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.