Monday, January 3, 2011

Brandon Webb's shoulder

I started this article on the day Webb signed (made official today), but it was such a labyrinthine tale of shoulder intrigue, that I left it in draft form until sprucing it up today. What follows is a maddening account of the last 2 years of Webb's shoulder problems.

Based on all the stuff that i read, the news is both good and bad. For one, the expectation for Webb to return by April 2010 (from an early August 2009 surgery) was not realistic. Though the surgery was relatively minor, it was clear that he needed more time, with a mid-season return more likely than not. Though he appeared to have some legitimate physical setbacks, most of his problems from May through August appear to have been both mental and mechanical. So that is the positive news. His arm appears to be healthy (he had a frayed labrum with no tear, and substantive wear). The bad news is that the arm slot problems he had all year could rob him of the effectiveness of his sinker (think Feldman) and continue to plague him in 2011. Furthermore, the "mental" hangups he has developed during his rehab process appear substantial (listen to the interviews with him and his coaches in the links below), problems that are likely to plague him during ST 2011 as well.

If I had to take a guess at what Webb's season looks like for 2011, I would say that he has mental and mechanical (if not also some real soreness) issues throughout ST that will delay his debut until mid-May. His effectiveness over his first 4-6 weeks might not be all that great, which could lead to a recurrence of the mental and mechanical issues he had in 2010. I would think that the best scenario for Webb in 2011 would be for him to pitch well in the second half. Given that he will likely be on an innings limit for 2011, this works out for the best, as it might allow him to pitch in the post-season if he gets on a roll.

For my money, despite the fact that Webb appears healthy enough, his other issues are substantial enough derail him completely, or only allow for him to be productive in the second half. I would still acquire a mid-roto starter if I were Texas as Webb is unlikely to fill that roll in the first half.

Before the analysis, I just remembered this nice article by Crasnick on shoulder surgeries, with a prominent mention of Texas as well as Brandon Webb.

OK so here we go. In 2009, Webb developed shoulder issues during/after his first start and was DL'd with "shoulder bursitis." I'm not certain if he had problems during the offseason or spring training that lead up to that the problem. He tried to rehab the "injury" - I'm not sure they knew exactly what it was prior to his surgery - for 4 months to no avail. Texas' team ortho guy Meister performed a debridement of his shoulder on August 3 2009. Here is a note I found on the nature of the injury:

Now, Webb did not injure his Rotator Cuff, but rather his teres major muscle. This muscle is found in the rear part of the shoulder area, next to where the shoulder blade is located. He only strained his teres major so it did not require major reconstructive surgery. Surgeons had to go in and clean up the area around the muscle to release the tightening sensation he was feeling from the strain. Even though his surgery wasn’t as major as it could have been, it will still require months of physical rehabilitation.

I've seen a couple of reports refer to it as a labrum injury so that doesn't appear to be accurate. His rehab called for him to begin throwing 3-4 months thereafter. During spring training this year however, he developed some soreness in the shoulder and recieved a cortisone shot on April ~2. It didn't appear that Webb would have been ready for the season anyways, likely needing a month-long rehab assignment but the injury/soreness knocked him out another month and He didn't start throwing side cessions again until mid-June (though he seems to have played catch beginning in mid-April). Webb attributed his problems poor mechanics, to an arm slot that had gotten to high (here is a video of Webb's delivery, 4.30 mark) in order to protect himself from re-injury:

Out since last Opening Day with a shoulder injury that eventually required surgery in August, Brandon Webb said yesterday that the past five months of rehab have “been almost wasting my time” because he was “throwing bad.”
Nick Piecoro of the Arizona Republic reports that Webb met recently with a specialist at the rehab facility connected to Dr. James Andrews’ practice in Alabama and was told his arm slot is too high and needs changing before he can get healthy again. Or as Webb put it: “I have to retain.”
Webb “was hooked up to motion-sensing technology that helped illustrate to him that his arm slot is far too high” and “far higher than how he pitched before surgery.” Webb said he made the change “trying to protect myself going up there, but it’s actually doing the exact opposite.”
The good news is that he’s had no recent setbacks in terms of the actual injury, but Webb won’t be throwing off a mound until he’s fully comfortable with the new, lower arm slot.


However it looks like he might have been shut down again at some point thereafter, and didn't start throwing bullpens until early September, eventually, making a couple of appearances in the AFL (sitting low to mid 80s).

People have a lot of success these days coming back from TJ in as few as 12 months, while labrum and rotator cuff surgeries are more tricky, and depend on the extent of the repair(s) (Eric Hurley had both and wasn't really ready to start throwing 12 months out if I remember correctly). Debridements, "loose joints", "wear and tear", chronic soreness, muscle tears, strained ligaments - it all sounds like a big wild card to me, so the signing shouldn't stop Texas from acquiring/signing another arm that they could hang their hat on for some innings (Pavano, Francis, trade).

Other than the injury itself, the effectiveness of his sinker will ultimately determine his level of success. He throws that pitch 75% if the time, so if he doesn't have it, it could get "Feldman" ugly (or at least 4.8 fip ugly, which wouldn't be a compete waste). If it is true that the main issue that thwarted his return in 2010 was mechanical in nature, then there is really more reason for optimism. The other unknown about him will be the # of innings he will be capable of throwing after two years off (admittedly with a lot of throwing during his rehab). Will Meister set a cap on the # of innings for him or will he be free to pitch as many innings as he can? Will TX skip his starts when they can, and maybe even give him a couple of starts off to allow him to pitch into the post-season? Will they build him up in the minors in April delaying his debut until May?

So here is a down and dirty timeline charting Webb’s injury and rehab history over the last 2 years:

2008
Had some shoulder soreness mid-season 2008 had MRI, results were negative. Pitched through it. Had MRI examined by Andrews during off-season; negative findings.


