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Cordero -- torn labrum, out for year

Another day, another major injury for the Nats.

I'll give it first in a sentence or two (along with the lineups below), and then come back with something more comprehensive within an hour or so.

For now:

Chad Cordero was discovered today, after receiving an arthrogram, to have a torn labrum. He will miss the rest of the season -- at least. He had been down in Viera, Fla., trying to come back from the shoulder injury that's bothered him all season. Cordero likely had the tear -- to some degree -- all season. He had been troubled by his lack of progress during rehab, and the team had been looking for an explanation.

Well, this was it.

More to come soon.

Washington

Bernadina - 8
Guzman - 6
Dukes - 9
Flores - 2
Young - 3
Belliard - 5
Lo Duca - 7
Harris - 4
Redding - 1

Florida

Ramirez - 6
Hermida - 9
Cantu - 5
Willingham - 7
Jacobs - 3
Ross - 8
Andino - 4
Treanor - 2
Tucker - 1

By Chico Harlan  |  June 30, 2008; 6:05 PM ET
 
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Next: More on Cordero

Comments

Wow, holy when it rains, it pours MattMan.

Seriously, the news about the Chief shouldn't come as a shock, but it does.

I'm going to go cry.

Posted by: Litany of Disappointments | June 30, 2008 6:09 PM | Report abuse

NEW POSTED!

If JimBow hadn't overpriced his closer on the trade market, this would be some other team's problem. Now, he and the team are stuck with the dreaded natsluck trifecta - Cordero is of no use to the Nats, he wasn't traded for any assets to bolster the farm system and this could be some other team's problem if he had been traded.

Posted by: leetee1955 | June 30, 2008 6:11 PM

Posted by: leetee1955 | June 30, 2008 6:13 PM | Report abuse

Chad, thanks for the chest-thumping, sheer courage and joy you gave us! There are many great things about having baseball here since 2005, but you are the best! Be well, my friend, and come back anew with the spring! Your complete recovery is in our thoughts and prayers.

Posted by: flynnie | June 30, 2008 6:15 PM | Report abuse

Can you blame Cordero for being "out for the year." If you were him, would you want to come back to the Nats and their stellar record?

Posted by: O's Exec | June 30, 2008 6:19 PM | Report abuse

I agree with Flynnie in this instance. Let's hope Chad comes back and looks like one of the two youngest closers ever to 100 saves.

But does this raise anew the questions about the medical evaluation process? I respect Dr. Andrews very much, but something about this just doesn't add up.

Posted by: L of D | June 30, 2008 6:20 PM | Report abuse

Didn't Cordero have an arthrogram before? If not, someone's head should roll. An arthrogram is an MRI with dye injected so the internal workings of the shoulder are much more visible to the doc reading the films. It is much more accurate than a regular MRI. With an investment of millions of dollars along with poor Chad's livelihood on the line, the Nats need to spend the money on the best medical testing available.

I had surgery for a torn labrum in January. After nearly six months of therapy, I almost have full motion in the shoulder, but I still have significant stiffness and pain in the join when I stretch my arm out. I can't even imagine throwing a baseball at full force. Even though I'm sure the physical therapy that Cordero will receive is more intensive than I'm doing, and he's also 25 years younger than me, it may not matter because these things take TIME to heal. And three months may have been burned for want of a valid diagnosis.

Chico, there are too many instances of injured Nats not getting the right diagnosis quick enough. I'm sure it won't endear you to Stan and Jimbo, but a serious story on this issue seems warranted.

Posted by: Section 222 | June 30, 2008 6:24 PM | Report abuse

Sigh.

I hadn't expected him back, really.

Posted by: Positively Half St. | June 30, 2008 6:24 PM | Report abuse

The only good news is that Dan Uggla, who seems to be good for a homer in every game the Nats play the Marlins, isn't starting. Also, don't be surprised if Cordero's injury takes up to or more than a year to heal to where he can physically and mentally throw without pain.

Posted by: leetee1955 | June 30, 2008 6:25 PM | Report abuse

who's the nats' team physician, dr. vinnie boombatz?

Posted by: natsscribe | June 30, 2008 6:26 PM | Report abuse

"Shoulder injuries tend to present themselves as pain and tenderness with a concurrent loss of speed on the fastball. A torn labrum is no different. But because it's positioned between two bones, a damaged labrum is far more difficult to detect than other shoulder problems, like a torn rotator cuff."
http://www.slate.com/id/2100895/

Yes. Dr. Andrews did an arthrogram on Chad, who had to wait for the dye to re-absorb.

