In June, an MRI determined that Mulder was suffering from a shoulder impingement, inflammation of the rotator cuff and slight fraying of the labrum. Yet rest and anti-inflammatories, rather than surgery, was prescribed. The big lefty went onto the disabled list on June 22.
He was throwing again by the second week in July and continued to do so off and on for the remainder of the month. After three lukewarm minor league rehabilitation starts, Mulder returned on August 23, only to be rocked in two appearances. He claimed he wasn't in pain, but was still unable to fully extend his arm.
A second MRI with the same finding as the first put Mulder back on the DL on August 31. He underwent surgery in New York on September 12 to repair a partial thickness tear of the rotator cuff. According to Cardinals head team physician George Paletta, the rotator cuff was approximately 50-percent torn.
In my limited research, I have found few pitchers who have come back from rotator cuff surgery to perform at their previous level of effectiveness.
So what are the Cardinals trying so hard to buy here? Is Mulder still damaged goods?
Former(?) teammate Chris Carpenter is among those few who have came back from labrum surgery, but how do the two, rotator cuff and labrum, differ?
This 2004 article from Slate magazine, though slightly dated, explains the two surgeries quite well. link
To better understand the expected time and level of recovery possible here in 2006-2007, I contacted our baseball injury expert, Rick Wilton of the Baseball Injury Report. Wilton has looked at rotator cuff and labrum injuries in the past at the BIR.
Getting detailed information about these surgeries is often difficult in these days of HIPAA, the Health Insurance Portability and Accountability Act, which includes provisions for the security and privacy of health data. Basically, we get to know what the player wants us to know and no more.
Wilton explained. "With HIPAA now in force, teams are less likely to reveal the extent of the damage. What the Cardinals released regarding Mulder was amazing and rare.
"Unlike Tommy John surgery where it involves one ligament in the elbow and is fairly simple operation, the rotator cuff is much more complex and involves four muscles/tendons and the glenoid labrum is a cartilage-like tissue that tends to be a slow healer," Wilton said.
In the case of Mulder, Wilton was not nearly as optimistic as his agent Gregg Clifton, who forecast this past week that Mulder should be ready to make 21 to 25 starts in 2007. Rick sees it quite differently.
"When a pitcher has a rotator cuff injury, unless we are told it is a massive tear, most will make it back, though it may be a year before the pitcher gets all his strength back," Wilton warned.
But, again due to HIPAA, information flow is spotty and therefore, so is an accurate reading on recovery time. Wilton used the labrum as an example to make his point. "In regards to the labrum, we rarely get word if it was a tear or a fraying. If we get word of a tear, was it off the bone? How much of a tear? Etc…"
He continued. "Labrum injuries (like Carpenter's was) are more serious because the tissue heals a lot slower, due in part to limited blood supply. As a result, the pitcher may never be the same after the injury. Pitchers with labrum injuries seem to need at least one full year to bounce back."
Some unfortunate few have been dealt a double whammy. "If they have both a rotator cuff and labrum tear like (free agent) Tony Armas (formerly of Washington), it can be years or never before they fully recover," said Wilton in closing.
So, what does this mean to Mark Mulder and the Cardinals? Despite the glowing reports coming from his agent, expecting as much as half a season out of the lefty in 2007 would seem to be overly optimistic.
Certainly, the Cardinals or any other club will be looking to get a second year in any contract for the rehabbing pitcher. That makes sense because based on his November rotator cuff surgery and normal recovery time projections, 2008 would seem to be the best season of the two. On the other hand, no one knows if the fully-rehabbed pitcher will be the Mulder of old, so committing a third year would be risky.
Ron Shandler's "2007 Baseball Forecaster", for which Wilton is a contributor, says this about Mulder. "Write this season off due to a torn rotator cuff and surgery. But the real question is whether this ailment has been festering for two-and-a-half years. This is not the same pitcher who dominated pre-2004. Wait for post-surgery results."
There has been disagreement as to the duration of the injury. Agent Clifton feels it may have first developed in 2005, which would explain Mulder's inconsistent mechanics during his first season in St. Louis. Yet, after the surgery Paletta said, "…it does not look like something that's been there chronic for years and years and years."
It certainly begs the "What if?" question of where Mulder would be now had he undergone surgery this June or even back in 2005. But, that is water under the bridge.
The bottom line is to be pessimistic about Mulder's projected 2007 contributions no matter where he signs.
So even if Walt Jocketty lands the free agent, Cardinals fans should hope his Holiday shopping doesn't stop there.
Brian Walton can be reached via email at firstname.lastname@example.org.
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