The Ted Lilly Chronicles --The Knee Bone is connected to the Shoulder Bone

Bruce Levine reports Ted Lilly goes to the DL, righty reliever Justin Berg (acquired in the 2005 Matt Lawton trade from the Yankees) gets called up from Iowa. Lilly's MRI-Arthrogram apparently didn't show "any significant abnormalities" (possibly showing tendonitis but no structural damage) but as we've all seen what the media gets to report and what the radiologist and orthopods see isn't always identical.

Levine also says Lilly has agreed to having his sore left knee undergo arthroscopic surgery (scheduled for Monday) to clean up Lilly's meniscus (link to anatomy pic), speculating that he can be back in 3 weeks if they do that now.

From a report on Levine's ESPN-1000 radio show, Lilly said the shoulder got his attention the day after the game in Philly. The shoulder felt "a little unusual". Yesterday he tried to throw and had sharp pain. He said he was familiar with it as it felt like his symptoms in Toronto. Lilly said he expects himself to come back in 3 weeks...

Based on my experience, how long it takes to recover from a knee arthroscopy varies greatly and 3 weeks is certainly possible but continuing to push the envelope on these injuries is like playing with fire. This implies the medical staff thinks Lilly's shoulder injury is a cascade problem, meaning that his knee soreness lead to altered pitching mechanics that secondarily lead to the shoulder problem. I found evidence that they connected his knee and shoulder woes when his shoulder took the brunt of the blame in 2005. 

From this mlb.com article on the Bluejays archive circa Spring 2006:

Last year, he said he had a tendency to have a "stiff" landing with his right leg, which put unnecessary strain on his throwing shoulder. Perhaps not coincidentally, Lilly sat out last spring with a shoulder injury.

I did some additional background research on Lilly's shoulder problems from 2005. Back then his diagnosis was biceps tendonitis (link to anatomy drawing). He missed most of spring training and started his season by coming off the DL 4/10/05 but had a rough April and worked through the problem until it flared up at the end of July 05. This lead to a 2nd DL stint lasting 5 weeks. 2005 wasn't kind to Lilly producing a 10-11 record but Lilly is a tough guy and naturally he didn't make his injury an excuse in this end of season interview from the Bluejays site.

"To put it very mildly, I'm disappointed in the way I've gone out there and competed," Lilly said Wednesday after his last start of the season. "I guess, coming into this year, I just expected us to be competitive in this league. And [I expected] myself to really make a push to help us do that."

To be fair, injuries played a large part in his inability to meet those goals. Lilly missed all of Spring Training with a case of shoulder tendinitis, and when he came back, he clearly wasn't ready to pitch in the big leagues.

Regarding the 2009 version of Ted Lilly, his shoulder tendonitis/torn knee meniscus might just take 3-5 weeks if they don't push things and add the knee arthroscopic surgery to his recovery list. Getting Lilly back in September is just like trading for an All-Star for the pennant stretch (slamming head in Rob G's door).

A chronology of the Ted Lilly 2005 biceps tendonitis after the fold...

Here's a chronology of Ted Lilly's 2005 shoulder problem ridden season:

Lilly chronicles I, report from spring training 2005:

Last year, Lilly spent most of Spring Training battling the effects of a sprained wrist. This year, he came to Dunedin with a sore shoulder and wasn't able to throw from the mound until last week. He still hasn't faced live batters, and he won't do that until Wednesday, when he pitches in a simulated game.

The decision was made and the opinion noted. Ted Lilly's last-minute appeal was denied on Monday when the Blue Jays announced their starting rotation for the first six games of the regular season.
Lilly, battling back from shoulder tendinitis, will be on the disabled list when the regular season begins. If all goes according to plan, he'll be activated to start the sixth game of the season. That means the earliest Lilly will debut is April 10, a full five days after he wanted to pitch.

"It makes perfect sense not to rush him, because he's got the whole year ahead of him," said Toronto manager John Gibbons. "I know he wants to go that second day in Tampa Bay, but we decided this was better for him."

Lilly Chronicles II, early season 4/25/05:

Mailbag: Is Ted Lilly hurt? When will he start pitching up to his capabilities?
-- Jim B., New York

Lilly may be hiding a little bit of discomfort, but he's told the media that his shoulder is completely healed and that his early pitching returns have nothing to do with the tendinitis he dealt with for most of Spring Training. Assuming he's telling the truth, there are a few potential reasons for his struggles.

One is that he just tried to come back too quickly. Lilly wasn't able to pitch in any genuine exhibition games -- he was stuck working in simulated games and against Minor League opponents while his teammates were getting the legitimate Grapefruit League experience. In that respect, his first few starts of the season are actually his Spring Training. Lilly went through the same thing in 2004, and he didn't gain all his strength back until mid-May or early June.

No. 2 deals with his mental state of mind. Lilly may have all his stuff without being able to use it correctly. The southpaw likes to mix his pitches in random fashion and get the hitters thinking, a style of pitching that requires consistent mechanics and dead-solid precision. If he's off -- even by a few inches or a few decisions -- it can throw the rest of his game out of whack. If he's unable to find his rhythm, it doesn't really matter what kind of stuff he has that day.

The final theory is also the least exotic. Lilly may be perfectly fine, despite the fact that he hasn't pitched well. His only positive start was his debut, when he tamed the Boston bats largely on adrenaline. Since then, he's had two largely forgettable starts -- against Texas and New York, teams that boast two of the league's most potent offensive lineups. Lilly may not have been at his best, but those batters can make you look that way.

Lilly Chronicles III, before heading to the DL 7/26/05:

Ted Lilly could feel the pain in his pitching arm before his last start, but he willfully ignored it to take the mound. The southpaw explained his perspective on Tuesday, and he also confirmed his injury is a case of biceps tendinitis.

"The other day was a situation where I didn't want to press the panic button too early," said Lilly, who should miss at least one start. "Obviously, as a pitcher, you go through some times where you have some [discomfort] in your arm. There have been times where I didn't say anything, and then it's gone.

Lilly Chronicles IV, after a 10-11 season 9/29/05:

"To put it very mildly, I'm disappointed in the way I've gone out there and competed," Lilly said Wednesday after his last start of the season. "I guess, coming into this year, I just expected us to be competitive in this league. And [I expected] myself to really make a push to help us do that."

To be fair, injuries played a large part in his inability to meet those goals. Lilly missed all of Spring Training with a case of shoulder tendinitis, and when he came back, he clearly wasn't ready to pitch in the big leagues.

Lilly Chronicles V, a healthy Spring 2006:

Lilly in 2006, his last season in Toronto, didn't have any shoulder issues after resting the problem through the offseason. Here's his 2006 line:

2006: 181 IP, 15-13, 179H, 81BB, 160K, 1.43 WHIP, 4.31 ERA

but I did find this one mention in a spring 2006 article saying that his shoulder problems may have been related to having a stiff landing with his right leg... having implications that his knee/meniscus issues this year may hbe a cascade injury, particularly since tendonitis often develops over time rather than an abrupt event (hence knee problem leads to shoulder problem):

Last year, he said he had a tendency to have a "stiff" landing with his right leg, which put unnecessary strain on his throwing shoulder. Perhaps not coincidentally, Lilly sat out last spring with a shoulder injury.

Sing along with me..

Oh those bones, oh those bones,
oh those skeleton bones.
Oh those bones, oh those bones,
oh those skeleton bones.

Oh mercy how they scare!