Angels & Demons & Wings

I'll leave it up to the media to tell us what's going on with Angel Guzman's shoulder problems.

On second thought, I'd better not.

Once again the media doesn't get it. From Howard Schlossberg's piece in the Daily Herald:

While surgery is a possibility, the Cubs are aware that most major rotator-cuff surgeries, while successful in and of themselves, don't always enable the player to make a comeback.

Thank God it wasn't Bruce Miles writing this (I love Miles work). It does show, once again, a lack of understanding regarding what gets reported.

To quote Dan Aykroyd, "Just the facts, ma'am":

1. The Cubs.com article reports, Angel Guzman's MRI showed a "significant tear in a ligament in his right shoulder" which medically speaking translates into a torn inferior glenohumeral ligament (see diagram, item C). If the glenoid or socket's labrum is also torn, this means the entire front of his shoulder is very loose and may be detached. This is an injury that leads to instability, as in shoulder dislocations or subluxations (partial dislocations). This is what Aramis Ramirez had last season in his glove side shoulder (not his throwing shoulder).

2. Angel Guzman HAD a glenoid labral tear repaired in 2003. The labrum is the fibro-cartilagenous rim of the socket (glenoid). The middle and inferior glenohumeral ligaments are adjacent and embedded in the capsule of the shoulder joint in front of the shoulder and they attach to the labrum. These ligaments do not have to be injured for the labrum to tear or detach from the glenoid. 

3. Angel Guzman DOES NOT HAVE a rotator cuff tear. The muscle-tendon commonly understood to tear when referencing a rotator cuff tear is the supraspinatus (see MRI image of supraspinatus tendon tear) which is on top and attaches to the greater tuberosity of the humerus (arm bone). The rotator cuff muscles and tendon attachments are immediately outside the shoulder capsule layer, so it is quite separate from the labrum and capsular ligaments.

Guzman's shoulder woes date way back and include labrum repair surgery in 2003. Jim Callis from Baseball America had this on Guzman back on November 26, 2003:

The Cubs thought Guzman was ready to make a Mark Prior-like ascent in 2003, beginning the season in Double-A West Tenn and getting to the majors by midseason. If Chicago didn’t have so much pitching, he could have pressed for a big league job. Guzman led the Cubs with a 1.13 ERA in the Cactus League, and his teammates voted him the most impressive rookie in big league camp. He caught fire in late May, going 3-1, 1.01 over his next five starts. After shutting out eventual Southern League champion Carolina for seven innings on June 20, Guzman was picked to pitch in the Futures Game and would have been the logical callup when Prior hurt his shoulder in mid-July. But Guzman never threw another pitch in 2003, as his shoulder was bothering him. Doctors diagnosed a slight tear in his labrum, and he had it corrected with arthroscopic surgery.

Also remember they shut down Guzman last September with shoulder pain that got labeled a triceps strain based on exam and an MRI. No commentary on other shoulder pathology was mentioned. The Cubs must have felt his shoulder was OK with the rest from an early shut down although one wonders what impact his recovery from January knee arthroscopic surgery might have had on his throwing.

The FEAR of full recovery in a pitcher's throwing shoulder in repairing this is warranted. See Mark Prior if you want to see how well someone recovers from instability surgery. Although from what I've read Prior had capsular laxity and not a detachment of the labrum and there is a difference. Capsular laxity gets surgically addressed by a procedure that tightens up the capsule (capsular shift) and a detachment needs to be reattached. In reattaching the capsule-ligament complex, the trick is to do it where it's not overly loose or tight, so in a pitcher this is the problem because they need more laxity than non-throwing athletes, just not too little, as they'd lose extension and external rotation and not too much or the instability persists.

So near term, Angel Guzman will get a second opinion, probably from orthopedic guru Dr. James Andrews, in Birmingham, Alabama. He'll probably go the ARam route in trying to rehab for 3 months and if that fails go the repair route. That's what 2nd opinions are for though.

So for all the sportswriters out there, here's the rest of my mini-primer on shoulder anatomy:

The rotator cuff is a group of 4 muscles that surround the shoulder in front (subscapularis), on top (supraspinatus) and behind (infraspinatus and teres minor). These muscles lie immediately outside the shoulder capsule which is the fibrous tissue (all joints have capsules) that connects the two major parts of a joint, in this case the glenoid (socket component of the scapula or shoulder blade) and humeral head.

