Albert's elbow

by lefty fan on Jan 24, 2008 10:23 AM EST

After reading about Albert Pujols' appearance at the Winter Warmup on Monday, I have been suprised by the lack of comments posted here about his elbow condition. On one hand, Albert's elbow has been a problem for several years. On the other, when you see the names Dr. James Andrews and Albert Pujols in the same sentence it raises an eyebrow. As erik pointed out in a comment earlier this week, he can't straighten his arm.

Based off Albert's comments, it appears that surgery is now a when, not if proposition. The question is how long would he be out if he had Tommy John surgery? For pitchers, this is typically at least a year between active duty. Is this timeframe any different for position players? What about 1st basemen who can "hide" their arm strength? I seem to remember Tony Womack having TJ surgery and being back in about 6 months.

My concern is that Albert is going to play hurt until it's obvious that he needs to get fixed. His numbers last year were good but not Albert good. My biggest fear is that he plays 3/4 or all of 2008 and then decides to go under the knife. This team is being built for 2009 and losing Pujols for any amount of time for '09 would be a big blow. Any thoughts?

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Thoughts?

If we're out of it come the All-Star break, and Pujols is still hurt (I'm sure he will be). Do it then! In fact if we're more than 15 games out at any point...do it then!

Thanks for the highlight moments 15 and 27!!!

by cardzfanbub on Jan 24, 2008 11:41 AM EST reply actions

Hmm

I agree with your sentiment RE: the combination of James Andrews and Albert Pujols's elbow. I honestly have no idea what the down-time is for a position player's TJ recovery. I'd imagine it's not as long as for a pitcher, b/c a pitcher's elbow is subjected to more extreme stresses and theoretically would require more strengthening/rehab. I'm no doctor, so I could be completely wrong.

I think he should just go ahead and get it done. It seems like surgery is an inevitability at this point, so they might as well just do it now and not risk losing parts of two seasons.

"Your Holiness, I'm Joseph Medwick. I, too, used to be a Cardinal."-Joe Medwick, to Pope Pius XII.

by redbirdnation8206 on Jan 24, 2008 11:52 AM EST reply actions

He should have gotten it done

at the end of last season. For a position player, the return time is 6 months.

If he had it October 1st, he'd be rip-rarin' to go March 1st, April 1st at the latest. Just another example of the Cardinals medical staff botching another players health.

I will be boxer briefs

by Hardcore Legend on Jan 24, 2008 11:59 AM EST up reply actions

For an example

Tony Womack made it back from TJ surgery in 5 months to play for the Cardinals.

I will be boxer briefs

by Hardcore Legend on Jan 24, 2008 12:02 PM EST up reply actions

re:

From all I have read it seems like it has been Albert's choice, not the medical staff's fault.

by abothebear on Jan 24, 2008 12:03 PM EST up reply actions

He seems to be one of those guys that wants to avoid the knife if at all possible.

by abothebear on Jan 24, 2008 12:05 PM EST up reply actions

It's the medical staffs fault

for not making it abundantly clear to him that it NEEDS to be done.

I will be boxer briefs

by Hardcore Legend on Jan 24, 2008 12:15 PM EST up reply actions

re:

why does it NEED to be done?

by abothebear on Jan 24, 2008 1:06 PM EST up reply actions

Cause the man can't put his arm

in a straight position. How is he supposed to swing a bat if he can't straigthen out his arm?

The team doctor's blew the Carpenter elbow situation and pushed his surgery back 3 months, thus costing him 2 seasons. If they had called a duck a duck when they first inspected it, he'd be ready in May, full strength by mid June. Instead, he'll be lucky to pitch by August in any form.

Pujols would be in the middle stages of rehab from TJ surgery and not have to worry about that elbow for a LONG time again if they had just done the surgery. Now, they will let it effect 3 seasons of his career, probably (last year, this year and next).

The Cardinals medical staff probably still gets more right than it does wrong and I am constantly amazed at how they've been able to manage Albert's leg and foot problems but when it comes to arms and shoulders, they seem like some of the least competent physicians in sports, atleast as far as diagnosis comes.