2009

March
He missed his first turn in ST due to forearm tightness (~3/1/09)

April
Gets blown up in his first start.
Bursitis and fluid buildup, placed on the DL 4/12 (retroactive to 4/7)
MRI results 4/10/09
had mri last summer for shoulder soreness, examined by James Andrews in Dec, normal wear and tear
Webb setback, 4/24/09

June

Brandon's Labrum
(6/27/09)
Webb's June 2009 Setback

July
7/2: Decides not to have surgery.
Note on Webb, 7/6/09: "Brandon Webb also spoke to reporters before the game. He says the doctors compared his MRI to that from last year, and was told, "There was no change in it - and that's encouraging because I won 22 games last year." They told him he has an internal impingement in the shoulder, which he had a year ago in May but pitched through it. He will shut it down - not pick up a baseball - for 4-to-6 weeks during which time he will strengthen the shoulder, and aims to return for at least one September start to prove to himself and the Diamondbacks that he can pitch."

LA Times - Arizona ace has another setback with his ailing right shoulder.
July 31, 2009|Associated Press
Arizona pitcher Brandon Webb has had another setback with his ailing right shoulder, raising the possibility the Diamondbacks' ace may need surgery. Webb missed the team's trip to New York and instead will visit Dr. Keith Meister of the Texas Rangers in Dallas, Diamondbacks General Manager Josh Byrnes said Thursday.Webb has consulted numerous doctors but has been unable to relieve stiffness and soreness in the shoulder. The 2006 NL Cy Young Award winner has not pitched since opening day.Earlier this month, after meeting with team doctors and three other physicians, Webb rejected surgery and opted for a more conservative approach. At the time, he expressed hope that he would pitch again this season.


AZSnakepit dump on his late July setback.
Webb's Barnstorming Specialist Tour (7/30/09)
Webb's barnstorming specialist tour, deux
From (AZSnakepit) the best summary of Webb's 2009 ordeal:

It's not the reporting. It’s Webb himself that is stirring it up. “It was just the little Discomfort. I will skip my next start, and it will all be better!”, “I guess I’m a little more sick than I thought. A 15-day DL stint and some rest should fix it!”, “The shoulder is still a little sore. I just need more time”, “I’m on track to recovery”, “Oops, I felt The Discomfort! Maybe something really IS wrong? I have to see 1,387,549 doctors now, just to be sure!!”, “I don’t need a surgery even though I can’t even pick up a baseball in the next 4 weeks”, “Oh no! I felt The Discomfort after I threw a baseball 10 feet! I must see the doctors again!”HAVE THE SURGERY ALREADY!!! dima1109 on Jul 30, 2009 4:22 PM CDT up reply actions


August

Surgery not Recommended (8/2/09)
8/3: SURGERY
Cleanup Successful (8/3/09)
MLBTR on 2009 rehab prior to surgery (Adams)
Webb had gone through two different periods of rest and strengthening with visions of pitching in September. However, the stiffness in his right shoulder has not improved. The recovery time from the procedure is not yet known.
(Not) Brandon's Labrum (deux)
Meister on Surgery
Having some fraying in the labrum area per D-Backs beat writer

2010
Nov 09-Jan 10:
Rehab going well beginning of November and then again end January
ESPN Profile: Brandon Webb

Feb - March
threw off mound 1st time 2/9, 2/12 (comeback predicted sometime in April)
Manager Hinch, PC Stottlemyre, talk about his spring training, 2/28
Note some talk of getting his arm slot corrected; 42 pitches, no batters, a changeup or two (no breaking balls?)
bullpen, 3/4; 45 pitches, a few batters, a few changeups (no breaking balls?), "can't let it go yet"
Webb update, still not facing hitters 3/8
Webb has setback, d2d ao 3/27

Webb's Spring (3/31/10)
Webb hasn't thrown off a mound since March 4, a day when his velocity looked to be down significantly from its pre-surgery level. He also appeared tentative in his delivery.

April

Webb's Cortisone Shot
(4/1/10)
Mental Hurdles (Hinch, 4/1/10)
“There are mental hurdles to clear. I think there are physical hurdles to clear in terms of the workload, and these dead periods show up from time to time in the recovery process. When to push him, when to lay back on him, when to accelerate his deals has been very hot and cold this spring. That’s the frustrating part for everybody involved. It’s been a little on again, off again.”

Webb's Spring, Deux

Webb on 2d on/ 2d off, less than 100 feet, 4/13

June
June 10
Webb update 6/12, throws 30-pitch bullpen off mound with lower arm slot with no issues, fastballs
Webb update 6/16, 75 pitches, better velo, extending better

July
Webb Rehab session, 7/7/10
Webb Rehab session, 7/16/10

Webb Rehab session, 7/21/10
Webb Rehab session, 7/28/10

August
Webb Rehab session, 8/5/10
Webb Session, 8/22/10

Webb Sim Game, 8/28/10


September
Webb Session, 9/8/10
Webb Session, 9/11/10
Instructs on the Horizon, 9/13/10
Webb Session, 9/18/10
Instructs 9/30
Instructs outing 9/29
However, he was not able to get the arm speed he needed, and this summer has been filled with long toss, bullpen sessions and simulated games. (gilbert) 9/28
Scouts comment on 9/29 instructs innning:
A scout in attendance Wednesday said Webb threw his fastball with good sink -- his trademark -- but only 78-82 mph. The scout said Webb's curve was "rolling" and his changeup was "good" but only 70-72 mph. "Scary that that is all he's got after such long rehab," the scout said.
Instructs, 10/8
Webb on 2nd instructs outing



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