The acromion is the bony overhang from the scapula that connects the shoulder blade to the clavicle (collar bone) or the AC joint (acromio-clavicular). The acromion is also an attachment for the larger and more superficial deltoid muscle. Impingement syndromes often are related to spurs or curve-shaped components from the anterior acromion and the AC joint. When the AC joint is injured, that is called a separated shoulder. It is the glenohumeral (ball and socket) part of the shoulder that is injured when a dislocated shoulder is described.

The long head of the biceps attaches at the 12 o'clock position just above the glenoid socket. It attaches into the fibrocartilaginous glenoid rim which surrounds the socket in which the capsule attaches as well. This can be injured inside the joint, known as a SLAP lesion (superior labrum, anterior to posterior) or it can be injured outside the joint from impingement when the humeral head rubs against the acromion.

Shoulder bursitis also comes from similar impingements. The bursa is a normal layer of tissue that helps the gliding between two impinging surfaces and when it gets inflamed, it thickens, making the space between the two surfaces tighter, a vicious cycle.

Finally, Since Guzman was shut down last year from a triceps injury near the shoulder, I'll mention that the triceps isn't usually a consideration in shoulder injuries. Still, it does have one of it's three attachment sites just below the very bottom of the glenoid socket.


Update: Sun-Times writer, Gordon Wittenmeyer just posted this interview with Angel Guzman

Cubs pitcher Angel Guzman says he plans to have surgery on his injured shoulder, even though he's been told few pitchers ever come back from that kind of surgery.

"It's going to be tough," said Guzman, 28, who was diagnosed over the weekend with a significant ligament tear near his armpit and instability in the shoulder. "But it's better than not having it and not having a chance. Doing it, I have a small chance, but there is a chance. So I'm going to take the chance."

Guzman says the decision isn't final. He plans to see famed orthopedist James Andrews – who already has done operations on Guzman's shoulder and elbow -- as soon as this week and then consult with his agents and his family.

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Comments

wow, a Phil Rogers, "On Baseball" article I didn't hate. Maybe because it's about St. Louis...

I liked this little tidbit:

That means that Holliday and Pujols will combine to take up about 35 percent of the payroll this season and in 2011, and then jump to an annual average above 40 percent for the next five years. Compare this to the Yankees, whose oversized payroll means the combined $57.3 million they're paying to Rodriguez and CC Sabathia accounts for only about 27 percent of their total.

http://www.chicagotribune.com/sports/baseball...

Wittemmeyer just posted that Guzman expects to go ahead with surgery, pending 2nd (and maybe 3rd opinions). Titled: Guzman plans to have risky surgery to fix shoulder

http://www.suntimes.com/sports/baseball/cubs/...

Cubs pitcher Angel Guzman says he plans to have surgery on his injured shoulder, even though he's been told few pitchers ever come back from that kind of surgery.

"It's going to be tough," said Guzman, 28, who was diagnosed over the weekend with a significant ligament tear near his armpit and instability in the shoulder. "But it's better than not having it and not having a chance. Doing it, I have a small chance, but there is a chance. So I'm going to take the chance."

Guzman says the decision isn't final. He plans to see famed orthopedist James Andrews – who already has done operations on Guzman's shoulder and elbow -- as soon as this week and then consult with his agents and his family.

"It's very sad, but what can I do?" he said. "I'm still breathing."

He may also seek a third medical opinion before deciding, he said.

...But Guzman said, "I think there is no chance to get it fixed without the surgery. By doing rehab, it wouldn't do anything. I spent four months here working out [over the winter] and I felt as strong as ever. And still, pain. I think that's the only way to get it fixed."

..."I'm going to get all the people that are close to me involved in my decision, because I've got a family to support and I think it's a good idea to talk to them," he said. "Maybe it's going to take a few days, or a few weeks."

For now: "Disappointed. Sadness," he said. "I just have to go through it."

