When the Doctor says Oops

What happens when the Doctor Says "Oops?"

You become a Cub.

Lookie here. The Cubs get an early holiday present under their tree in 31 year old starting pitcher Scott Baker. In typical Cub fashion, the wrapping paper is a bit discheveled and the bow on the gift is a little off kilter. Scott Baker toiled on the mound for the Twins from 2005-2011 including his best year in 2009 with 33 starts, 200 IP, a 15-9 record and a WHIP of 1.190. He had Tommy John/Ulnar collateral ligament (UCL) reconstructive surgery on his elbow last April, missing the entire 2012 season. Fitting Jedstein's Modus Operandi, it's a one year deal at $5.5M with $1.5M in incentives. According to XM Radio's Jim Bowden, the Cubs have made an offer to lefty Francisco Liriano, so maybe they are just going after ex-Twins. Matt Garza should soon be tweeting: "Collect em all."

Baker was supposed to have the (quicker to recover) flexor-pronator muscle attachment repaired in his right pitching elbow (compared to Tommy John ligament reconstruction) , but there was a change of plans decided intraoperatively...

In looking up the history on Scott Baker, I saw some pre-surgery articles in April that said his elbow injury was diagnosed as a tear of the flexor-pronator muscle attachement but when his surgeon, reknown Dr. David Altchek from Hospital for Special Surgery in New York (who did former Twin, Joe Nathan's TJ surgery) opened the elbow up it was clear that Baker needed his UCL reconstructed. The flexor-pronator recovery is usually 6 months whereas the Tommy John surgery is typically felt to be longer at 12-18 months for recovery. 

An MRI taken late in spring training showed that the ulnar collateral ligament - the one that is replaced during Tommy John surgery - was sound. But Twins spokesperson Dustin Morse said that when surgeon Dr. David Altchek opened up the elbow and took a look, he decided to repair the ligament.

...and going into the April surgery, the Twins GM Terry Ryan said in  a press conference that Baker's flexor-pronator attachment surgery would just be a simple "cleanup"

Baker said this preoperatively:

"He (Dr. Altchek) said this is something that’s not going to repair itself. It’s not going to cure itself. It’s something that needs to be taken care of. Fortunately, he said the (UCL) ligament looked great, so I guess in a way, as bad as this is, the flexor pronator tendon is what needs to be repaired. Nobody hates this more than me. So it’s tough.”

When asked about his Ulnar Collateral/Tommy John ligament, Baker said:

“Yeah, he said there’s no need to mess with that. I haven’t had any discomfort there, which is a good thing. But at the same time, what’s going on right now, I just know two things: It’s painful and it’s affecting my ability to be effective in a major league baseball game. What do you do when that’s the case? You have to get it taken care of."

A Simple Twist of Fate

Of course, the anatomy of the flexor-pronator tendon attachment and the ulnar collateral ligament attachment are so close together it's not unusual for an MRI or physical exam to be misleading. It is common practice to include in the surgical consent permission to do both procedures "just in case" this scenerio plays out. According to the Star Tribune article, if Baker had the cleanup elbow surgery with a 6 month recovery estimate, they probably would have picked up his $9.25M option on his contract and he'd still be a Twin. Then again, that's a lot of $$ for any pitcher coming off of any elbow surgery unless you're under 30 or your initials are SS (or both).

Biomechanics 101

The forearm flexors are really responsible for controlling wrist flexion but they originate just above the elbow which gives them maximal leverage. The forearm pronator muscles are responsible for forearm rotation, in the direction of going from palm up to palm down, clearly needed to put spin on the ball. The reverse direction of pronation is supination where you move the forearm to a "palm up" position. The Ulnar collateral ligament is a bit deeper but in the same general attachment area and is responsible for keeping the elbow joint on the medial or inside from opening up. The elbow joint is a complex hinge where the forearm bones (radius and ulna) and the radius bone rotates around the ulna to produce forearm rotation (pronation and supination). The hinge component involves the ulna (olecranon) and distal humerus (medial condyle) on the inside (medial) and the radius (radial head) and lateral condyle or capitellum of the humerus on the outside (lateral).

 

  Ulnar Collateral Ligament Origin:                               Flexor-Pronator Muscle Origin:                                  

Tommy John LigamentPronator-Flexor Origin

Star-Tribune author, La Velle E. Neal III, so generously offered the link to a comparable case, former Giant pitcher Russ Ortiz. Ortiz at age 32, who in 2007, went in thinking flexor-pronator and wound up with Tommy John surgery. Ortiz came back to pitch in 2009-10 but lasted only 90 innings before retiring.

