Michael Wacha & Jaime Garcia to the DL. What now?

Scott Rovak-USA TODAY Sports

A look at the news and the road ahead.

After yesterday's rousing win over the Phillies, which featured the twin exotics of Carlos Martinez and a functioning offense, John Mozeliak called a press conference and announced that Jaime Garcia and Michael Wacha are both headed to the DL with shoulder ailments. A brief segment of the press conference can be found here and some quotes I pulled from the complete press conference can be found here.

Jaime

The short of it is that Jaime Garcia has aggravated the same injury that has plagued him since August of 2012. This post Ben wrote in February has a refresher of Garcia's history with that shoulder as well as the prescient warning that our expectations for Jaime ought to be reserved. Mozeliak said "His shoulder has been re-aggravated and right now we've decided that we are going to put him on the dl and allow that some time to quiet down and just go through standard rehab."

I was doubtful of ever seeing Jaime pitch again before he came back and performed admirably over seven starts this season. Perhaps some rest will allow him to pitch again in spurts, but given how quickly his injury re-appeared, it would be foolish to depend on his contributing at any point in the future.

Michael

The news regarding Michael Wacha is more surprising. He had a pair of rough starts June 5 and 11 with just a single strikeout and slightly diminished velocity, but Wacha rebounded in a dominant game against the Mets June 17. At the start of the Phillies series, John Mozeliak announced that Carlos Martinez would take Michael's turn in the rotation so that Wacha could bank a few innings for later in the season.

Wacha said yesterday that he had been bothered by some minor irritation for four or five starts, and that it was believed he could work through it. A CT and MRI were performed "a few days ago" and yesterday it was revealed that he has a stress reaction in his scapula.

Shoulder injuries are generally terrifying for pitchers, with a level of concern higher than that with the elbow. As Jaime Garcia's case demonstrates, injuries to that joint can become chronic and difficult to overcome. However, Wacha's injury is very unusual, and possibly entirely unrelated to the labrum and/or rotator cuff injuries that so threaten pitcher careers.

John Mozeliak was careful to point out that Wacha does not have a fracture or a stress-fracture, but that a stress reaction can lead to a stress-fracture. During the interview, Mozeliak was asked if it was a "fissure," and he nodded his head that it was. It's not a common injury among pitchers, but Wacha is not the first to have it. Hopefully more details will come out soon about the specifics of the injury, but there's another pitcher out there who has dealt with a stress reaction in the shoulder: Brandon McCarthy of the Diamondbacks.

McCarthy discussed the specifics of his injury with SBN site Athletics Nation here. I encourage you to read the first couple of paragraphs where he addresses it, but here's his description of the location and cause in his instance

"It's just right here (points to just under the shoulder blade almost around to the armpit/underside). It's a group of muscles that decelerate your arm. When you're throwing and your arm is trying to pull itself out of its socket, these are the muscles that say, "No you stay here." And they attach right through the scapula...and for some reason mine doesn't pull -- everyone else's does it fine, but mine would pull and pull and pull, so eventually the muscle keeps pulling on bone, the bone cracks a little bit."

McCarthy has missed time with this injury nearly every year of his career, however he's also both pitched through the injury and pitched well after resting the injury at times. As far as recovery, in the various iterations of the injury, McCarthy has missed between a month and two months. He has pitched 170, 111, and 135 innings over the last three years (he also missed time in 2012 with that awful skull injury on a comebacker), and has thrown 97 innings so far this year.

The McCarthy comp is chilling, but there are two silver linings. First, McCarthy HAS pitched, and he's generally not seemed to be worse off for the injury when he's healthy enough to do so. Second, it appears that McCarthy and his trainers were a lot more cavalier about the injury early on in his career, pitching until it turned into a full fracture. As he's learned about the unusual injury, he's managed it more effectively. It seems like Wacha's version, if it is indeed analogous to McCarthy's, was caught far earlier than Brandon's initial battle with it, and hopefully can be managed better as well.

We'll find out more soon, but in the meantime it seems reasonable to expect one or two months off for Michael followed by a return where he appears very much like himself.