I will be boxer briefs

by Hardcore Legend on Jan 24, 2008 1:17 PM EST up reply actions

I'm often one to call the medical staff

into question but they didn't think Carp was going to need TJ surgery initially. Will Carroll talked about it at BP but it was something that developed largely after the first surgery, IIRC.

by azruavatar on Jan 24, 2008 2:20 PM EST up reply actions

If I recall correctly

they took a 'wait and see' approach, hoping that it was only the bone spurs that was causing the problem. The only dillema with that is that the bone spurs were there because the ligament was injured.

I understand surgery is the last resort for almost anything but in situations like that, I would hope they would weigh the reward vs cost. It wasn't as if he was never going to need ligament replacement surgery. The bone spurs (for a second time) were showing that the ligament was not getting better. So, instead of costing him 1 season, it's going to cost him two.

The Carpenter situation is somewhat understandable. This Pujols one is not. The down time would have been the off-season. He'd have missed a month of the season worst case scenerio. He has had this elbow problem happen over and over again. Just fix the damn thing and move on with your career.

I will be boxer briefs

by Hardcore Legend on Jan 24, 2008 2:26 PM EST up reply actions

You're wrong about Carp.

The armchair medical analysis around here is laughable.

I'm sick of refuting claims such as this.

Why must fans place ALL of the blame on the injuries on the medical staff? 95% of the time, the "solution" is neither black nor white. We're dealing with the human body here. "Fixing it" is such a relative term. You can't fix or repair nature.

I know nothing about Albert's situation, but I don't see how you can extend the blame to the medical staff. It is Albert's body and there is a such thing as informed consent when it comes to medical procedures. Now do I agree that he should go ahead with the TJS if he truly cannot fully straighten his elbow or throw the ball on a line? Of course. But the decision is his.

by silent_bob on Jan 24, 2008 2:35 PM EST up reply actions

More disgusted by the armchair medical

analysis than the armchair GM moves, armchair managerial decisions, or armchair ownership?

I find it laughable that the medical staff gets a pass on the idea that dealing with injuries aren't an exact science.

No kidding. I don't think anyone believes that you can treat a player like a car, repair the part and take it back out on the road.

But purely anecdotal, if my companies doctor repeatedly misdiagnosed illness or injury and faced lawsuits from my employee, I'd probably look for a new doctor.

I will be boxer briefs

by Hardcore Legend on Jan 24, 2008 2:50 PM EST up reply actions

Hear, Hear

Medical diagnoses and doctors' decisions are open to criticism and debate just like all other baseball-related topics discussed on this site.

by Ray Lankford on Jan 24, 2008 3:44 PM EST up reply actions

You can equate criticism of a Mgr/GM to a Surgeon?

Laughable indeed.

It takes 12 years of education, residencies, fellowships, plus numerous years of practicing your medical specialty to even be considered as a team surgeon.

Hooray for freedom of speech as it pertains to criticism and debate, but can you really sit here and call Paletta a poor surgeon by the outcomes of 3 or 4 surgeries that just so happen on members of the St. Louis Cardinals?

Look, I am amazed by the level of baseball knowledge that VeB members possess. Last I checked, however, no orthopedic specialists have come out and said that they'd go about things any differently than Dr. Paletta did.

Being an armchair GM or manager is completely different than being an armchair orthopedic surgeon.

by silent_bob on Jan 24, 2008 5:54 PM EST up reply actions

"Dr." makes all the difference?

I am guessing you are in the medical field in some capacity, Bob, because this issue seems to hit close to home for you -- I recall you posting comments with the same general thrust before.

I agree -- it is likely incredibly difficult and undoubtedly prestigious to become a surgeon, especially a team surgeon. No one is suggesting otherwise. However, the education and experience a surgeon amasses doesn't make him immune from criticisms of his performance. No one is saying, as you suggest, that Dr. Paletta is "a poor surgeon." People are suggesting, and rightfully so, that Paletta's recent performance on Cardinal players (Rolen x2, Mulder x2, Carp) suggests that Cardinal fans ought to adopt a more skeptical view of any projections about neat and tidy future surgeries. No one needs to wait until other surgeons come forward and say "Paletta botched the job" to voice criticisms based on reasoned (although unscientific) analysis.

There's a difference between saying "Paletta should have made a three inch incision instead of a two inch incision" and saying "Given Carpenter's symptoms and the Cardinals' position in the season / offseason, it would have made more sense to perform TJ surgery the first time around." I understand what you are saying, but I think you place Paletta on too high a throne. I agree: I don't have the medical expertise or knowledge of the facts Paletta does. But it shouldn't be "laughable" whenever I voice an opinion contrary to Paletta simply because he is a surgeon.

