Picking at a Scab

As I'm sure you've all heard by now, ex-Cubs wonder boy Mark Prior went under the knife yet again last week for his troublesome shoulder. But you might have missed this little detail (emphasis added):


The Padres' right-hander stood in the clubhouse with his right shoulder
bandaged and his right arm in a sling following Wednesday's surgery to
repair a torn anterior capsule. If that weren't enough to put an end to
his bid to pitch this season, doctors also found a second injury -- one
that isn't normally associated with baseball.

Prior's anterior capsule was torn away from the humerus, the
bone in the upper arm. Team physicians Heinz Hoenecke and Jan Fronek
performed the surgery and said the second injury is normally associated
with traumatic events like a fall.

Hmm, that's an interesting little tidbit, now isn't it? I recall a time and place where our resident orthopedic surgeon, Dr. Hecht/aka Cubster, speculated that not everything added up with Prior's first surgery.

If MP(Mark Prior) really did have a Bankart lesion. That usually takes a trauma of
some sort (of course he could have fallen on the pavement walking his
dog). This type of injury is typically treated with rehab in the
beginning (see my comments on Toby Hall), with decent recovery until
the symptoms become more chronic. MP’s pitching was fantastic after he
recovered from that the collison in 2003, so it took time for the
looseness/instability the tear created to lead to what occurred in 2006
and 2007.

That answer was in response to a question of mine regarding if any of the rumors about Prior never fully recovering from that faithful collision with Marcus Giles in 2003 could be true. And now Hanz and Franz are saying that there indeed was a traumatic event that created at least one injury in Prior's shoulder.

Of course, for those who remember that conversation and article from last year, Will Carroll of Baseball Prospectus didn't take to kindly to Dr. Hecht's analysis:

Your take on my wrap up is emotionally based and wrong. This doesn’t
happen to just the Cubs and suggesting that this was a misdiagnosis is
… well, I hesitate to state anything in an absolute, but I think even
Dr. Hecht would defer to the opinions of Dr. Andrews, Dr. Yocum, and
Dr. ElAttrache.

And since we have nothing better to talk about on this off-day, let's play out the entire conversation:

(Dr. Hecht): A true bankart lesion is traumatic, it’s not just from stretch.
Something has to detach the capsule from the glenoid rim. It’s just
hard to sort out in a chronic situation. Plus your conclusion said he
was dealing with this for two years, hence clearly chronic. I just put
together the implications of what was the most traumatic event to MP’s
shoulder.

Be careful of throwing terms out without explaining them. Mumford
procedures are for AC joint stabilization after type 3 injuries. That
would have been a significant surprise if such a procedure was needed.

I might be emotional and might be wrong, but I didn’t imply
misdiagnosis, just delay in diagnosis. Certainly if MP listened to
advice to treat his problems with rehab, it’s not the Cubs fault. It
always boils down to the patient’s decision when it comes to elective
surgery.

And last, but not least from Mr. Carroll:

And my “wrong” statement was stronger than I liked. I just want to
make it clear that there wasn’t a “misdiagnosis” here. Believe me, I
understand the frustration of this thing dragging on and on. I had to
write about this thing every day it seems!

Oh and one last thing — the links I did on my Unfiltered post didn’t
match up well. I thought the big filetted shoulders looked cool though
and would reinforce just how serious this type of thing is. (Dr Hecht,
feel free to email me directly anytime.)

When in doubt, trust the diploma! As our very own Dr. Hecht did say, Prior could have fallen walking his dog, but it's far more likely that the collision between him and Marcus Giles was the beginning of the end...at least for his Cubs career.

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Comments

It was however the beginning of the beginning of the “Mark Prior is a/an (effeminate term)” or “Mark Prior strained his (random female body part)” posts that never really seemed to get old.

It's been five years so here's what the collision looked like

http://i.xanga.com/Starlix/Prior%20collision.jpg

Clearly, Prior is about to land directly on his shoulder.
Which is what we all saw at the time. Why only fans thought
this was troublesome is beyond my ken.

