The shoulder is perhaps the most complex joint in the human body. Three bones meet in the shoulder: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The humerus fits into the scapula. The labrum and rotator cuff are integral to the joint formed at this point.
The rotator cuff consists of four tendons that surround the shoulder capsule. This grouping of tendons keeps the shoulder bone centered in the shoulder socket. It connects the humerus to the scapula.
Jaime Garcia sustained a partially torn rotator cuff.
The head of the humerus is typically larger than the shoulder socket it fits into. The labrum is a soft tissue rim that surrounds the socket and gives it more depth, which helps stabilize the shoulder joint. In essence, the labrum helps the humerus head better fit into the socket. It also serves as an attachment point for several ligaments.
Garcia suffered a partially torn labrum.
In August 2012, Garcia first started experiencing shoulder problems. The diagnosis then was a partially torn labrum and rotator cuff. Surgery was a possibility. But Garcia sought the opinion of Dr. James Andrews, who recommended a conservative course of treatment–rest and rehab. Understandably, Garcia chose to listen to one of the most prominent orthopedic surgeons in the country and not undergo invasive surgery on his pitching shoulder.
Of course, we know sitting here today that rest and rehab didn't work. Garcia reported to spring training a year ago and was a full participant. The southpaw broke camp a member of the rotation. He and his fellow starters were even featured on a Sports Illustrated cover that harked to El Birdos. But, after just 55 1/3 innings pitched, Garcia's shoulder started barking once again. And this time there was no avoiding the surgeon's scalpel.
Last May, Dr. George Paletta performed surgery on Garcia's left shoulder. The procedure ended Garcia's season. In the months that followed, reports uniformly categorized his post-surgery rehabilitation as on track and going well. The Cardinals wanted Garcia to be able to engage in a full offseason throwing program, and every indication was that the lefty did just that. There was reason for optimism, even with the significant nature of his prior injury and surgery.
On Saturday, general manager John Mozeliak announced that Garcia's surgically repaired left shoulder had not felt right for about two days and so the Cardinals were shutting him down and sending him back to St. Louis for an evaluation. Even before being examined by Dr. Paletta, Garcia asked for a second opinion from Dr. Andrews (a right he was wise to exercise).
The Cardinals announced on Wednesday that neither doctor found structural damage in Garcia's shoulder. The reported diagnosis is that most nebulous of baseball injury designations: inflammation. The prescription is a cortisone shot. Because the root cause of Garcia's shoulder issues couldn't be found via examination or MRI, the doctors are treating his symptoms with an anti-inflammatory. And this is being framed as good news.
On the one hand, it certainly is very good news that Drs. Paletta and Andrews could find nothing structurally wrong with Garcia's shoulder. When the news first broke, many feared the worst–myself included. Thankfully, the worst isn't the diagnosis. On the other hand, Garcia is in pain that is significant enough to prompt the Cardinals to shut him down and send him to two orthopedic surgeons for examinations in late February. And his shoulder feels badly enough to inject it with cortisone. This could very well be the beginning of a vicious cycle.
Shoulder injuries are nothing new to Cardinals fans. We all remember the drawn-out affair of Scott Rolen's (second) shoulder injury and how it lingered, eventually transforming the game's best third baseman into trade bait. There's also Mark Mulder, who may be the poster boy for how difficult it is to actually repair the torn-up shoulder of a pitcher. Neither Rolen nor Mulder's experiences were short or painless. Both left fine ballplayers shadows of their former selves.
Garcia is not Rolen. Nor is he Mulder. His shoulder is different from theirs, as is his injury and genetic makeup. Nonetheless, the post-shoulder surgery phase of Garcia's career has gotten off to an inauspicious start. And it feels fair to posit that Garcia will be dealing with the lingering effects of his shoulder injury and its repair for the rest of his career if not life. After all, less than a year post-surgery and just two weeks into Cardinals camp, and Garcia's shoulder is already uncomfortable enough to require a cortisone shot.
My expectations for Garcia entering this season were rather low. It would be unfair to the young sinkerballer if they were anything else. Recent developments have dropped them even further–to zero.
Don't get me wrong, I'm pulling for Garcia. Garcia's repertoire, when healthy, is a joy to behold. The way his array of pitches dart across the plate with movement is unmatched by any other Cardinal and few in the game. I really want to see that pitcher throw, often and effectively. But the odds of that ever happening again–which were long entering spring training–got even lengthier with the developments of the last week. The good news is that Garcia's season didn't end this week. The bad news is that he's still attempting to come back from major shoulder surgery.
Correction: This post originally referred to cortisone as a painkiller. It is an anti-inflammatory.