You aren't a GM, and don't have knowledge of all the facts MO has . . . does that really mean you can't criticize his performance? Or are you entitled to criticize MO because he doesn't have "M.D." after his name?

by Ray Lankford on Jan 24, 2008 8:03 PM EST up reply actions

Here's the point you're missing:

Here's a sampling of some of the stuff I've read/viewed, and I'm guessing I'm probably about average in baseball knowledge for a VeB poster:

3 Nights in August
The Bill James Baseball Abstract
Moneyball
MAny blogs, including VeB, BCB, MLB Trade Rumors, Future REdbirds, Leach's articles
I'm a stat junkie when using Baseball-Reference
First Inning
ESPN.com and FoxSports.com reports and articles
MLB and MiLB articles
I also have conversations with several friends of mine who I would consider very knowledgeable about baseball, including former college players and current high school coaches.

I would say that arms me with a decent amount of information to discuss/analyze baseball decisions. I may be wrong in my analysis, but at least I have a base of knowledge to come from when I open my mouth (or start typing).

Here's what I regularly read/view when it comes to Medical or Pharmaceutical information:

Uhm, medical reports on ESPN.com and FoxSports? Do those count?
SilentBob's posts here.
I go to the doctor about once a year, if I happen to share a condition with one of the Cardinals, I'd know about it.

That's about it.

If you're seriously stating that we, as VeB critics have equal grounding to criticise a medical staff as we do the GM, then you're either underestimating our baseball knowledge, overestimating out medical knowledge, or you just have a lot MORE medical knowledge than at least I do.

Having said that, I think it's still fair to do, but also having said that, when someone like SilentBob, who actually has experience in the field, makes a comment, let's at least acknowledge that he's speaking from a far greater amount of knowledge than most of us are. That does in fact make his opinion better than ours.

by mtalken on Jan 26, 2008 12:23 PM EST up reply actions

What orthopedic surgeon would come out

and publicly critique another? How often to doctors publicly critique each other? Rarely.

It's a tight nit group that when something goes right they are hailed as brilliant and when something goes wrong they deflect it as 'not as easy as it looks'.

As I originally said, Paletta has probably more success than he does failures. He's probably a brilliant surgeon. But there is something SERIOUSLY wrong if the average fan knows the name of the team surgeon and not for the right reasons.

I will be boxer briefs

by Hardcore Legend on Jan 24, 2008 8:05 PM EST up reply actions

All those with confidence

in the medical staff raise your hands.

Mr. Rolen and Mr. Edmonds, I said hands, not middle fingers.

by vinniefromjersey on Jan 25, 2008 10:16 AM EST up reply actions

I gotta go with Bob on this one

Looking at the last couple of examples given (Rolen, Mulder, Carpenter) that involves a shoulder, a shoulder, and an elbow.

I'm not a doctor and I don't even play one on TV, but I pitched, and had both elbow and shoulder issues.

Let's look at the shoulder first. Bob, please come in and correct me if I'm at all wrong, but I seem to recall hearing that the shoulder is one of the most complicated joints in the body, given it's attachment points and range of motion. That makes rotator cuff and labrum surgeries some of the most difficult to recover from. The muscles of the rotator cuff are so tiny that it makes rehab for those muscles quite difficult. What I'm saying is, I think you could have had anybody operating on those guys and the result would have been no different.

Now to Carpenter. Tommy John Surgery is ligament-replacement surgery. Think about that. That's pretty extreme. They're taking the ulnar collateral ligament completely out of the patient's body and replacing it with a completely different piece of tissue, either from that patient's body or that of a cadaver. Granted, with the miracles of modern medicine, it's not nearly as career-threatening as it used to be, but still! As a pitcher, if I went to a doctor with elbow pain, I would hope the doctor would try everything he could before cutting away a year of my career. As long as the doc was up front with me and said, "We're gonna try to rehab this, but we might have to operate down the road if the condition doesn't improve."

As fans, it's easy to sit back and say, "cut on him! We want him back!" But as a human being, I would hope doctors use surgery only as a last resort.

by Jhusk on Jan 25, 2008 1:45 PM EST up reply actions

Saying "We might have to operate

down the road' is disingenious. The ligament was damaged. The human body doesn't stop taking wear and tear. The ligament was going to get worse every day of his life.

