Will Bad Elbows Unite Carpenter and Pujols?

Chris Carpenter's elbow chronology offers an interesting comparison to Albert Pujols' present and future.

St. Louis Cardinals fans clearly recall the spectacular 2005 season, during which the club racked up 100 regular season wins for the second consecutive year. Pitcher Chris Carpenter and first baseman Albert Pujols swept the major player recognition in the National League, the Cy Young Award and Most Valuable Player Award.


The following season, the two led their club to its first World Series victory in a quarter century, but immediately in 2007, their fortunes diverged, until both returned to the top of their individual games in 2009.


On April 1, 2007, starting on opening day for the third consecutive season, Carpenter uncharacteristically struggled, yielding five runs in six innings. The next day, the right-hander complained of stiffness and soreness in his elbow. Carp was diagnosed with inflammation and placed on the disabled list.


From there, a downhill slide began that cost Carpenter the remainder of the 2007 campaign with his rehab continuing into July, 2008. At that point, an unrelated nerve problem affecting his shoulder cut down the remainder of his 2008 season, too. 


We will look back at what occurred during that 2007 with an eye toward whether the current situation with Pujols' injured elbow might follow a similar trajectory.


Carpenter was placed on the DL on April 10, 2007. Following an MRI, the official reason went beyond the initial inflammation description to state moderate arthritis and a mild impingement in the elbow were found, but no evidence of an acute ligament injury. The latter implied Tommy John surgery did not appear to be required.


In late April, Carpenter threw a 67-pitch bullpen session, which I recall being among the masses watching with great interest. At that point, the impingement and swelling was commonly being referred to as having been caused by bone spurs.


A quick digression into the medical world. According to WebMD, "A bone spur forms as the body tries to repair itself by building extra bone. It generally forms in response to pressure, rubbing, or stress that continues over a long period of time."


So what you have is bone spurs occurring as the body tries to compensate for another problem.


Back to 2007, on May 8 the Cardinals announced that Carpenter underwent arthroscopy of the right elbow with debridement and removal of bone spurs. According to the club, the surgery went well with no unexpected findings.


By the start of July, Carp was throwing again in Jupiter, Florida. He made two rehab starts with Palm Beach before the swelling returned. By mid-month, Carpenter had consulted with at least two specialists, including famed Dr. James Andrews in Birmingham, Alabama, who reportedly does 150 ligament replacement surgeries per year.


On July 24, 2007, Cardinals team physician Dr. George Paletta conducted the Tommy John elbow ligament replacement surgery on Carpenter's right elbow.


In summary,


  • April: First there was inflammation.
  • Bone spurs were found but no significant ligament damage.
  • Carpenter tried to pitch through the pain caused by the spurs.
  • May: Surgery for removal of the spurs was required.
  • July: When Carp tried to return, the ligament required surgery.
  • A year and a half of his career was lost.


How does this compare to Pujols' current situation? While there are similarities, there is at least one big difference – Pujols existing condition.


Whereas Carp's ligament apparently checked out ok when his spurs were removed, it is already known and has been for years that Pujols' ulnar collateral ligament (UCL) has a high-grade tear. Pujols' tear was called worse than Carpenter's by Paletta and as such, he will eventually require Tommy John surgery. Yet he has been able to play with it longer since first base is far less demanding on the elbow than is pitching.


Another difference is that Pujols already had nerve transposition surgery on the elbow last off-season, a procedure Carpenter required a year and a half after his TJ surgery. The stated reason Pujols had that October, 2008 surgery was in an attempt to relieve numbness and weakness in his hand. The official terminology was decompression and transposition of the ulnar nerve.


Pujols was diagnosed on Tuesday as having five bone spurs, an ongoing problem that has been known since at least 2008. I found a reference to Pujols mentioning pain caused by bone spurs during his rehab from the nerve surgery as a reason for having to sit out of the World Baseball Classic this spring.


Though no other issues with the elbow were reported following the nerve surgery, some of the spurs were already there. Given that, why were they not removed during last October's procedure? The answer could be because they were helping to protect and stabilize the injured ligament.


The big question is what might happen following the removal of the spurs.


Will Pujols' UCL then give out as Carpenter's healthier one did or will Pujols continue to buy time, evading the major surgery that will eventually be required?


Another unstated possibility when the elbow is opened up on Wednesday is that Paletta and Andrews will go ahead and replace the ligament as well, a step that would cost Pujols as much as the first half of the 2010 season.


We should have at least part of the answer later in the day on Wednesday.


Update noon CT Wednesday, 10/21: The surgery was completed Wednesday morning and was proclaimed "a success" by the Cardinals. Chips were removed, spurs debrided and Tommy John surgery was deemed not to have been necessary.


For the rest of us, the waiting will continue. 


Pujols is two seasons away from potential free agency. Any lingering concern over the elbow could provide some drag on the player's open market value.  


In the interim, an in-season flareup requiring TJ surgery during 2010 or 2011 would most likely mean Pujols missing the entire remainder of that campaign, an occurrence that could doom the Cardinals' post-season hopes.



Link to earlier article: "Pujols Elbow Surgery Wednesday".


Brian Walton can be reached via email at brian@thecardinalnationblog.com. Also catch his Cardinals commentary daily at The Cardinal Nation blog.


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