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

Subscribe to Recent comments
The first 600 characters of the last 16 comments, click "View" to see rest of comment.
  • That's a hell of a first impression by Montgomery. Brian Cashman having a good laugh on that debut.

    Eric S 9 hours 50 min ago view
  • ...and it's a 3 run homer.

    hey, vogelbomb had a HR on his 1st game with SEA AAA, too!

    crunch 10 hours 10 min ago view
  • montgomery comes on with men on 1st/2nd, 2 out, in the 8th.

    crunch 10 hours 12 min ago view
  • from rotoworld...

    "Tommy Stokke of FanRag Sports reports Chris Sale was sent home from U.S. Cellular Field on Saturday after cutting up throwback jerseys that he did not want to wear.

    crunch 10 hours 19 min ago view
  • I thought the same. It'd be great luck to face these non-contenders after the trade deadline.

    Charlie 12 hours 2 min ago view
  • ...why isn't j.lucroy playing for TEX yet?

    :(

    2r HR on a 12-pitch AB.

    crunch 12 hours 36 min ago view
  • nathan to join the cubs tomorrow.

    crunch 13 hours 10 min ago view
  • Wow in deed.

    Rob Richardson 13 hours 14 min ago view
  • FOX Sports @MLBONFOX
    Chris Sale was scratched from tonight's scheduled start due to a clubhouse incident before the game

    ...wow

    he was sent home by the team, too. the wsox released a press statement and everything. they stated it was non-physical in nature.

    crunch 13 hours 19 min ago view
  • He was scratched from his start today. No reason given.

    Rob Richardson 13 hours 24 min ago view
  • At the start of the season the book was that he was trying to pitch to more contact so he could stay in the game longer and it seems to be working so far. Contact against is 77.5% this year and it was 70.2% the year before. He averaged 6.7 IP/game last year and so far it's 7 IP/game. His actual pitches per game are only down to 106.1/game from 107.2/game last year but if he's able to go a bit farther into games without throwing more pitches and without giving up more runs that is a good thing.

    johann 14 hours 28 min ago view
  • sale's skills and insane value makes it almost too hard to have a market for the guy...he's got 3/38m owed to him over 3 seasons (2 team options). he could easily pull in 30m/yr if he was on the market as a FA.

    he's throwing a bit differently this season, especially with more sliders and less changeups like earlier in his career, but all his stuff still looks great even if the HRs are a little elevated and the Ks are down.

    crunch 16 hours 22 min ago view
  • Torres, Happ, McKinney, Jimenez, and Candelario for Sale. Deal or no deal?

    "The White Sox are reportedly asking for “five top prospects” for Chris Sale, FanRag Sports’ Jon Heyman reports."

    John Beasley 16 hours 36 min ago view
  • Unless he develops 30+ HR power and keeps his walk rate close to his K rate at the MLB level, he's not going to turn into Prince Fielder. And even if he does turn into Prince Fielder, he's gonna have a short prime. His very limited athleticism is likely to also detract some value from his ability to reach base--I don't buy making an out as being preferable to base clogging, but you'd certainly prefer just about any base runner other than Vogelbach, David Ortiz, etc.

    Charlie 17 hours 6 min ago view
  • seeing as arod has played a total of 27.1 innings of D at 1st/3rd and somehow managed a -0.5 dWAR with his 1 error at 1st and an overall positive total zone rating...he might end up even more in the shitter via the characteristics/flaws/whatever of how some sites determine various WAR values. dWAR doesn't directly lead to a WAR value, but the 2 main entities pushing the most popular variations of WAR sometimes lead to some interesting discrepancies in value.

    crunch 17 hours 22 min ago view
  • I have a lot of faith in Baez that he's going to turn into a more consistent, solid player. It looks like it took him about a half season or so of futility at the plate to figure out he was not talented enough to get away with the crazy approach he had. I think his running game will eventually have a more measured aggression.

    Charlie 21 hours 16 min ago view