At the time there was much more general concern for Marcus Giles who was knocked out (ironically replaced by Mark DeRosa) and taken to the hospital. Reports said he appeared to take Prior's knee directly to the face.

A sane manager, but we're talking Dusty Baker here, would have immediately replaced Prior as well but Baker left him in the game until his shoulder stiffened in the fifth.

Oh yeah,

Prior was out for interference on the play. It was all so unnecessary.

great picture...the shortstop looks like a background player in a Three Stooges sketch with that expression.

Great pic, indeed. Love Furcal's expression.

"Why only fans thought
this was troublesome is beyond my ken."

Was the unlicensed trainer the Cubs trainer that year?

Dusty's cronie.

At the risk of bringing up a sore subject again, could this be evidence of some performance - enhancing drug use earlier in his career? If not, and the chief reason appears to be the collision on the base paths, then that truly does suck. No reason he should have still been in that game, I remember screaming at the manager (whom I will not name here) to yank him the hell outta there.

At the risk of bringing up a sore subject again, could this be evidence of some performance - enhancing drug use earlier in his career?

Risk? You just brought it up. Sigh...

For all the flack he has taken about not "manning up". Prior obviously had a serious injury that needed to be taken care of. Who's fault is it that it took 3-5 years to discover the injury?

I know Dr. Hecht can shine more light on the subject, but some things you just can't find or diagnose until they open you up. Now, how they didn't discover this with his first surgery, you got me...

be caused by colliding with a 5'7'' second baseman who one Cub's Blogger had a serious man crush on? It would just be typical Cubs if the Giles play did that and the idiotic unlicensed trainer Dusty brought over did not detect an issue.

Congrats to Griffey..... just like Maddux, in this era, it's hard to root against the guy.

Congrats to a dude who I will be proud to say I saw play "once upon a time." I hope he can hang around the AL a few more years and take a serious run at 3K hits.

is will carroll still trying to be the "guy you call when you need a medical/stats baseball prediction dude on your radio/tv show" guy, btw?

mmm professional branding.

I was going to say something to that effect, but you beat me to it.

I've probably done more than enough to establish my feelings on Mr. Carroll around here. I find it wierd that everybody calls HIM about injuries to pitchers despite not being a doctor or a pitcher.

I know he's on XM radio every Monday morning...probably throws darts at a picture of Stephania Bell though, who took his ESPN gig.

http://insider.espn.go.com/espn/blog/index?name=be...

he deserves to work...its just the whole pitcher-expert/medical-buff thing he's went into with his career that i found odd.

Now, how they didn't discover this with his first surgery, you got me...
---------------------
I'm not so sure this was an issue at the first surgery. It's unlikely that this would have been missed the first time around and I do believe it's a new finding. Sorry if I subsequently use too many anatomic/medical terms but I can translate later if anyone has questions.

Remember the first surgery was a capsular tightening apparently to treat a chronic Bankart lesion (a detachment of the labrum and main stabilizing ligaments of the anterior shoulder particularly the middle/inferior glenohumeral ligaments) . This procedure took redundant capsule tissue and reattached it to the front of the glenoid (socket). So tearing the anterior capsule off the humerus is pretty far from where the capsular work that was done in the first surgery (almost the other end of the shoulder capsule joint attachment but still in the front or anterior capsule). It tearing in this location might be related to the capsule now being tight and when stretched during his current rehab, just happened to be the weakest place where something could give. Still it's a pretty unusual site to tear. I would have thought it would re-tear in the area adjacent to the repair, near the glenoid.

what the hell does 'translate' mean?

btw, i imagine a lotta people, including myself, would want to know at least if this is something that would generally show up on a MRI/xray if applicable.

translate means... if you don't understand chinese, someone who does will tell you what it means.

Confucius

according to Rotoworld with a sprained middle finger. One of the posters over at NSBB is saying the rumor in STL is that the tendon is ruptured to in a simlair fashion to Zumaya (who missed 4 months).

It wouldn't show up on an xray. It might show up on a MRI. The results of the most recent MRI apparently were read as an anterior capsular tear but they didn't indicate more precisely where in the anterior capsule.

