St. Louis Cardinals fans clearly
recall the spectacular 2005 season, during which the club racked up 100 regular
season wins for the second consecutive year. Pitcher Chris Carpenter and first baseman Albert Pujols swept the
major player recognition in the National League, the Cy Young Award and Most
Valuable Player Award.
The following season, the two led
their club to its first World Series victory in a quarter century, but
immediately in 2007, their fortunes diverged, until both returned to the top of
their individual games in 2009.
On April 1, 2007, starting on
opening day for the third consecutive season, Carpenter uncharacteristically
struggled, yielding five runs in six innings. The next day, the right-hander
complained of stiffness and soreness in his elbow. Carp was diagnosed with
inflammation and placed on the disabled list.
From there, a downhill slide began
that cost Carpenter the remainder of the 2007 campaign with his rehab continuing
into July, 2008. At that point, an unrelated nerve problem affecting his
shoulder cut down the remainder of his 2008 season, too.
We will look back at what occurred
during that 2007 with an eye toward whether the current situation with Pujols’
injured elbow might follow a similar trajectory.
Carpenter was placed on the DL on
April 10, 2007. Following an MRI, the official reason went beyond the initial
inflammation description to state moderate arthritis and a mild impingement in
the elbow were found, but no evidence of an acute ligament injury. The latter
implied Tommy John surgery did not appear to be required.
In late April, Carpenter threw a
67-pitch bullpen session, which I recall being among the masses watching with
great interest. At that point, the impingement and swelling was commonly being
referred to as having been caused by bone spurs.
A quick digression into the
medical world. According to WebMD, “A bone spur forms as the body tries to
repair itself by building extra bone. It generally forms in response to
pressure, rubbing, or stress that continues over a long period of
So what you have is bone spurs
occurring as the body tries to compensate for another problem.
Back to 2007, on May 8 the
Cardinals announced that Carpenter underwent arthroscopy of the right elbow with
debridement and removal of bone spurs. According to the club, the surgery went
well with no unexpected findings.
By the start of July, Carp was
throwing again in Jupiter, Florida. He made two rehab starts with
before the swelling returned. By mid-month, Carpenter had consulted with at
least two specialists, including famed Dr. James Andrews in
Birmingham, Alabama, who reportedly does 150 ligament
replacement surgeries per year.
On July 24, 2007, Cardinals team
physician Dr. George Paletta conducted the Tommy John elbow
ligament replacement surgery on Carpenter’s right elbow.
- April: First there was
- Bone spurs were found but no
significant ligament damage.
- Carpenter tried to pitch through
the pain caused by the spurs.
- May: Surgery for removal of the
spurs was required.
- July: When Carp tried to
return, the ligament required surgery.
- A year and a half of his career
How does this compare to Pujols’
current situation? While there are similarities, there is at least one big
difference – Pujols existing condition.
Whereas Carp’s ligament apparently
checked out ok when his spurs were removed, it is already known and has been for
years that Pujols’ ulnar collateral ligament (UCL) has a high-grade tear. Pujols' tear was called worse than Carpenter's by Paletta and as such, he will eventually require Tommy
John surgery. Yet he has been able to play with it longer since first base is far less demanding on the elbow than is pitching.
Another difference is that Pujols
already had nerve transposition surgery on the elbow last off-season, a
procedure Carpenter required a year and a half after his TJ surgery. The stated reason
Pujols had that October, 2008 surgery was in an attempt to relieve numbness and weakness in his hand.
The official terminology was decompression and transposition of the ulnar
Pujols was diagnosed on Tuesday
as having five bone spurs, an ongoing problem that has been known since at least 2008. I found a
reference to Pujols mentioning pain caused by bone spurs during his rehab from
the nerve surgery as a reason for having to sit out of the World Baseball
Classic this spring.
Though no other issues with the
elbow were reported following the nerve surgery, some of the spurs were already there. Given that, why were they not removed during last
October’s procedure? The answer could be because they were helping to protect and stabilize the
The big question is what might
happen following the removal of the spurs.
Will Pujols' UCL then give out as
Carpenter’s healthier one did or will Pujols continue to buy time,
evading the major surgery that will eventually be
Another unstated possibility when
the elbow is opened up on Wednesday is that Paletta and Andrews will go ahead and
replace the ligament as well, a step that would cost Pujols as much as the first
half of the 2010 season.
We should have at least part of
the answer later in the day on Wednesday.
Update noon CT Wednesday, 10/21: The surgery was completed Wednesday morning and was proclaimed "a success" by the Cardinals. Chips were removed, spurs debrided and Tommy John surgery was deemed not to have been necessary.
For the rest of us, the waiting will continue.
Pujols is two seasons away from potential free agency. Any lingering concern over the elbow could provide some drag on the player's open market value.
In the interim, an in-season flareup requiring TJ surgery during 2010 or 2011 would most likely mean Pujols missing the entire remainder of that campaign, an occurrence that could doom the Cardinals' post-season hopes.
Link to earlier
Elbow Surgery Wednesday”.
Walton can be reached via email at email@example.com.
Also catch his Cardinals commentary daily at The Cardinal Nation
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