Schilling receives shot of cortisone

Email|Print| Text size + By Gordon Edes
Globe Staff / February 9, 2008

Curt Schilling was given a cortisone shot in his right shoulder yesterday, the first step of a conservative treatment plan laid out by the Red Sox medical staff, which believes surgery probably would end Schilling's season, and quite likely - given his age (41) - his career.

Pitchers and catchers are due to report to spring training Thursday, and with Schilling out of the rotation possibly for months, questions are being raised about why the Sox elected to re-sign him in November. Yesterday, there were multiple sources contending that team medical director Thomas Gill raised red flags about re-signing Schilling - two sources said Gill recommended that the Sox not do it - but the club was willing to take that chance, especially with top prospect Clay Buchholz in the wings.

But the reality of the situation, according to a baseball source with direct knowledge of Schilling's situation, is considerably more complicated than Sox ownership merely giving general manager Theo Epstein the green light to re-sign Schilling over the objections of the medical staff. Management was aware, based on information from the medical staff, that Schilling's shoulder likely would not hold up to the stress of a full season and most likely would require time on the disabled list. For that reason, they initially proposed to Schilling that he sign a Roger Clemens-type contract, one that would have required him to pitch no more than a half-season.

The Sox' thinking was that Schilling could contribute around 100 innings at the level he did last season, and with Buchholz and Julian Tavarez on the staff, they had enough starting pitching to cover a season. But Schilling refused to go along with that plan, which led the Sox to offer him an $8 million deal, considerably less than the $13 million he made in 2007. They assumed that at best, he'd give them about 120 innings and would not attain the performance incentives included in the deal, and in that light, $8 million was money well spent.

But then Schilling reported severe shoulder pain, and that plan has unraveled.

Dr. Craig Morgan, who performed surgery on Schilling's right shoulder twice, in 1995 and again in a cleanup procedure in 1999, believes the treatment prescribed by the Sox has no chance of succeeding, that the degeneration in Schilling's biceps tendon is irreversible and requires surgery if the righthander is to have any chance of pitching this season. With surgery to address the tendon, Morgan contends, Schilling could be pitching by the All-Star break.

A prescribed course of rest and rehabilitation, beginning with the cortisone shot, is doomed to fail, Morgan said, and is wasting precious time in which Schilling could be recovering from surgery.

"If [the Sox' plan] was successful, I think it would be the greatest thing known to man," Morgan said by telephone yesterday morning. "But, unfortunately, that's not the case. That's like wishing for the best-case scenario. Wishing isn't going to make it happen.

"Within a week or two of the cortisone shot, he's unable to exercise due to pain, then it's over."

Complicating the matter further, according to Morgan, is that a third doctor called in to help resolve the disagreement between the Sox and Morgan also identified a tear in Schilling's rotator cuff as worrisome. According to Morgan, that doctor, David Altchek, the Mets' medical director, said surgery would end Schilling's season. That "muddied the waters," according to Morgan, who said Altchek sided with the Red Sox in recommending a conservative approach.

It's important to note that beyond a brief statement released Thursday night, the Sox have not commented on Schilling's condition. "Curt Schilling was examined by Red Sox doctors in January after he reported feeling right shoulder discomfort," the statement read. "Curt has started a program of rest, rehabilitation, and shoulder strengthening in an attempt to return to pitching."

The situation is sensitive and, by several accounts, contentious. Morgan, for one, said the Red Sox said they could void Schilling's contract if he elected to have surgery without their permission. Schilling's deal contains an additional $3 million in performance incentives and $2 million in weight clauses.

When Gill and Morgan could not settle their differences, the sides turned to a third party, Altchek. Even that process was contested, according to Morgan. Schilling rejected some of the Sox' options before settling on Altchek.

Morgan believes the problems in Schilling's biceps tendon have been building over the last two years. They manifested themselves in a major way last summer, when Schilling was shut down for seven weeks with what was called biceps tendinitis. Schilling returned to pitch in early August and finished the season, though he was forced to dramatically change his approach, relying much more on offspeed pitches instead of the power pitches that made him successful throughout his career.

When Schilling re-signed, he evidently passed the physical. But after beginning workouts, Morgan said, Schilling reported sharp pain in the shoulder to the Sox and to Morgan, whom he asked to examine him late last month.

Morgan's conclusion after seeing Schilling was that the pitcher's problem was far more severe than biceps tendinitis. "This is not just soreness, but big-time pain," Morgan said. "It's very painful, and it's irreversible. There's a fragmenting and tearing of the tendon in three stages." The problem is centered, according to Morgan, in the bicepular groove, defined by Merriam-Webster's Medical Dictionary as a furrow on the upper part of the humerus. Biceps tendintis often is caused by impingement or inflammation, and rotator cuff disorders or labral tears are often secondary causes.

Morgan said he was uncomfortable characterizing the diagnosis made by Gill and the Sox medical staff. "It seems to be evolving on a daily basis," said Morgan, who claimed the sides had agreed Wednesday night that Schilling would have his cortisone shot the next day, but no one contacted Schilling to make arrangements for the shot. "Given the urgency with which they talked about the cortisone shot Wednesday night, that struck me as odd," Morgan said. A baseball source contradicted Morgan's account, saying on Thursday Schilling was told he'd be having the shot today.

"The diagnosis is not the issue," Morgan added. "The disagreement is in the course of treatment." He did acknowledge, however, that the Sox medical staff noted a "thickening" of the rotator cuff and some fraying of the labrum. Altchek expressed even more concern about the rotator cuff, Morgan said.

"The crux of the matter," Morgan said, "is that the Red Sox feel strongly that surgery of any kind, and Curt will miss the whole year to recover. I disagree. We are diametrically opposed.

"I want to clearly state my function. My function in all of this is as Curt's doctor of 13 years. Curt called me and asked me if he could come down for an exam and to render an opinion.

"My opinion hasn't and will not change. It's based on the physical exam, the MRI, knowing Curt for 13 years. It's uninfluenced by any outside factors, including financial pressure."

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