Ted Lilly Complains of Knee Pain and Gets His Shoulder Scoped

Ah, another new adventure in Cubbery.

Sorry for missing the day's rampant speculation on Ted Lilly's left pitching shoulder arthroscopy. I was in the OR all day and connecting hip bones to...

So in one hour what can you see during a shoulder scope? Dr. Yokum puts the scope in from the posterior portal, low and behold he sees a caricature of Sean Marshall smiling face on the anterior capsule. He then puts in a Wissinger rod to create an anterior portal and whoa, is that a Tom Gorzellany autograph on his biceps tendon?

As we all remember from a report right here at TCR, the Ted Lilly Chronicles...

Lilly was on the DL as of July 25th after experiencing left shoulder pain that was diagnosed as tendonitis and treated with 3 weeks of rest. In one of the stranger events of the season, he goes on the DL because of his shoulder but because he was going to have to rest his shoulder, he opted to have his knee scoped since it had been acting up for awhile from a torn meniscus. The original plan was for him to tough it out and get the knee scoped after the season but the doctors felt his shoulder pain was a cascade problem stemming from his knee, so the shoulder symptoms changed the gameplan. Lilly did have a shoulder MRI-Arthrogram in July (leading to the DL stint), which was reported to show tendonitis but no structural damage. He returned from the DL on Aug 17 against San Diego and pitched a healthy and strong 6 shutout innings only for the outing to be wasted in one of the more painful losses of the season, courtesy of Kevin Gregg's 4 run ninth inning stint ending with Kyle Blanks walk off HR.

In 2005 with Toronto, Lilly had several DL stints because of left biceps tendonitis which didn't require surgery. His shoulder didn't act up again until around the All-Star break (he was the lone Cub representative last season and didn't get into the game because that is when his shoulder started to ache). 

In the media reports of what Dr. Yokum's procedure found and what he did, we see the terms debridement, washout and cleanup. That doesn't say much really except that some tissue was a bit worn and smoothed off. In this context debridement doesn't refer to removal of dead tissue (just worn tissue, so no maggots were needed) but specific anatomic structures like the biceps attachment to the glenoid/socket or biceps tendon as it enters the shoulder joint, the labrum (fibrous rim of the glenoid/socket) or the rotator cuff aren't specifically mentioned. When they say no structural damage was seen, it means none of the aforementioned items had enough damage to require reattachment. If his problem was biceps tendonitis or minor wear of the rotator cuff tendon (supraspinatus) they might have "cleaned up" these problems without feeling the need to repair or reattach anything. If he did have some signs of inflammation from friction outside the joint, often referred to impingement or bursitis, it's common to reshape the bone that rubs on the cuff (the acromion, which is a part of the shoulder blade/scapula). This is referred to as an acromionplasty and by flattening the front of that bone (it's common to have a curved shape in that area), it opens up the area that rubs on the cuff or biceps tendon where it enters the shoulder joint. Unfortunately, we're not told much from the media reports so I don't know if this was done.  Clearly, this minimalist news is better news than getting reports that he had a capsular shift or tightening (Mark Prior), a labral repair (Angel Guzman, Kerry Wood) or a rotator cuff repair or even a biceps tenodesis  which is a reattaching of the biceps tendon to the upper arm/humerus) and is done when the biceps is severely worn (Curt Schilling's situation which lead to controversy with doctors arguing whether he should have that surgery or not).

In the 6 months from November until late April, there is more than enough time to rehab and recover from a shoulder arthroscopic cleanup without any major structures needing repair. Unless Cubbery intervenes.

Ted Roosevelt Lilly a tough guy so I suspect he'll just do the return to sender thang,  when pitching coach Larry Rothschild sends him the towel drill video. Ultimately we'll know if this surgery worked if it keeps his KNEE from acting up.

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Comments

Good write up, Doc. Thanks. Is it likely the tendinitis inflammation from the July MRI-Arthrogram prevented the doctors from seeing the above issues? Or did the MRI likely reveal exactly these issues which they decided to fix surgically?

I think the MRI-Arthrogram matched what they found at the arthroscopy since neither event has identified any "structural" damage. They didn't think he would need to be arthroscoped back in July and if he did have it scoped then it would have ended his season. The recovery from a knee scope can be obviously quicker. The original plan was to have his knee scoped after the season but it got bumped up when his shoulder started aching too. So the timing on these decisions are factored into how much playing time will the surgery impact, but it's far from the final factor which is usually persisting pain over time (usually months). The Cubs weren't officially out of the race when Lilly's shoulder-knee combo became an issue and they thought he could get back in a 3 week window of time, which was pretty accurate. If that window was longer he might have needed more time just to do the minor league rehab thing. The Cardinals caught fire in August (while Lilly was on the DL) so his absence did have an adverse affect but he wasn't able to pitch with both problems so the decision at that time became fairly obvious. There can be other factors pointing to the decision to have surgery including what his shoulder physical exam suggests, but in this case persisting pain in the face of nonsurgical management (anti-inflammatory meds and physical therapy) made Lilly eventually decide to have it scoped. It was still Lilly's decision and these are always shades of gray to this decision. Sometimes these symptoms go away with extended rest (i.e. the off season). If the problem cropped up next year after extended rest then they would have been faced with that decision and it would have interfered with his season more extensively so that's a plus to having it done now. Still there is no guarantee that it won't recur even after him getting an arthroscopy depending on what is causing the inflammation, for example if his shoulder is still impinging.

