Chips Ahoy

According to Sun-Times beat reporter, Gordon Wittenmeyer, with the signing of John Grabow to a 2/7.5 contract (backended as only Jim Hendry can do) and the trading of Aaron Heilman to the Snakes, the Cubs have supposedly made their final bullpen move of the offseason.

The deal appears to secure the final key piece to the Cubs' projected 2010 bullpen, coming one day after the team traded veteran Aaron Heilman to the Arizona Diamondbacks.

I'm pretty happy to see Heilman move out of town but replacing him with Grabow seems kind of blah. It's a Hendry thing to get a grizzled veteran for that 8th inning setup role and since Grabow is able to get lefty and righty hitters out (i.e. not a LOOGY), he's the heir apparent for the crusty veteran out of the bullpen for 2010.

List em. Since Jim Hendry was given the reins to the GM job in 2002, he's added through trade or free agency the following veteran bullpen lugnuts: Antonio Alfonseca, Mike Remlinger, Dave Veres, Mark Guthrie, Alan Benes, Phil Norton, Joe Borowoski, LaTroy Hawkins, Glendon Rusch, Cliff Bartosh, Scott Williamson, Chad Fox (twice), Bob Howry, Scott Eyre, Neal Cotts, Chad Gaudin, Jon Lieber, Luis Vizcaino, Aaron Heilman and lastly Grabow. I'd say for the most part, that's the ugly underbelly of MLB pitching although I know the Cubs are far from being alone in accumulating pitchers like these. Hence, I'm hoping the 2010 Cubs get more out of their young pitching so we don't see Chad Fox (round three?) ever again. Esmalin Caridad, Jeff Stevens and Justin Berg, I'm talking to you. It would be really nice to see productive seasons out of the recent 40 man roster additions including John Gaub, Blake Parker and even longshot/hotshot Raphael Dolis.

Grabow's career has been fairly lackluster but we all know how magically important lefty's are in the bullpen. Guys like Will Ohman, Scott Eyre, Joe Beimel, Brian Shouse, Scott Schowenweis, Ron Mahay,  Ron Villone, Eddie Guardado and Alan Embree keep hanging around when righty's of their ilk would be long retired.

Looking at fangraphs, including charts on lefty/righty splits on Grabow, we see his strength is a fairly low HR/9 (0.95/9) rate, a decent LOB% (around 75%) and his weakness is walks (4.15/9).He's gonna drive Lou crazy if that walk rate continues.

The kicker on Grabow though is that he's got a time bomb in his elbow. He has a history of left (pitching) elbow bone chips. Again from the sun-times piece:

As recently as 2007, Grabow pitched with pain and spent time on the disabled list for the problem, but he did not have surgery to remove the chips. He opted for a treatment and maintenance program that allowed him to make 149 appearances the last two seasons.

''If you look at a lot of pitchers, they're going to have something going on in their shoulder or in their elbow,'' Grabow said. ''Just throwing a baseball all these years, your arm's going to develop a lot of things that are just part of the wear and tear. It's something you learn to manage. I've got a routine every day to be able to pitch every day.

''Thank God it hasn't been an issue the last two years. Maybe it's something I've put in the past and can just pitch through.''

Grabow was on the DL from the beginning of the 2007 season, after being shut down in spring training on March 11th with "elbow inflammation" (the inflammation was due to loose bodies/chips). He returned on April 25th but only pitched 51 innings that year. The last two seasons he went 72 and 76 innings, so the problem hasn't acted up lately. 

Where do these loose bodies aka bone/cartilage chips in the elbow come from?

The elbow joint (anatomy video) is a complex hinge joint made up from the distal humerus (arm bone) and the two forearm bones that rotate (supination/palm up and pronation/palm down) around each other, the radius (radial head at the elbow) and the ulna (olecranon at the elbow which is the main hinge).

Elbow mechanics in throwing a baseball with spin, create significant compressive and shear forces across the elbow which can lead to damaging the articular cartilage and subsequently break off little pieces of cartilage or even bigger pieces that have bone and cartilage. This is the equivalent of getting sand in your shoe. Smaller grit isn't as irritating as larger pebbles. The larger pieces float around and if they wind up in tighter parts of the joint can cause it to lock up or get stuck. Usually they will move around to make the locking temporary but if the symptoms get more recurrent it makes more sense to treat this problem more agressively.

Grabow mentioned that he has a rehab routine to manage his elbow condition but there is luck involved in how well this works. Hopefully the loose debris is small enough he can work through it. Other non-surgical options include the usual non-steroidal anti-inflammatory meds or possibly a cortisone injection. If the symptoms are enough of a problem there is elbow arthroscopy to look inside the joint and remove the loose pieces of cartilage. MRI imaging usually does a good job of seeing these small loose cartilage pieces. X-Rays don't image cartilage well but they are useful to see bony loose pieces and spurs. 

Elbow arthroscopy / (image), like other joint arthroscopy is done under fluid to distend the joint. The elbow anatomy has many important nerves (such as the ulnar and radial nerves) passing nearby so the portals (or entry incisions) to the joint are very precise to minimize nerve damage risk. Because the elbow is a smaller joint, some of the equipment like shavers and grasping tools are smaller as well. Loose bodies and debris are fairly straightforward to remove but for the same reason they developed in the first place they can recur.

Elbow bone chips aren't limited to pitchers. NL MVP, Albert Pujols just underwent removal of bone chips from his right elbow (his 2nd surgery as in 2008 he had ulnar nerve surgery). Kosuke Fukudome missed the end of his 2007 season in Japan to undergo an elbow scope to remove bone chips. I wrote on this last season at TCR when he was quoted about the impact of his elbow problem on his subsequent play.

Fukudome had elbow surgery late in the 2007 season, and the elbow started bothering him last season right about the time his decline began in May. By the end of the season, his hitting mechanics were a mess.

''I didn't feel the pain physically, but I must have been subconsciously feeling the pain of the elbow,'' said Fukudome, still reluctant to openly admit pain. But when asked if it was a factor last season, he said, ''Probably it was.'' 

Of course, the issues are different for a pitcher than a hitter. The repetition, particularly a reliever who has to warm up and might not get into a game makes them more likely to get into this kind of problem. Lets just hope that Grabow's subconscious remains as calm as his elbow for 2010.