Carp's MRI Results

by silent_bob on Apr 9, 2007 5:48 PM EDT Comment 34 comments

Update [2007-4-11 11:47:0 by SilentBob]: Paletta weighs in. Per Matthew Leach: Dr. George Paletta, the Cardinals' head team physician, clarified Chris Carpenter's diagnosis on Tuesday and professed optimism about the right-hander's rehabilitation from a right elbow injury. The Cardinals issued a brief release on Monday describing Carpenter's condition as "moderate arthritis and a mild impingement" in his elbow. Paletta explained that the impingement resulted from bone spurs in Carpenter's elbow, and said that the impingement is a more significant issue than the arthritis. "They are working in tandem," Paletta said by cell phone from St. Louis, "but I think the more significant problem is the spurs -- that's what's really causing impingement in the back of his elbow." Check Liam's links below for details. [end update] Carp's elbow is essentially fine, but this could be a drawn-out process - Rest/rehab/NSAIDs/rehab starts, etc. They aren't just going to go and cut on his elbow because of some arthritis. Surgery will be the last choice.

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Bob....

Are you a doctor? You seem to have a damn good knowledge of this stuff.

Definitely would like your incite on this injury when you get a chance, I hate the word impingement (after Mulder). Is this something we should be worried about?

Miller sucks.

by Ankiels Missing Curveball on Apr 9, 2007 5:55 PM EDT reply actions 0 recs

Not a doctor..

but I did stay at a Holiday Inn Express last night...

Anyways, no, I'm a physical therapist.

by silent_bob on Apr 9, 2007 7:58 PM EDT up reply actions 0 recs

well it's much appreciated

hearing your point of view.

Future Redbirds

by erik on Apr 9, 2007 9:38 PM EDT up reply actions 0 recs

I have to admit

I don't really understand much about this but I know that arthritis is better than the words "torn ligament"! For those of you who know better than I, how much rest does he need? Will he need an extra rest day here and there or to skip a start here and there? Once he rests a month and continues to take the anti-inflammatories, should we expect that this is just something he'll have to deal with from time to time? Thanks for the help.

by chuckb on Apr 9, 2007 6:05 PM EDT reply actions 0 recs

Isn't arthritis that thing that ended

Sandy Koufax's career?

"Oh. My. God." -Andy Pettite

by BigRedZed on Apr 9, 2007 6:43 PM EDT up reply actions 0 recs

Yes it was

but Koufax's arthritis gave him extreme pain, even at the first time he woke up with the swelling.

However, that is a big time concern. Even with pain, Koufax was able to pitch 3 more dominating seasons before having to retire.

Walk your dog, not Pujols.

by Hardcore Legend on Apr 9, 2007 8:51 PM EDT up reply actions 0 recs

also re koufax

---- and i have no idea whether carp's condition is in any way related to koufax's --- his elbow caused him to miss six or seven weeks in both the '62 and '64 seasons. there's talk that carp may be out about 6 weeks . . .

probably cost the dodgers the pennant in '62. in our more forgiving playoff era, maybe it won't cost the cards to the same extent . . . .

by lboros on Apr 9, 2007 10:13 PM EDT up reply actions 0 recs

I hope this doesn't become a recurring issue

that they continually try to rehab unsuccessfully. If he needs his elbow scooped out or patched up -- let's not try what we did with Mulder, even if the consequences are less extreme.

I don't want to watch Carpenter mess with his mechanics and do worse damage to his shoulder. . . that's my real fear at this point.

John Rodriguez for Right Field

by azruavatar on Apr 9, 2007 11:29 PM EDT up reply actions 0 recs

Arthritis

never really goes away. I should know; my right knee has been arthritic since my senior year in high school, and I'm 54. You can control the inflammation and pain with meds, though.

by cardsrul on Apr 9, 2007 7:45 PM EDT reply actions 0 recs

As I noted in the bigger game thread

An impingement is when the membrane lining the elbow becomes caught in the elbow joint; it's common with athletes who perform repetitive motions (such as throwing, in Carp's case). Usually rest and meds can clear it up, otherwise it'll be arthroscopic surgery. But as I think we've seen, that'll be generally the last-resort solution. Hopefully it doesn't come to that... I am beyond relieved that (they say) there is no ligament damage, as that probably would have shelved Carp for the year.

