..appears that one continues on a little bit. #3 He was really on that day.

Lefty - Monday, July 28 2008 @ 06:51 PM EDT (#189652) #
I'd do it too.
In fact I liked this idea as last season was coming to a close.
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