Sometimes MRI's are done with dye injected into the joint to enhance the imaging (MRI/Arthrogram). Not sure if that was done, but it doesn't sound like it. It took an MRI arthrogram to diagnose Kerry Wood's rotator cuff tear. Of course he didn't get surgery for it (his surgery was for a labrum tear and no cuff tear was seen at the time of his arthroscopy).

thanks.

Cincy's JHJ with a fractured thumb. Voodoo doll, no?

Who's next in line for their shortstop job?

until Keppinger comes back from the DL.

If the Giles run in really is the cause for the shortened, if not completely ended, of what could have been great career for a young man that really is a shame.

We all knew he wasn't going to throw for the cubs ever again, i just hope he can get his shoulder in order and make a living once again...

erm, should i say EARN a living once again...

http://msn.foxsports.com/mlb/story/8225468/Fresh-r...

some sort of Roberts for Weeks talk and this:
One thing is certain: The Orioles no longer can get the same deal for Roberts that the Cubs offered during the off-season. One reported package included right-hander Sean Gallagher, shortstop Ronny Cedeno, Class AA left-hander Donald Veal and Class A righty Jose Ceda; another proposal substituted outfielder Matt Murton for Veal, according to a source.

Cedeno since has emerged as a valued utility man who can play three infield positions and help spell shortstop Ryan Theriot, who batted .202 last September. Gallagher, meanwhile, is showing progress in the Cubs' rotation and drawing raves from new teammate Jim Edmonds.

"He's the first guy I've seen in a while with Carpenter stuff," Edmonds says, referring to his former Cardinals teammate, Chris Carpenter.

I guess Gammons mentioned something about Burnett, Meche or Wolf being possible Cubs targets on the broadcast Sunday night.

"One reported package included..."

yeah, one of 10,000 reported packages...they kinda went for a sensational group of "could have beens" in that article.

veal, gallagher, AND ceda...oh wait...AND cedeno, too.

reminds me of some of the j.santana rumor offers before he went to the mets.

either way, though...it would have probably involved at least a couple of those guys. not like he was gonna go cheap.

And to think that I took heat for comparing Gallagher to Peavy and Carpenter last year...

This is TCR, Carlos. People will make you take the heat for anything, anything!!

I would take one more starting pitcher and I would be happy with this team in the playoffs.

No not Traschel!!

During the trip to SD, I thought Maddux would be great :) A short-term loan? :) I love watching him pitch whatever team he is on. I think he looks best as a Cub tho.

I still think we could use another bat to upgrade at either SS or CF. It would be nice to have a Crawford or H. Ramirez type player around for when the offense sputters, as it has been doing so lately. Yes, neither of those players are available, and it would be difficult to get anyone similar to them, but if we're talking about wishes, that's one of mine. I would agree that starting pitching is more of a concern however.

It would be nice to have a Crawford or H. Ramirez type player around

Heh... you think that would be nice? I am sure that there are a lot of Crawford or Ramirez types lying around.

Right, which is why I wrote the rest of my post.

My wish: C.C.

because Sabathia has yet to show this season he is worth the haul the Tribe will want for him. With the Phillies as are main challenge in the NL right now, I would like to have his groundball machine right arm on the hill in Game 3 of the NLCS at the Citizen's Bank Park. Also with the Dodgers lacking solid back of the rotation options for next season I think we can make a deal work. Lowe for Sean Marshall and a B grade prospect seems fair.

I don't think Lowe will be available. Why would the Dodgers give up arguably their best pitcher when they still have a likely chance of winning their division? That's a fantasy trade scenario.

Despite the D-backs playing bad baseball for awhile now, the Dodgers are 3.5 games back. I would give it 1 in 3 odds that the Dodgers will be sellers at the deadline. BTW, the Dodgers best pitcher far and away has been Billingsley.

I agree; Lowe could be the odd pitcher out in the rotation next year, especially if Schmidt ever comes back. They will want to keep Penny because he's only 30, so that would mean:

Penny
Billingsley
Kuroda
Kershaw
Schmidt/Kuo/Lowe?