Sparks of Dementia Cards, A's, and Rockies coverage by an amateur if very enthusiastic blogmistress, myself.

by Scarlet the Cardinal on Apr 9, 2007 9:43 PM EDT reply actions 0 recs

the loss of Carpenter

I think its interesting to read and watch everyone saying the loss of Carpenter is huge. Yes we are losing our best pitcher for a couple of starts. Significant, yes Huge, no. I believe our rotation this year is the best we have had in a long, long time. Wells has looked very good, Wainy is a future number 1 starter, we all know what we get from Reyes, and then you have Looper, maybe the biggest surprise so far in the majors. I believe there are a lot more players that would be a bigger loss than Carpenter. Now hopefully its only a weekor two and someone from memphis can gives us a decent five and hopefully our offense and bullpen win those games. Now if he's out for an extended time, i think we can fill his role well enough to stay on top of the central. We have a guy named Mulder who will be back eventually. If we want a cheap replacement, we can go get Kim from Colorado.

I guess what I'm saying is that I'm not freaking out over this loss. Yes it doesn't help lossing one of the top starters in baseball. However if it were going to happen any year, this year is probably the best. Starters have not nor will be our problem. If Pujols or Rolen went down, then I will be freaking out. Until then, lets go Keisler and lets show them so called experts what the Cardinals are all about this year.

by stl3bagger on Apr 9, 2007 11:55 PM EDT reply actions 0 recs

I like your...

attitude!!! No doubt we've managed in the past three years everytime Carp went down ('04 series excluded).

As long as he stays in the dugout with the young guys and keeps them focused, educated, growing... Well, Wainer and Reyes need that.

And Keisler is a lefty, we could you a lefty. And if he doesn'tworkout,we callup someone else.

If Carp is out for an extended time, like say 2-3 months... Do we go get someone like Penny? That's the real issue here!

by onebigdummy on Apr 10, 2007 8:18 AM EDT up reply actions 0 recs

Arthritis PLUS "impingment"

Nothing against our physical therapist poster (my mother is a PT) but the article said arthritis plus impingment caused by bone chips. I hear the PT poster that nothing can be done surgically about the arthritis, however, I am mystified why they do not remove the bone chips. This problem will continue to raise it's head with Carp being less effective on the mound until they bite the bullet and remove the bone chips. I'll wait for a surgeon to comment but it sounds like another case of the Cards medical staff / management trying to get an injury player through the season when the player would be better off having surgery immediately. See Mulder, Rolen (sure I am missing someone else during the TLR regime).

by jjray on Apr 10, 2007 8:14 AM EDT reply actions 0 recs

Surgery is no magic bullet, man

And Rolen's case was treated like you or I would be treated. Look, Rolen did have surgery on his shoulder in mid-season, to clean up the joint, and it didn't work. That's the breaks.. I really am sick of explaining that fact to people. Sometimes surgery doesn't work; sometimes rehab doesn't work. It's great that you have an opinion, but respectfully, you are not a medical professional.

As far as Carp goes, I NEVER said that nothing can be done surgically. I said that the best course of treatment will probably be a frustrating process of rest/therapy/NSAIDs, etc. Surgery is a last resort. Sorry to disappoint, but even baseball players are human, and there are risks in undergoing surgery.

I don't know if you read the Post today, but:

"This is not Carpenter's first encounter with elbow problems. With the Toronto Blue Jays, he had surgery in September 1999 to remove a bone spur. Carpenter spent almost four weeks on the disabled list that June because of elbow inflammation. He compiled a 3.24 ERA before the All-Star break that season before suffering a 6.31 ERA in 10 second-half starts."