Cubs split-squad games cancelled as it's raining hard in Glendale, AZ

per multiple tweets (Muskat, Sullivan, Len & Bob)

http://twitter.com/lenandbob

...go watch the Blackhawks-Wings (2-0, Hawks in the 1st period)

Fantastic article, Dr. Hecht.

Carlos Silva read the headline and thought the article was about...

http://tinyurl.com/yclxm83

via ye olde world o' roto:

"Lou Piniella said that Cubs stud shortstop prospect Starlin Castro will start the season at AAA."

http://www.chicagobreakingsports.com/2010/03/...

Good. If he manage a .725+ OPS in a year there and play consistent defense, it will be worth considering him as a starting shortstop in 2011.

I am more interested to see what happens with the bullpen. The bullpen is going to be young, inexperienced, and valnurable, to be quite frank. Pitching could be a big problem this year. We shall see.

gray and/or caridad need to step up...

marmol/grabes miss bats...but they also miss the strike zone a bit.

Gray is probably not going to step it up. He is also injured. See this from a couple of days ago:

http://muskat.mlblogs.com/archives/2010/03/35...

brilliant. meh...

Byung Yung Kim is on a minor league deal, and has a contract clause that allows him to opt out by March 15 if he feels that he can make another team.

Kim may not set your heart a flutter, but there may some experienced guys out there on similar deals who might have some value and would cost us nothing in trade in just s few days...

well if he's throwing well, the Mariners will keep him.

but a bunch of guys will get cut near the end of spring training, or be available in a trade because of a numbers crunch, Cubs should be able to find someone.

bullpen right now:
Marmol, Grabow, Caridad, 2-3 spots filled by Marshall, Gorzelanny, Samardzija, Parisi or Silva (two the rotation likely), and then Berg, Cashner, Russell, Atkins, Stevens, Gaub fighting for the last spot or two.

"So even if he continues to prove his health, and evokes memories of the 2005 All-Star who placed fifth in the voting for that year's NL Cy Young Award, he may emerge as a candidate for a trade, not for the Seattle bullpen."

anything can happen of course, but you don't make those kinds of signings and then get rid of the player if he's showing his old stuff. If he's marginal or not quite as good, then sure, they could move him.

If he's showing his 2005 form, I'm guessing the mariners find a way to keep him. If they're looking to move him, chances are he's still not the pitcher he once was and then the Cubs probably don't want him.

I have a hard time rooting for players who wear their hats in such a goofy way anyway.

But maybe there's someone else in the Mariner pen who's going to be bumped.

I may very well be in the minority, but I don't really care how he wears his hat.

No David Patton?

SO, Lou decided he has had a bad spring already? Or is this his way of taking some pressure off The Riot? Somebody take that magic 8 ball toy away from the manager, this is just madness.

You know one out of ten posts here have been about 2011. Aren't we going to enter a team this year?

You honestly thought a 19 year old prospect was going to make the major league roster?

Yes its madness! Madness to actually let him work on his game over the next 3-4 years and by then he will be an ancient over the hill 23-24! By then it will be impossible for him to make the jump to the majors because he will be too old to be worth a damn.

Yeah, I know. Probably more cement flying down from the upper deck, if he were to make the team. Balloons blocking the view from the rooftops, and Soriano making a diving all star catch without injuring himself. Beastly!

I actually watched Joe Nuxhall play, though not when he was 15. Now we're stuck with Fontenot at short...Where's Sammy Taylor when you need him???

s.castro needs to do more with his hands/wrists than rope singles around before anyone he's replacing is considered much of an impact.

on D riot ranges below average to his left, but usually stops the ball in time to make plays. his arm isn't steady, but dlee's glove is.

I wasn't too impressed with Theriot's defense on Saturday, he turned two balls that you would expect to be outs into hits (one to his right and one to his left). I can't help but wonder if that extra muscle has cut further into his range.

Did he get big again?

I know he dropped weight after 2007.

I think he was like 220 in 2007.

depends on your definition of big, but he allegedy added 10-15 pounds this offseason of muscle.

on the small frame yeah that's bigger

Shit. I wish I added 10-15 lbs. of muscle instead of Holiday fat!

Right, Castro never was going to break camp with the big team. He's exciting, especially the way he knocked the ball around this winter, but let's all take a chill pill.

