These days, surgeons racking up the saves

Medical advances mean injuries no longer always career-ending

By Chad Finn
Globe Staff / March 27, 2011

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Their likenesses aren’t found on baseball cards, and when their names are mentioned on “SportsCenter,’’ it usually happens when there’s ominous news regarding the condition of a celebrated pitcher’s arm.

Yet the innovations in elbow and shoulder surgery developed by distinguished surgeons-to-the-sports-stars such as Dr. Frank Jobe and Dr. James Andrews can have as significant an impact on a team’s short- and long-term success as many of the ballplayers on the roster.

And perhaps an even greater contribution is the career-saving effect the advances in diagnosis, treatment, and medical technology have had on hundreds of pitchers over the last three decades. Just ask the Washington Nationals, whose promising young righthander Jordan Zimmermann returned in good form this spring after undergoing Tommy John surgery on his elbow in August 2009, a development that might enhance their optimism that phenom Stephen Strasburg can make a similar recovery from the same procedure next season.

Or consider the St. Louis Cardinals, who lost ace righthander Adam Wainwright to the same surgery this spring. They know all is not lost after a pitcher gets a scar on his arm. Chris Carpenter has won 84 games with a 2.98 ERA in seven seasons for the Cardinals despite undergoing Tommy John and shoulder surgery.

Decades ago, an elbow injury often meant a pitcher would soon be looking for a new profession. The obvious example is Sandy Koufax, who retired at age 30 after his 27-win season in 1966 because of pain in his left elbow that was exacerbated by arthritis.

But a new hope was discovered in September 1974, when Jobe (who partnered at a clinic with Dr. Robert Kerlan, the doctor who diagnosed Koufax with arthritis) pioneered a new procedure on another Dodgers pitcher.

Tommy John was a 31-year-old lefthander with a 13-3 record and a terribly sore elbow from a damaged ulnar nerve. With John’s career in jeopardy, Jobe attempted a revolutionary technique in which a ligament in the pitcher’s elbow was replaced with a tendon from his right arm. It proved to be a medical marvel and a baseball miracle. After missing the entire 1975 season, John returned in ’76 and pitched until 1989, when he was 46. He won 164 games after the surgery, one fewer than Koufax won in his entire career.

While Tommy John surgery hasn’t reached the point of elective surgery, there are increasing instances when pitchers have not only come back as good as new, but arguably better than ever. The list of pitchers who have thrived after the surgery is long and distinguished, among them Carpenter, Josh Johnson, Billy Wagner, Tim Hudson, Francisco Liriano, and John Smoltz. The success rate, which is estimated at 90 percent in terms of a full comeback, must give hope to the Wainwrights and Strasburgs and even lesser names such as Red Sox prospect Junichi Tazawa, who is just now working his way back to the mound.

The hope is not always so optimistic for pitchers who suffer shoulder injuries, in part because the surgery is so complex. While elbow surgery involves one joint, the shoulder has three joints and 21 muscles that must work in synch to deliver a pitch. Just a few years after John became the first athlete to undergo successful ligament replacement surgery, accomplished pitchers of his era such as Kansas City’s Steve Busby and Cleveland’s Wayne Garland were still losing effectiveness or falling by the wayside altogether because of shoulder problems.

Even now, a labrum tear is often regarded as essentially a kiss of death for a pitcher. When Red Sox closer Jonathan Papelbon walked off the mound clutching his right shoulder during a game in September 2006, the fear was that he’d suffered a labrum tear, and the Globe noted a 2004 study by Baseball Prospectus’s Will Carroll that concluded only 1 of 36 pitchers who’d suffered labrum tears in the previous five years had returned to their previous level of success. No wonder there was practically an audible exhale coming from the vicinity of Fenway Park after Papelbon was diagnosed with a shoulder subluxation that did not require surgery.

The list of recent pitchers whose careers were irreparably damaged by a labrum injury is long, and in the baseball sense, tragic: Erik Bedard, Mark Prior, Ben Sheets, Brandon Webb, Chad Cordero, and countless more. Carpenter and Curt Schilling are on the much shorter list of those who have come back and thrived.

And then there is the remarkable case of Roger Clemens. In 1985, before he emerged as “The Rocket,’’ an all-time (if eventually disgraced) great who would win 354 games and seven Cy Young Awards, he was an extremely promising but alarmingly sore-shouldered 23-year-old with 16 big-league wins to his credit.

The Red Sox were sufficiently concerned with the recurrent pain in his shoulder, but team doctor Arthur Pappas’s recommendation that Clemens have surgery on a “flap tear’’ surprised the pitcher, who told the Globe at the time he was unaware of the seriousness of the situation and angry with the way the team had handled it.

Randy Hendricks, one of Clemens’s agents, went against the conventional wisdom of the time that a team’s diagnosis was the final word, and sought out a second opinion in August 1985, which is how Dr. James Andrews began to make his name.

Hendricks connected his client with Andrews, who instantly connected with Clemens. Then an obscure orthopedist based in Georgia who’d operated on the shoulder of Auburn football star Bo Jackson but had no baseball clients of note, Andrews quickly diagnosed the specifics of the injury — the dreaded labrum tear — and performed arthroscopic surgery at the end of month.

Eight months later, Clemens returned to the mound. In his fourth start of an unforgettable season in which he would win his first 14 decisions, finish 24-4, and earn the AL MVP and Cy Young awards, he struck out 20 Seattle Mariners.

Even with his scar, Clemens had arrived as a star. And so did Andrews, who’s career-changing operation on Clemens proved to be a rather effective way to build a client base, which has included Smoltz, Michael Jordan, Jack Nicklaus, Drew Brees, and Troy Aikman.

That night in ’86 when Clemens whiffed 20, Andrews sent him a congratulatory telegram. In retrospect, it very well could have been the other way around.

Chad Finn can be reached at Follow him on Twitter @globechadfinn.

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