It would have been more appropriate to say "We can continue to rehab it and hope to get by and you may be able to get by for 10 years with minor to moderate discomfort, but the ligament will have to be replaced if you ever hope to be rid of this problem".

I don't know what Paletta told Pujols. Albert's a stubborn man. He may have thought that since he's been able to rehab his legs and avoid the DL that he can get away with it on his elbow. Heck, he's been doing it for 4 years now.

No one is saying that Paletta is a hack. No one is saying shoulder and elbow surgeries are simple or for that matter a sure thing. But at a certain point, you think the team would move on to someone else, whether they be more lucky, competent or just a fresh pair of eyes to look at these situations.

I will be boxer briefs

by Hardcore Legend on Jan 25, 2008 2:17 PM EST up reply actions

Jose Alberto

Albert has commented that if it is as bad as last year, he won't play through it. I think the odds of him playing the entire season are very low, and I also hope that he elects to shut down his season sooner rather than later. The reason he didn't have the surgery in the offseason is that he would have missed all of '08.

by Beware the Molinas on Jan 24, 2008 11:57 AM EST reply actions

I imagine it's a bit difficult

to Albert to do anything. He probably has his own platoon of doctors, too.

by Red in Chicago on Jan 24, 2008 12:24 PM EST reply actions

Josh Phelps

It wasn't a coincidence that the cards signed him to a minor league deal this season. I believe the organization is genuinely concerned with Albert's elbow.
I think they keep Phelps in AAA this season getting his reps, so that in the event Albert is shut down for the season Phelps can step in and provide league avg. production at 1b if not something a little better.

by Handsome B Wonderful on Jan 24, 2008 12:28 PM EST reply actions

What about Duncan?

I would have though that in the event of a Pujols injury that Duncan could be brought in to play first and then we used our glut of OFs to make a decent set up out there.

The hot stove is burning...

by cardzfan24 on Jan 24, 2008 12:34 PM EST up reply actions

RE: Duncan

My guess would be the cards would be willing to play either Duncan or Speizio there if it was just for a couple games or maybe a week.
I think if its for any longer than that they leave everyone is their normal roles and bring Phelps in. He's proven he can hit in the big leagues and has a career OPS+ over 110. I think he would provide more immediate offense than an outfielder call-up (Rasmus would probably go through some growing pains, for example), and he'd probably be better than Duncan defensively.
If LaRussa really expects to compete this season, as he has stated numerous times, this seems like the most likely course of action.

by Handsome B Wonderful on Jan 24, 2008 12:42 PM EST up reply actions

That does make sense

and it makes me both happy and sad. I certainly want Albert out there as much a possible since he is such a force, but if this let's him come back stronger in a year when we are shaped for competing a bit better, then so be it.

It will also help me compete in a keeper league where I don't own Albert, so I have that going for me at least.

The hot stove is burning...

by cardzfan24 on Jan 24, 2008 12:50 PM EST up reply actions

Makes sense...

but Phelps is more of a sure thing offensively than any of the OF's at AAA. Also he is a righty power bat...if we moved Duncan to first and called up Rasmus (for example) that would be another LH bat.

Thanks for the highlight moments 15 and 27!!!

by cardzfanbub on Jan 24, 2008 12:53 PM EST up reply actions

albert

I have to say that I am much happier to hear Albert's name in conjunction with Dr. James Andrews than Dr. Paletta.

I'm a man, a manly, manly, man. Unknown

by Eckstreem on Jan 24, 2008 1:23 PM EST reply actions

Last Place

That is where the Cards will end up if Pujols goes down for the year. Is there a real stud at the top of the 09 draft? Have the surgery, put Phelps in there and draft a stud and trade Phelps in 09.

How about handin' me another helpin' of those mashed taters...thank you very much!

by Elvis on Jan 24, 2008 3:56 PM EST reply actions

Albert is this teams' most valuable player.

He IS a difference maker. He is signed to a long term contract. His health should be of the utmost importance of this organization. I don't see the logic in putting this off. He should have had his surgery scheduled the day after the season ended. I don't understand why he would put it off; I don't understand why the club wouldn't insist he get the elbow repaired.