There is an in-house comp. We've seen Tommy John surgery work well in Ryan Dempster. Dempster was younger at age 26 when he had the surgery in August 2003. The Reds didn't pick up his contract in November 2003 and the Cubs signed him in January 2004. Demp missed most of the 2004 season with a brief 20 inning bullpen comeback in September. He remained a Cub closer/reliever for 3 seasons and finally went back to the starting rotation in 2008. 

People as saying there is not much risk paying a starter at $5-6M. Upside: See Paul Maholm. Downside: See Russ Ortiz or Good ol' duct tape himself, Chad Fox. Nuff said.

 

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  • "The Boston Red Sox were banned from signing any international players for the next year and had five of their teenage prospects declared free agents on Friday after a Major League Baseball investigation showed they circumvented signing-bonus rules last year, a source familiar with the situation told Yahoo Sports."

    https://www.yahoo.com/sports/news/source-red-sox-b...

    Rob Richardson 2 hours 14 min ago view
  • The thing with Heyward is its not just free agency. He is way under performing his career #s. He's making the same % of contact but his soft contact is much higher and hard contact much lower than all his previous years so there is something very specifically going on this year causing the issues. Chances are he will eventually get back to his previous #s and it's better to get the slump now and get that hot run later but I wish I knew what is different about this year. He's either just not seeing the ball as well or a swing change is causing it.

    johann 2 hours 29 min ago view
  • Only 3 pitches for Leathersich. Not much of a rehab outing.

    Thanks for the reporting Phil.

    QuietMan 2 hours 41 min ago view
  • He's the nastiest pitcher I've seen in awhile. I'm gonna give them all a mulligan on this one.

    Coghlan's strike out was more disappointing. He was fighting off a lot of pitches and not swinging at crap, and on the last pitch, he swung at stuff he was laying off, and struck out.

    And Heyward, too. I don't blame Heyward - I blame free agency. I hate it. You almost never get a valid return on the investment.

    I look forward to the day when ball players own the teams. The current economics are not sustainable.

    Old and Blue 3 hours 43 min ago view
  • Oh, I'm sure you're right. He's not 27-27 in saves for nothing. But, man, I hope they learned last night that he didn't throw a single pitch in the zone to KB, Contreras or Baez, and they all just kept swinging.

    billybucks 5 hours 50 min ago view
  • Sounds like a much better game than last night's fiasco in Flushing.

    Old and Blue 6 hours 7 min ago view
  • I'm pretty sure it looks like a sweet pitch on the way in. How many sinkers like that are there at 98 mph? I agree that they should just do a Lackey and stand their with their bat on their shoulders until he throws a strike next time, but I can see how that's hard to do.

    The bullpen, on the other hand, is a mess, and Heyward is starting to piss me off.

    Old and Blue 6 hours 8 min ago view
  • I noticed that too. He's getting to everything, but when he gets right under it on a high flyball he looks uncomfortable

    cubbies.4ever 14 hours 42 min ago view
  • Did you expect anything different?

    billybucks 15 hours 12 min ago view
  • Wow, did they blow this game. Stupid plays by the kids in the 7th -- Almora throwing to 3rd instead of 2nd to keep the DP in order (when a DP probably wins the game) and Baez throwing to 3rd (to a backpedalling KB) instead of getting the easy 2nd out at first - cost them the game. Also, Contreras almost throws the ball into RF on a nonexistent pick-off play. And Maddon, for using Peralta in the first place. Did they do a bunch of shots in the dugout before the 7th? Unbelievably bad baseball. I thought Almora had a high baseball IQ?

    billybucks 15 hours 34 min ago view
  • men on 2nd/3rd, 0 out...and nothing.

    cubs lose :(

    crunch 16 hours 7 min ago view
  • UH OH! RALLY TIME!

    crunch 16 hours 17 min ago view
  • Getting tired of this Heywood weak sauce

    jacos 16 hours 28 min ago view
  • Yep, can't say I disagree with that. His first batter and resulting walk was just brutal. Reminded me of a bit of Jacque Jones spiking his throws into the ground from RF.

    Eric S 16 hours 36 min ago view
  • The use of Peralta in any semblance of a high leverage situation is questionable at best.

    fixed that for ya.

    crunch 16 hours 43 min ago view
  • The use of Peralta in any semblance of a high leverage situation is questionable at best. Hind sight is easy but Peralta had nothing.

    Eric S 16 hours 51 min ago view