Posted by: flynnie | June 30, 2008 6:28 PM | Report abuse

Not to mention the potential loss of the young man's livelihood.

"If JimBow hadn't overpriced his closer on the trade market, this would be some other team's problem. Now, he and the team are stuck with the dreaded natsluck trifecta - Cordero is of no use to the Nats, he wasn't traded for any assets to bolster the farm system and this could be some other team's problem if he had been traded."

Posted by: Values check | June 30, 2008 6:36 PM | Report abuse

Right you all are on the waiver rule for the other teams. And am I glad to hear it. He might actually make it through waivers at a certain point, given his production.

Also, forgot to issue a thanks to the poster who listed all the things NJ has helped to fill in to make the ballgame more exciting. I feel the same way, but couldn't have said it half as well, so I appreciate you doing it better and look forward to flynnie cutting and pasting it for future reference some day.

And flynnie, your verse was exquisite.

Count me a second to +.5St's suspicion that Cordero would never come back. I felt the same way. Add to that list Kearns, Zimmerman, Wagner, Milledge, Hill...

Posted by: Section 506 (Before moving) | June 30, 2008 6:38 PM | Report abuse

"Nolan Ryan, who played major league baseball for 27 years, often threw pitches more than 100 mph, even past the age of 40, and he liked to throw on flat ground in his waning years. I think others might follow his lead."

Pitching Mound Height Affects Throwing Motion, Injury Risk
ScienceDaily (Mar. 24, 2008)

This was presented at the 2008 Winter meetings. I present it here for Chad's rehab.

Posted by: flynnie | June 30, 2008 6:44 PM | Report abuse

Chico - did you spot Lopez during BP?

Posted by: PTBNL | June 30, 2008 6:46 PM | Report abuse

Here's what I thought it was. When the Mitchell report came out, those who did, stopped. Because his velocity was down, I assumed he couldn't get back up to speed due to the lack of "help". And by trying to muscle it up there, he hurt himself. I am glad to see I was wrong.

Posted by: 6th and D | June 30, 2008 6:46 PM | Report abuse

Flynnie, are you saying that Chad had an arthrogram back in April when he first saw Andrews and just now got the results? That's clearly not the case. The results are pretty much instantaneous. You walk out of the MRI shop with the films.

Or are you saying that he had one in April, but Andrews didn't see the tear, and then he had to wait over two months to have another? Perhaps that's right, but how do you know that? Thanks for the link to the Slate piece. You would think that if there's any chance of a labrum tear, they'd do everything humanly possible to get it diagnosed ASAP. Some tears may be tough to see with an arthrogram, but some aren't.

By the way, Chris Needham speculated on the possibility of a labrum tear on April 23:
http://dcbb.blogspot.com/2008/04/so-does-this-mean-stan-will-give-me.html#comments
So it wasn't quite three months burned, just nine weeks.

Thank God Zim isn't a pitcher and his tear is not in his throwing arm. Still, diving to his left to stop a hot smash has got to hurt big time. And swinging a bat is no picnic either.

Posted by: Section 222 | June 30, 2008 6:46 PM | Report abuse

So what's the over-under on how soon we get the same news about Ryan Zimmerman?

A few quotes on torn labrums and pitching woes in general:

"Dr. James Andrews, a noted orthopedic surgeon who operates on 150 or so pitchers a year, once said, 'If you throw a baseball long enough, sooner or later you're probably going to wind up in somebody's operating room. And maybe more than once.'"

"Andrews estimates that 85 percent of pitchers make a full recovery after Tommy John surgery, a rate that has improved dramatically as the medical technology has improved. The success rates with torn rotator cuffs and torn labrums aren't nearly as high, with the labrum being the most difficult injury because it involves reconstruction of the shoulder. But there are no guarantees that a pitcher will recover from any surgery to pitch again."

That was from the Seattle Times. And this is something I found on futilityinfielder.com:

"Part I: The Fruits of My Labrum
OK, I'll admit it. My shoulder injury -- a torn labrum suffered last June in a swimming pool mishap and arthroscopic surgery in November -- was little more than an excuse to milk sympathy and gain fodder and publicity for this column while taking a walk on the wild side of the health care system. A dabble in shoulder injury chic, if you will.