This may be another reason not to rush into surgery...don't you think?

by silent_bob on Apr 10, 2007 8:47 AM EDT up reply actions 0 recs

questions

I'm definitely no medical professional, but isn't arthritis when the cartilage is worn down/gone? Is that whats causing the bone chips? bone rubbing on bone because of the lack of cushion? And if that's the case, isn't this going to be something that keeps cropping up down the road, even if the rehab is successful?

by Birds on the Matt on Apr 10, 2007 9:36 AM EDT up reply actions 0 recs

Well, he had surgery in '99

and it's back in 2007. Chances are, he'll have surgery again, and this will crop up again in a few years.

by silent_bob on Apr 10, 2007 9:38 AM EDT up reply actions 0 recs

so

it's entirely realistic that even if he goes through surgery to clean this up, that he could live out the rest of his contract without this problem coming up again? That sounds promising. I would expect as time went on for there to be more likelihood of bone chips more quickly - but thats just me using my non-medically informed logic. I guess our bodies and bones can be pretty resilient huh?

by Birds on the Matt on Apr 10, 2007 9:59 AM EDT up reply actions 0 recs

Apparently it's a spur, not "chips."

Spurring is caused by extra pressure on a bone. When a bone has force placed upon it, it responds by laying down more bone. This happens when arthritis sets in - cartilage has worn away, exposing some bone. Then since the bone doesn't have its nice shiny cushion (cartilage) it grows a spur when pressure is put on it. Happens in knees all the time. Carp's elbow has spurred up from the repetitive torque on the elbow.

The fact that Carp doesn't have pain when throwing is probably the biggest reason the Cards' aren't rushing into surgery. I'm concerned, just as everyone else is.

He will probably end up having surgery because one of these scenarios will likely play out when he comes back to pitch:

a) His elbow continues to swell up every outing.
b) He changes his arm angle and he's not as effective and/or shoulder pain develops
c) He begins to have pain when he throws.

by silent_bob on Apr 10, 2007 12:39 PM EDT up reply actions 0 recs

actually, after reading the post again...

I think I misread it! I thought that it said that Carp missed a month after surgery and then pitched poorly thereafter. My bad - that may give some of you some ammo for your agenda. And that's fine.

Personally, I think that Carp will end up having surgery - that was my opinion before. Looks like Paletta injected some "lubricant" into the joint the other day. They still won't rush this thing - Carp's elbow has arthritis in it - surgery will not "fix" the problem, it will only clean up the mess and bide him some time. How much, we won't know.

My point is just trust the medical staff a little more. They know what they're doing. It's still April. Even if he gets surgery in May, he'd be back by July at worst.

by silent_bob on Apr 10, 2007 9:37 AM EDT up reply actions 0 recs

Speaking from pseudo-experience

My wife (23) has psoriatic-arthritis. She has to get a shot every week to keep it under control. What hers does is makes her joints swell therefore losing ROM and damaging the cartilidge/joints. The doctors have put her on enbrel which just after two weeks (shots) she can squat which used to be impossible. Unfortunatly whatever damage to her joints cannot be reversed. So IMHO I believe that if Carp goes on some form of meds the swelling will stay down and it won't get any worse. He'll have arthritis, but it will be under control and not do damage anymore. I think he will have his elbow scoped to remove the bone chips and put on a form of arthritis medication. However long it takes to recover from bone-chip removal, should be how long he is out.

Jimscobert Purolmonds - MV3

by OKCardsfan on Apr 10, 2007 11:04 AM EDT reply actions 0 recs

this worries me.

We just signed Carpenter to a five year deal, and he seems to be injured quite often. last year he went on the DL now this year? And at the end of 2004? isn't that how we signed him cheap because he was injured? I love carpenter but couldn't we have signed him to a 3 year deal or something? then resign him later?

by jedmonds15 on Apr 10, 2007 1:29 PM EDT reply actions 0 recs

Put him under the knife now!

What I don't get is why they wouldn't just go for surgery now. I'm not confident the problem won't recur with the whole "rest and anti-inflammatories" appraoch...so lets get him scoped up, and hope for his healthy retrn in (best case) mid-June.

In other news, I can't help but be saddened by this line...Why'd you leave Dunc, you idiot? Why!!???!?!

And he's not done yet...

