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.


Recent comments

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  • Oh what do you know, Cubster? Go back to your day job.

    --- Ducks, puts on Cardinals cap, runs.

  • Russell had a severe hamstring last year while with the A's system, forcing him to miss the first half of 2014. I've even wondered if his injury last year was a component of Billy Beane putting him on the trade market. He was quoted saying that last year's injury was a 10 out of 10 when it happened. Last night he said his hamstring soreness was a 1/1.5 out of 10. Hamstring injuries are tricky though, so I'd expect the medical team to be overly cautious here.

  • ...I want to reinforce the observation that there was no sea of red in the crowd. The usual Cardinal fans roaming the stadium were few and far between.

    Also, almost every 2 strike pitch brought the fans to their feet. Good for those in knee rehab.

  • "1st team hit hit 6HR in a game in the postseason." rises above obvious...i checked it with the official fact-finding commission of Douche, Douche, and Douchestein. they agreed with you, but they're a bunch of f'n douches so who cares?

    btw, the cubs are 2-1 in the post-season series.

  • I should be able to watch the game on the NFL replay app, whatever that thing is called. I've got it on my iPad. This is the first year I haven't forced myself to somehow watch every game - no I take that back, last year was - in quite some time. Last year was so unbearable, no pun intended.

    You make some good points about Cutler, and I was a holdout defender of Cutler for a long time. I gave up on him a bit after one too many dumb interceptions, but last year doesn't count. Trestman was the worst coach in Bears history.

  • Nice little reportage there!. I think you're older than me. Considerably older. Maybe several generations. Working out is so essential, especially as age kicks in, isn't it? I still lift weights, and so I'm confident that when I get to be at the hip breaking age, mine won't be a statistic. But I have a ways to go for that to be a concern.

  • What was impressive to me is that the Cubs won despite poor base running, several defensive miscues, Russell leaving due to injury, Arrieta having an off game and getting knocked out early, and Rondon giving up 2 runs in the 9th. If they can win a game like that... 

  • I was there too. The crowd was absolutely electric. People were standing for every big and semi-big moment, from the first inning on. It felt incredibly strange and exhilarating to see the Cubs (the Chicago bleepin' Cubs!) score playoff insurance runs on the Cardinals. What a game. One to remember.

  • 14 in attendance. What's the record for attendance in the fall? I guess I should ask what the record attendance listed is in one of your recaps.

  • I was there too, with my grown son. This is my miracle year-- I rose to the top of the season ticket list after eight years, completely unexpectedly, and my wonderful wife agreed to put the ticket fee on the emergency credit card. The whole point of course was that the Cubs were going to be good this year, and then for a while, so to get season tickets with the guaranteed shot at the postseason was incredible timing. We got to the remote lot at 4:10 after stopping at Nhu Lan for our usual banh mi sandwiches, only to find the lot full, way earlier than normal.

  • Wrigley was electric tonite
    Not many card fans
    Video board was great, they played "there goes my hero" by foos over ryno highlights before he came out. Spectacular

    Good times hopefully they win tomorrow but think Lester will beat poopy pants on Wednesday.

    Happy 4th anniversary of Theo's signing

    Go Cubs !

  • Yeah. "Goodbye!" is a lame HR call.

    I miss Len and JD -- although, driving home from a friend's, WBBM played all 6 HR calls in a row -- and Len got to call the Bryant/Rizzo back-to-back. Very fun.

  • Lackey has been a beast against us. His stats on 3 days rest, however, not as nice. There is plenty of hope.

  • And, no dreadlocks grown yet.

  • Captain Obvious Strikes Again!!!

  • Amen, brother.