Wow, good catch, Dr.

And, who wants to bet it isn't "genetic looseness", but an old injury. Who wants to bet he'll eventually get back to pitching and only be mediocre? Of course, I hope for the best for him, but still...

chifan
i would agree the phillies are our top competition and if dodgers drop off
lowe could be a good pickup definately playoff experienced.

noticed the iowa cubs played i think the cardinals team

both teams had a hoffpauir in the lineup

arethey related?

If you're talking about Jarrett Hoffpauir, they're brothers.

josh/jarrett are brothers. micah's on his own in baseball.

I assume you meant by brothers, not at all.

http://mvn.com/mlb-cubs/?comments_popup=3155#comme...
Jarret Hoffpauir had a brother Josh, that doesn't seem to be in organized ball anymore (born in Natchez, Mississippi)

Micah Hoffpauir had a brother named Bradley that briefly played with the Cubs (Fort Worth, Texas)

Bradley
http://www.thebaseballcube.com/players/H/Bradley-H...

Micah
http://www.thebaseballcube.com/players/H/Micah-Hof...

Jarrett
http://www.thebaseballcube.com/players/H/Jarrett-H...

Josh
http://www.thebaseballcube.com/players/H/Josh-Hoff...

Micah and Bradley played for their Dad (and another brother Adam), at University of Louisiana-Monroe. Micah transferred to Lamar University for his last 2 seasons.

http://www.jacksonvilleprogress.com/sports/local_s...

thank you navigator i thought that was a definate possibility

micah definately got the size lefthandedness and power
in that family.
heres hoping he is in toronto on friday

that should have read, jarrett and josh

sorry rokfish

Rickie Weeks lands on the DL with a knee injury (it's being called a sprained left knee).

http://www.jsonline.com/story/index.aspx?id=760138

Very late with this -- but, when I heard the Cubs were making Wood the closer, my "best case scenario" vision looked exactly like the 9th inning Sunday. Dominant, efficient and pounding the strike zone. 95+ mph fastball, nasty slider, batters helpless. Miller and Morgan were falling all over themselves gushing over his stuff. Hopefully, he is building confidence and comfort in the role.

Edmonds is growing on me -- not only his bat, but to go out of his way to compare Gallager to Carpenter has got to give Sean a big boost of confidence. He was also apparently the first guy to grab an Iowa "Gallagher" jersey to wear under his Cubs uniform, and others joined in. Good stuff.

http://www.kansascity.com/sports/royals/story/6568...

He has a NTC and does not like big cities.

A GOLDEN OLDIE FROM THE TCR VAULTS...

Arizona Phil — February 19, 2008 @ 8:27 pm response to:

Rob G. — February 19, 2008 @ 7:32 pm Is Jarrett Hoffpauir related to Micah?

==================

ROB G: No. Jarrett’s older brother is Josh Hoffpauir, a 2B who played in the A’s organization a few years ago. Josh is now an assistant baseball coach at Southern Missisippi.

Jarrett and Josh are from Vidalia,LA, where their dad is head baseball coach at Vidalia HS. Jarrett was an All-American 2B at Southern Miss (where Josh also played college ball), and resembles Mike Fontenot.

Conversely, Micah is from Jacksonville, TX, and is a 6′3″ strapping 1st baseman. If Will Ohman is a total jerk (which he is), then Micah Hoffpauir is a total nice guy, just a good ol’ boy from Texas.

Hoff-POWER!

AZ PHIL: How would yoyu compare Olka. State's former standout, and Cubs prospect, to EPat?

I have read Cubs scouting reports that Thomas is super speedy, nice glove, and terrific arm. But, as you know, EPat is a lefty, and already at AAA - also, the team has, like 35 2B players already...

What say ye PHIL?

CUBSTER - check your email.

ROB G. - Glad you had a fun and a big W.

It pays to edit.

I was meaning Tony Thomas, if you could not guess this from the above.

Sorry!

already moving to catcher...

http://cubs.scout.com/2/760842.html

I thought that Prior was shot after he struck out The Whammer.

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