Granted, I am not a medical professional. But don't ballplayers often end up with new injuries from trying to compensate while playing through injuries? I'm not comfortable with our best player being put in any situation that risks his health. Since surgery is the only cure, than surgery it should be. ASAP.

She isn't crazy, she's just not impressed.

by jillsinmo on Jan 25, 2008 6:40 AM EST reply actions

WTF? Did I miss something?

When did Pujols elbow get this bad over the winter? How did this happen?

by sdrone on Jan 25, 2008 9:16 AM EST reply actions

FWIW

Dr. Paletta performed shoulder surgery on my son's non-pitching shoulder. He is a very impressive guy (obviously I am not an M.D. and maybed too easily impressed) who seemed to care deeply about my son. The surgery went completely according to the prediction and he experienced a full recovery. He is still pitching at the D1 level.

I know this doesn't mean much, but I think it is unfair to characterize the guy as some kind of hack. I do believe WJ/TLR et al are pre-disposed against medical procedures and were at least partly to blame for the rehab/wait'n'see approach.

That being said, I am all for our marquee players being treated by the VERY BEST orthopedists in America and I don't think anyone would rank Dr. Paletta as the Albert Pujols of orthopedic surgeons.

The part that bothers me the most about Albert's elbow injury is that he initially hurt it playing LF.

I don't think there is any question that the decision on when the elbow is repaired, and by whom, should be entirely up to Albert.

Those Pilgrims ain't lookin' so proud now...

by giveml on Jan 25, 2008 11:44 AM EST reply actions

If this does happen

and Albert gets TJ, would he be able to move back to third base?

That would mitigate much of Glaus' defensive issues (in '09) and allow us to play duncan/craig/hill etc at 1B with Ludwick/Ankiel/Rasmus in the OF from '10 on...

21 days.

by SleepyCA on Jan 25, 2008 1:11 PM EST reply actions

Why do this?

Albert's a Gold Glove first baseman. He's probably only slightly above league average defensively as a third baseman.

I would prefer to have a proven Gold Glover at first, and a league average defender at third, than league average at both corners.

by Jhusk on Jan 25, 2008 1:49 PM EST up reply actions

because he's a lot more valuable

at third base. It's a lot easier to find a power hitting 1B with adequate defense than it is to find a similar 3B. The net value added to the team is higher, especially if you have guys like Craig or Mather or Duncan who profile as "amazing hitters with questions about their defense".

21 days.

by SleepyCA on Jan 25, 2008 2:22 PM EST up reply actions

"Amazing hitters with questions about their

defense"

Doesn't that describe Troy Glaus?

by Jhusk on Jan 25, 2008 3:49 PM EST up reply actions

which was my original point

There's been talk about moving him to first for years. I think the team would be better with pujols at third and Glaus at first, and after Glaus gets older or if he gets hurt it'll be easier to find a replacement 1B than a replacement 3B.

21 days.

by SleepyCA on Jan 25, 2008 4:56 PM EST up reply actions

Bad Idea

Pujols is a gold glover at first, and Troy Glaus is pretty good at third. I don't know where you're getting this idea that he has defensive issues.

His PECOTA card on BP for 2006 has him 5 runs better than average (for comparison sake, Scott Rolen was 12 runs better than average). In Tango Tiger's defensive ratings for 2006, he was rated a 55 (50 being average), with a plus arm (rated around 70).

Maybe you can find some recent metrics that rate him poorly as well, I dunno, but it seems from what I've seen that recently he's been considered an above average fielder, so I think it's just us comparing him to Rolen that makes him look questionable at third.

by mtalken on Jan 26, 2008 3:41 PM EST up reply actions

This seems the most logical time

If it indeed will eventually need repaired, now just seems to be the most logical time. There really doesn't even seem to be any question.

This year we are not going to contend. Therefore, the loss will not be felt as acutely as during a playoff push.

In a year of evaluation it would make available least 400 plate appearances to further evaluate players. If Duncan was moved to first, for example, we could have a better look at Barton, Ankiel, Ludwick, Rasmus, Schumaker without the need to keep one in the minors.

It would help eliminate the risk of having Albert on the DL when StL hosts the ASG.

Albert would be healed and readjusted by the time he team started looking to contend.

Now is the time. Well, October was really the time.

by RedbirdRay on Jan 25, 2008 3:35 PM EST reply actions