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Schilling's cortisone shot today

Posted by Gordon Edes, Globe Staff  February 8, 2008 12:27 PM

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

Dr. Craig Morgan, who performed surgery on Schilling's right shoulder twice, in 1995 and a cleanup procedure in 1999, believes that 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 Schilling is to have any chance of pitching this season. With surgery to address the disease in Schilling's tendon, Morgan contends, Schilling could be pitching again 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 the surgery Morgan recommends.

"If (the Sox plan) was successful, I think it would be the greatest thing known to man,'' Morgan said in a phone conversation this 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, (if) 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, detected a tear in Schilling's rotator cuff that also was a problem, and said, according to Morgan, that surgery would end Schilling's season. That "muddied the waters," according to Morgan, who said that Altchek also recommended a conservative approach.

It's important to note that beyond a brief statement released last night, the Sox have not made any comment regarding 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 that the Red Sox said they could forfeit Schilling's contract if he elected to have surgery without their permission. The Sox signed Schilling to a one-year, $8 million deal that contains an additional $3 million in performance incentives and $2 million in weight clauses.

When Sox medical director Thomas Gill and Morgan could not settle their differences, the sides turned to a third party, Dr. David Altchek, the Mets' medical director. Even that process was contested, according to Morgan: The Sox rejected the doctors suggested by Schilling, and Schilling rejected some of the Sox options before settling on Altchek.

What can be stated with some certainty is this: Morgan believes that the problems in Schilling's biceps tendon have been building over the last two years. They first manifested themselves in a major way last summer, when Schilling was shut down for seven months 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 a variety of off-speed pitches instead of the power pitches that had made him successful throughout his career.

Schilling re-signed with the Sox in November, evidently passing the physical he was required to undergo before signing, though one source involved in the process said some cautionary questions were raised by at least one member of the Sox medical staff. But after beginning workouts, Morgan said, Schilling reported sharp pain in the shoulder both to the Sox medical staff 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 bicipular groove, defined by the Merriam-Webster's Medical Dictionary as a furrow on the upper part of the humerus, the upper arm bone, and is occupied by the long head of the biceps tendon, which ultimately inserts onto the labrum. Biceps tendinitis 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 that the sides had agreed on Wednesday night that Schilling would have his cortisone shot the next day, but that 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 that on Thursday, Schilling was told he'd be having the shot today.

"The diagnosis is not the issue,'' Morgan said. "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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