If he can play big-league defense and play it well, I would be okay with him getting a callup if the riot & blanco were to get injured at the same time. Maybe we'll see him in September. Who knows.

Thanks, Cubster. Superb as always.

Castro going to Iowa is going to make Mike Wellman's season just a little sweeter. I like the notion of Sandberg managing him a little more too.

Castro, Castillo, and Jay Jackson are all likely to spend significant time at AAA this year, right? Maybe Cashner too? Put Brad Snyder, Tyler Colvin, and maybe Micah Hoffpauir and/or Samardzija there too and Iowa ought to be pretty interesting this year. Snyder, LaHair and Hoffpauir could make for some fun BP viewing in Des Moines.

Cashner went to three balls on seemingly everyone in Saturdays game when he pitched - and the fact that he went two innings, including a pretty long first one implies that they're continuing to stretch him out as a starter.

That being said, our bullpen doesn't look too good and he's probably the first or second most talented option. At this point I wouldn't be shocked if he made the MLB roster.

REAL NEAL: Cashner had control problems in his first inning of work on Saturday (25 pitches - only 11 strikes, and he walked the first two men he faced on nine pitches), but then he got through his second inning on only 10 pitches (8 strikes) - 1-3, F-7, 1B, and K.

It's raining again today, and it's not supposed to stop until sometime tomorrow.

Maybe the Cubs will be able to get today's and tomorrow's games in between the raindrops, but I am not optimistic.

http://sports.yahoo.com/mlb/blog/big_league_s...

come see the beautiful ballpark, ignore the average team...

in Moneyball flick if it gets going again, which it's suppose this summer.

http://sports.yahoo.com/mlb/blog/big_league_s...

Gonna play Paul Depodesta. Bwahahaha!!

since the A's never actually capitalized on the "moneyball era" besides just staying afloat i'm still shocked this project keeps getting attached to any name worth knowing...

it's the writer's fault for making everything so damn needlessly dramatic.

real moneyball seems to be going down in boston with a hotshot kid named theo...even if he has a lot more $$ to work with.

since the A's never actually capitalized on the "moneyball era" besides just staying afloat i'm still shocked this project keeps getting attached to any name worth knowing...

what do you mean by capitalized?

in the eyes of the "real world" that doesn't follow baseball as a hobby they got a handful of early-exit playoff appearances followed by f'n nothing. where's the hollywood ending after setting up scenes of undervalued players others just "don't see." hell, those players aren't even stars elsewhere at this point.

the "fever" of it all passed seasons ago. hell, theo-mania has come and gone since then and theo's still doing a hell of a job.

at least if they do decide to shoot it the flick won't come out in a season (this one) where they got great pitching and a lineup made of bench players + kids waiting to grow into their role.

we think it's neat ben sheets is being picked up as a possible mid-season dump, but that's just a fancy way of saying "these losers sure can shuffle some paperwork" since this seems to be yet another season no one's expecting them to do anything.

If sabermetrics is to viewed at best as a science and at least as a developing form of analytics, then Beane's legacy is not the success of his franchise but the way in which, like a scientist, he is seen as having shifted the paradigm of how players are evaluated and how an entire field is viewed. He will be remembered as an early, key alchemist of the revolution of the analysis of the game, results be damned.

He never got the hardware to show for it, but it's similar to discounting Aaron Burr's contributions to the democracy because he was never elected president.

yeah, but...hollywood movie.

the success of his franchise doesn't seem like that much of a success, too. we know it's good vs. the payroll, but since the book came out they've been to the playoffs once and promptly lost. they've had 3 losing seasons in a row and it's not looking too good for them in 2010, imo.

there's just nothing to show for the hype...even players in the book going off to do great elsewhere don't exist...it all seems a little flat.

i'm not discounting beane, especially with his payroll, but it all seems anti-climatic at this point.

Of course Beane's legacy has benefited from the hype machine, but among those who follow the game closely, I think it's pretty well understood that his greatness comes not from what he accomplished but in the influence he had on front office operations and the game's new-found gold rush toward unidentified advantages.

his greatness comes not from what he accomplished but...
---
from Hudson, Mulder and Zito?

steroids too

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