Probably an AZ Phil question here..... How does MLB insurance work in regards to injured players (Lilly). Does insurance cover 100% of Ted's contract if he misses 2010? Will this esentially give the Cubs an extra 10 million to play with in Free Agency?

DBags buy out Chad Tracy, put Petit on waivers (claimed by Mariners).

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In reply to by Rob G.

Not claiming he is a Cy Young candidate. But why not take a flyer on a young guy with average plus stuff. He has had some MLB success. He is only 24. We've resigned Chad Fox 3 times. We've given 3 seperate contracts to Glendon Rusch. We just claimed Thomas Diamond. Petit is a better bet than any of those dudes are. Especially for nothing more than a waiver claim. Especially with Lilly hurt.

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In reply to by Dr. aaron b

I don't see how the first two have anything to with it, Fox was a reliever with good stuff and guaranteed to give an extra roster spot come playoff time. Rusch's first signing was a late spring training move and then they resigned him thinking he could duplicate it.

Diamond's got good stuff, top prospect stuff, but had TJ surgery which guys come back from all the time and was of course claimed before Petit hit waivers.

I also assume Petit hit waivers because he's out of options.

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In reply to by Rob G.

Glendon Rusch was collecting a check from the cubs from 2004-2007. 4 years 3 contracts. My point is that not every move needs to be sexy/high dollar. Petit wouldn't hav cost anything to claim and give a ST invite to. He's probably as good a bet as Randy Wells to have a good year next year. Only he was an actual prospect and is 3 years younger. When money is going to be scarce, why not roll the dice with some guys like Petit. Maybe one of them turns into something. Or we can stand pat and just assume that everything works out.

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In reply to by Dr. aaron b

well it costs something to claim a player I believe albeit minimal...

Rusch got cut by the Rangers in 2004 in March, Cubs signed him as a free agent (I assume for not much over the league minimum) and then resigned in Nov of '2004 on a 2-yr deal.

http://chicago.cubs.mlb.com/news/press_releases/press_release.jsp?ymd=2…

apparently after 2005, he received another 2-yr extension, had that ugly 2006 along with a blood clot and was cut before 2007. He was due to make $3.25M in 2007.

By Fangraphs value tool he well-exceeded his contracts even with the disaster of 2006 and not pitching in 2007.

as for Petit being an actual prospect, then you should love Thomas Diamond.

but I don't see anything in Petit that makes it much of a travesty, especially if he's out of options.

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In reply to by Rob G.

I just want us to take a more proactive approach. If we don't have money to spend, then we need to do some tire kicking. To me, the worst thing possible this offseason is for management to decide 1) Ted Lilly will be fine 2) Randy Wells is a legitimate 3rd starter 3) Wells,Marshall,Gorzy will be an acceptable 3-5 in the rotation. Especially since we don't have 1 single MLB ready Starter at AAA. Travesty to have a 140 million dollar payroll and absolutely zero SP depth.

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In reply to by Rob G.

interesting note on Harden...

had a HR/FB% of 15.4% last year, usually you're around 10% I believe and that's mostly where Harden has been for his career (he's actually been below 10% for his career)..

his K rate didn't change much, so I'd expect a big bounce back year from him if he's not on the DL....

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In reply to by John Beasley

I agree. I cannot see Hendry going into the season with three number 4 or 5 pitchers, and Z who is a "two" at best. With that possibility, and the always-thin "good" pitching market out-priced for the Rickett's new budget, it would not be a surprise if Harden finds his way into the Cubs' plans again. Unfortunately, the Cubs will still not have a "Number One", elite Ace starter on the team. When I watched the Playoffs this year, the Phillies, Yankees, Cards, and Angels all have one (or two). I am still so fucking pissed at Hendry for his 100-year deal with Soriano. Knucklehead Hendry.

Abreu signs 2-yr deal with Angels... JJ Putz will be a FA, another broken wing buy low candidate...

The following pitchers are available: Steve Traschel Glendon Rusch Chuck Finley Tom Glavine Pedro Martinez (now more than ever) I'm sure I've forgotten a few. Actually, my pipe dream is Lackey. He and Zambrano would probably kill each other though....

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In reply to by The Real Neal

it was just a pre-emptive strike, they'd have to bid against other teams if Marlins non-tendered him and those other teams could have offered Hermida a better shot at a regular gig.

I'm not even a huge Hermida fan or anything, but two lefty relievers low on the prospect totem pole seems like a good deal for a guy with immense, albeit untapped talent. The road splits are intriguing as well....

Anyway, I say good move by the Red Sox, they obviously believe in his talent as he was a possible acquisition for Manny two years back and Red Sox have some money to burn....

Comparing driving stoned to driving drunk is like comparing apples to shoelaces. People BLACK OUT while drunk. Driving stoned is a piece of cake as long as you don't have to drive too fast or there aren't a bunch of crazy lights around.

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