(morning edit: VEB user olddomination just posted this is the breaking news thread, and it seems worth highlighting here.:

"The good thing about Wacha's injury is that it will heal with rest

The bad thing is that he may miss most, if not all, of the remaining season (as a precaution) and that the injury might recur in the future if it is due to his mechanics.This is a rare fracture (scapular stress fractures account for less than 1% of all fractures), but one associated with repetitive high-energy activities. Read more if you have access to medical articles: Brukner P (1998) Stress fractures of the upper limb. Sports Med 26:415-424." It seems to make some sense with the McCarthy comp.)

So what now?

The Cardinals are in shockingly good shape to absorb two simultaneous injuries. First, Carlos Martinez appears ready for his close-up. He's pitched well in his first two trial outings and it won't be long until he gets a full pitch count.

Some sort of malevolent genie is apparently granting wishes, but El Gallo appears ready anyhow. He will take Michael Wacha's spot in the rotation until further notice.

This leaves Jaime Garcia's spot. Joe Kelly will likely return to the rotation as soon as he is healthy. In yesterday's presser, John Mozeliak said that Kelly is set for a rehab start on Friday and will have 40-60 pitches. He will need "at least two" rehab starts before returning to the majors. Jaime's turn comes up this Wednesday, and it will need to be filled by someone other than Joe Kelly, but an off-day on June 30th would allow the Cardinals to skip the spot in the rotation next turn, and hope that Kelly is ready to go July 5 at home against Miami.

There are several reasonable options for the Wednesday game at Colorado. If Kelly's rehab stalls, things will quickly change, but for the time being we're just looking at a spot start.

correction: If Kelly makes two rehab starts beginning this Friday, he would not be ready until July 7. At that point, the spot in the rotation only has one start remaining prior to the all-star break, and could be skipped with off-days all the way through the rest of July. Do not expect to see Kelly rushed in any way.

Nick Greenwood is one option. He started occasionally in AAA over the last two years and has acquitted himself well so far in the majors. He pitched 3 and a third good innings piggy-backing off of Carlos Martinez' first start on the 16th, and had clean innings on the 19th and yesterday in relief. He will be rested and ready to go on the 25th and is already familiar with the majors.

Tyler Lyons pitched fairly well subbing in for Joe Kelly earlier this year. He suffered a shoulder injury himself in May, but has made two rehab starts, and Mozeliak mentioned him as an option for Wednesday.

Zach Petrick or Marco Gonzales could likely handle a single start and could be called upon if management simply wants them to get a look at the big leagues, but they seem less likely. Tim Cooney started Saturday and will not be called upon to pitch Wednesday on short rest.

Expect an announcement this afternoon about Wednesday's starter. Also expect a reliever to be added to the pen, especially if Greenwood will get the start. David Aardsma has a 0.91 ERA in AAA, so... there's that.

And what then?

If Kelly hits a setback, Tyler Lyons seems most likely to gain some starts in the meantime. He was reasonably effective in his appearances earlier in the year, and it's not likely that enough has changed in the last month to change management's view that he's the best choice. Of course, his health is also in question. Cooney, Petrick, and possibly the fast-rising Gonzales all are possibilities as well if several starts are needed. I'll leave it to the minor league system experts to discuss who would be best suited.

The Cardinals were rumored to be possible participants in this year's trade market prior to yesterday's news.

Craig took a look at the possibility of a trade for Price last week here, and the current situation will certainly add some fuel to that kind of speculation. Price will be the grand prize of this year's pitcher festival, but Jeff Samardzija, Cliff Lee, and a host of lesser stars will also be available. For instance, Ian Kennedy and, well, Brandon McCarthy.

A rotation of Wainwright, Lynn, Miller, Martinez, Kelly is not one that will require an upgrade, but an upgrade would make more sense now than it did 48 hours ago. There are suddenly some important questions: Can Martinez regularly exhibit strong enough command? Can Kelly return healthy and keep up his strand rate? Is Miller actually pitching any better now? Can someone in the minors step up if need be?

The trade deadline isn't until July 31, so don't expect anything imminent. The Cardinals will find out more about Michael Wacha and Joe Kelly, and they will start to receive some answers to the questions posed above. At the same time, more teams will feel comfortable selling as separation grows in the standings.

This is absolutely not a desperate situation, and the Cardinals should not mortgage their promising future for a short-term fix. At the same time, trading in a couple of tomorrow's chips to fortify their current campaign could be reasonable. Given the plausibility of a wide-variety of decisions, these next five weeks will not only shape the season, but the franchise's general direction.

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