Weaver, Jeff, 2 IP, 7 H, 7 R, 7ER, 2BB, 1SO, 1HR

by cardsfaninmass on Apr 10, 2007 3:08 PM EDT reply actions 0 recs

Scratch that- he is done

An "Unbe-Weaver-able" ERA of 31.50!!!

by cardsfaninmass on Apr 10, 2007 3:23 PM EDT up reply actions 0 recs

awesome!

I didn't really like him when we traded for him. WE gave him up for terry evans wasn't it? or was that for j. sosa?

by jedmonds15 on Apr 10, 2007 3:28 PM EDT reply actions 0 recs

Well,

he got the W on the clinching game of the WS. I think that Terry Evans would have to become Albert Pujols v.2 for that trade to not work out for us.

by Valatan on Apr 12, 2007 2:15 AM EDT up reply actions 0 recs

sorry didn't mean to make we in upper-case letters

i got sticky fingers by pressing shift 5 times in a row

by jedmonds15 on Apr 10, 2007 3:32 PM EDT reply actions 0 recs

A link about arthritis

http://www.everydayhealth.com/publicsite/index.aspx?puid=b046afa7-8208-4961-b6d5-f07fd7447808

Jimscobert Purolmonds - MV3

by OKCardsfan on Apr 10, 2007 5:19 PM EDT reply actions 0 recs

Regarding Surgery

http://www.everydayhealth.com/publicsite/index.aspx?puid=1980fe13-1f33-47be-b4ca-f5064378c5f2&p= 5

Jimscobert Purolmonds - MV3

by OKCardsfan on Apr 10, 2007 5:26 PM EDT up reply actions 0 recs

George Paletta Press Conf.

Joe Strauss writes it up here.

I'll share their optimism.

by liam on Apr 11, 2007 10:43 AM EDT reply actions 0 recs

Well I don't disagree

with anything he said...then again, my gut tells me he'll get scoped eventually.

by silent_bob on Apr 11, 2007 11:05 AM EDT up reply actions 0 recs

Leach's article

Has a little more detail. Paletta thinks the elbow may need to be scoped out at the end of the season.

We'll have to make a determination at the end of the year, depending on how this season goes.
Is it worth considering scoping it and cleaning it out, or was this just a little blip in the road like Albert's episode with his elbow last year? He's never had another problem since.
The long-term situation is unclear. The potential exists that he may eventually have to have the elbow cleaned out like he did in '98 or '99, but that's certainly not a certainty at this point.

by liam on Apr 11, 2007 11:09 AM EDT up reply actions 0 recs

Different injury and situation altogether

I'm just not sure that starter will be able to put up with these symptoms all year long. W

e saw how he responded to extra rest last year when he wasn't injured. Did that mean anything? Will he be able to go on regular rest when he comes back? Will his elbow stop swelling up every time he throws off a mound? Will he start having pain?

There's too many questions to be answered yet. I don't think that anyone (including Paletta) can make a definitive prognosis yet.

I understand that he thinks that conservative treatment will work, but there is a precedent here. Look up Kelvim Escobar.

by silent_bob on Apr 11, 2007 11:32 AM EDT up reply actions 0 recs

A little more to add

Hola, all...

Just wanted to clarify one thing that I should have made clearer in my article last night.

The bone spurs have been there for years, and not symptomatic. They became symptomatic this week. So the spurs don't NECESSARILY need to be removed for Carpenter to pitch effectively. Eventually they'll probably want and need to fix them, but it's my understanding that there's reason to believe he might be able to pitch the rest of the season without surgery.

Also, a very small quibble, not that it really matters, but there wasn't a presser yesterday. Joe and I spoke with Dr. Paletta separately by phone.

-M.

Any comments, opinions, or observations I post here are mine and mine alone. They should not be taken as any sort of statement on behalf of my employer.

by MatthewHLeach on Apr 11, 2007 1:29 PM EDT reply actions 0 recs

Thanks

I thought you made that pretty clear in the article.

The press conference thing was my mistake after reading Strauss' story... Just assumed that was the procedure now, for the Doc to have a weekly press conference where he talks about what's going on. Saw in your story that the news came from a phone call.

by liam on Apr 11, 2007 2:22 PM EDT up reply actions 0 recs