That's not really true, of course, but if I've learned anything over the past year, it's that a labrum tear is baseball's most devastating injury, a virtual death sentence for pitchers in an age where rotator cuff (shoulder) and ulnar collateral ligament (elbow) surgeries are routine, their recoveries predictable. As Baseball Prospectus injury expert Will Carroll summarizes in a recent Slate article (amusingly titled "Labrum, It Nearly Killed Him"):

The leading minds in baseball medicine are flummoxed by the labrum. Doctors can't agree on how to detect a tear, don't know the best way to fix one, and aren't sure why, almost without fail, a torn labrum will destroy a pitcher's career.

The numbers don't lie. Carroll contrasts leading orthopedic surgeon Dr. James Andrews' estimate that 85 percent of pitchers fully recover from ulnar collateral ligament replacment, a/k/a Tommy John surgery, with this bleak assessment:

[I]f pitchers with torn labrums were horses, they'd be destroyed. Of the 36 major-league hurlers diagnosed with labrum tears in the last five years, only midlevel reliever Rocky Biddle has returned to his previous level. Think about that when your favorite pitcher comes down with labrum trouble: He has a 3 percent chance of becoming Rocky Biddle.
Ouch. For those unfamiliar with shoulder anatomy -- and if you're a baseball fan, you might as well learn your way around this crucial joint -- Carroll explains that the labrum, located between the head of the humerus (upper arm bone) and the glenoid fossa (the socket where it attaches) functions as both a shock absorber and as part of the joint's connective structure. The most common labrum injury is a SLAP tear (superior lesion, anterior to posterior), which is what I suffered -- a tear in the tissue from front to back, disrupting normal overhand motion with a slight click or pop. It's a relatively subtle injury in that it's not terribly painful or debilitating unless you're exerting at a moderate level. My own experience felt like my shoulder had somehow had the wind knocked out of it, and I was unable to summon much force when it came to exercise.

The labrum's position between the shoulder bones makes injury to it difficult to detect even with magnetic resonance imaging (MRI), and multiple orthopedists might disagree on the same MRI. The current state of the art in repairing the damage is an arthroscopic procedure to reattach the labrum to the scapula by inserting plastic anchors for the sutures; in my case two were required, each leaving a scar about 1 cm in diameter.

Carroll runs down a few recent high-profile pitchers whose careers have been derailed by labral tears:

• Giants closer Robb Nen, one of the game's hardest throwers, has undergone three surgeries in 18 months and hasn't pitched since 2002.

• White Sox starter Mike Sirotka was traded to Toronto for David Wells in 2000 before his torn labrum was discovered. He hasn't thrown a pitch in the majors since.

• 6-foot-10 Seattle Mariners prospect Ryan Anderson, known as "The Space Needle," has missed all of 2001, 2002, 2003 and this year. Fellow Mariner pitcher Gil Meche missed 2001 due to labrum ailments and couldn't pitch well enough to make the big club in '02. His 15 wins in '03 made for a minor success story, but the attached 4.59 ERA isn't worth all that much in the Safeco environs. And it gets worse: thus far he's 1-5 with a 6.96 ERA this year and showing some ominous signs. Wrote Carroll recently:

The labrum curse may be biting Gil Meche. His continued ineffectiveness in the Mariners rotation is pushing him to the bullpen, but there are open questions about his shoulder's health. Not only is his stamina down, there have been reports of him wincing after pitches and altering his mechanics in ways that indicate some shoulder pain or weakness. I'm unsure how Meche will adjust to the pen as well, making him risky in multiple ways.
Not good. Position players, of course, aren't exempt from the dreaded injury. Troy Glaus, the Angels fine third baseman, missed much of last season with a tear but elected not to have surgery. After a hot start in which he was leading the league in homers with 11, Glaus reinjured the shoulder and finally went under the knife in the past week. He's almost certainly done for the year. Dodger outfielder Shawn Green's power outage last season was due to a severely torn labrum; his offseason surgery was more drastic, requiring the removal rather than repair of the cartilage, resulting in an unappetizing bone-on-bone scenario which Carroll covered last fall.

As Carroll explained to me last fall, another problem besides detecting the injury is the lack of an established rehabilitation protocol. Whereas Tommy John surgery timetables have become quite predictable (one year, with new-wave techniques pioneered by Yankee secret weapon Mark Littlefield cutting that time down to ten months), and rotator cuff surgery is, if not nearly as successful, at least somewhat moreso than its shoulder counterpart, there's no model of success for a baseball player to emulate. My own rehab consisted of a month wearing a sling and then four months of arduous physical therapy; only recently have I taken up my mitt again to chuck the ol' horsehide around, and though my comfort zone is increasing with each game of catch, I'm not sure I could break glass with my tosses yet.

If there's been a silver lining to my torn shoulder lining, it's that the work I put into writing about it impressed Carroll so much that he included it in his excellent new book, Saving the Pitcher. The recently-published volume combines vital, well-researched information about the anatomy and mechanics of throwing a ball with cutting-edge expert advice on how to treat -- and more importantly prevent -- injuries to the most fragile segment of the baseball population. The fruits of my labrum (sorry, I've been waiting six months to use that line), an adaptation of my November 11 entry, take up pages 49-51 of STP. Carroll also told me that Dr. Andrews -- the leading surgeon in sports medicine -- was quite impressed with my writing on the topic. All of this somewhat dampens the blow that my injury caused, but I still wouldn't recommend it as anything more than a painful learning experience."

Yikes. Good luck Chad.

Posted by: Bob L. Head | June 30, 2008 6:47 PM | Report abuse

Chico, is Lopez there in Florida?

Posted by: Brian | June 30, 2008 6:48 PM | Report abuse

He had the arthrogram when he went to Dr. Andrews in April. It was not diagnosed then. Some medical journals more recent than the 2004 Slate article give a success rate of 45%, but it is a dreadful injury, and dreadful news for Chad. Let's hope medical advances in the last four years have outpaced the above-quoted article.

Posted by: flynnie | June 30, 2008 6:55 PM | Report abuse

I've gotta go filet some fish.

Posted by: flynnie | June 30, 2008 6:59 PM | Report abuse

Thanks for that clarification Flynnie. I'm still concerned about the Nats medical diagnosis woes. I hope Chico will investigate. And BLH, I guess we can start a fraternity of NJ posters who have had labrum surgery. Isn't sleeping with your arm in a sling fun?

Posted by: Section 222 | June 30, 2008 7:03 PM | Report abuse

As long as no one from Cincinnati reads this blog, there's still time to trade him to the Reds...

Posted by: Anonymous | June 30, 2008 7:05 PM | Report abuse

Poor Chad. Poor beleagured team. But I agree with whoever [Section 222, I believe] wrote about the team's med eval process being suspect. I guess they won't be shopping Rauch for prospects any time soon (if the team's braintrust has half a lobe in its collective skull).

Posted by: samantha7 | June 30, 2008 7:06 PM | Report abuse

Values Check

Between the money Cordero will be paid for not pitching because his contract is guaranteed and that he's a vested member of the MLBPA's pension program, if he hasn't blown most of his money he'll be financially secure.

Posted by: leetee1955 | June 30, 2008 7:30 PM | Report abuse

Oh my God, Christmas in almost July with this news. I can make another joke about their record while giving them an extra kick while they're down with this latest news. AND it will distract them from the fact that the O's just dropped a series to them. I better not mess this up...God just gave me a big, fat softball right down the middle. I need to be funny, too.

Posted by: O's Exec's Conscience | June 30, 2008 7:33 PM | Report abuse

more on cordero in the new post

Posted by: Anonymous | June 30, 2008 7:41 PM | Report abuse

Will also district them from the fact that my team's closer blew another one with 2 outs and an 0-2 count.

Posted by: O's Exec's Conscience | July 1, 2008 8:24 AM | Report abuse

anyone there want to chat with a girl who likes sports? Let's mingle here at +++++(((((((-----u k i n t e r r a c i a l m a t c h . c o m------)))))))+++, where many black and white singles who want to meet and seek fun & love seriously! Join us to begin our connect!

Posted by: Maggie | July 1, 2008 11:26 AM | Report abuse

distract

Posted by: OEC's proofreader | July 1, 2008 11:37 AM | Report abuse

I share the concerns expressed by others re. the handling of injuries. I hope that Cordero was not irreparably damaged due to the delays. Best wishes to him for a full recovery.

Posted by: natsfan1a | July 1, 2008 12:09 PM | Report abuse

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