The St. Louis Cardinals' handling of Adam Wainwright's arm surgery raises questions

You may have heard that St. Louis Cardinals starting pitcher Adam Wainwright underwent surgery Friday on his throwing arm. MLB clubs are typically rather vague when discussing a player's health. The Cardinals are no exception. So let's review the evolution of Wainwright's right arm troubles this year.

• On June 11, Wainwright left the Cardinals while they are playing in Tampa to return to St. Louis for an MRI on his right arm.
• The MRI revealed no structural damage.
• General Manager John Mozeliak likened Wainwright's condition to tennis elbow.
• Manager Mike Matheny described the righty's forearm troubles as tendinitis.
• Wainwright received an anti-inflammatory injection and took a start off before returning to the rotation.
• Wainwright states he was dealing with a "dead arm" in August.
• In NLDS Game 1, Wainwright experienced what he described as an aggravation of his June injury, located behind his throwing elbow.
• On Monday, October 20, Mozeliak told the media that Wainwright underwent a battery of tests and that surgery was unnecessary; all the righty's moneymaker needed was rest.

The plot thickened on Friday as rumors swirled regarding the fate of ace starter Adam Wainwright's injured right arm.

• Bob Ramsey of CBS Sports 920 tweeted over the noon hour that Wainwright was scheduled to undergo or may have already had surgery on his throwing arm's elbow.
• Will Carroll, who made a name for himself at Baseball Prospectus and now writes for Bleacher Report, tweeted Friday afternoon that Wainwright would undergo surgery to remove bone spurs from his right elbow.
• Derrick Goold of the St. Louis Post-Dispatch tweeted that Wainwright had a ligament shaved and bone spurs removed.
• Jenifer Langosch of MLB.com reported Friday evening that Wainwright had cartilage trimmed in his right elbow.

At STL Baseball Weekly, Brian Stull has shared the press release the Cardinals issued after news of Wainwright's surgery broke:

"St. Louis Cardinals All-Star pitcher Adam Wainwright underwent a minor arthroscopic procedure earlier today to trim a small piece of cartilage from his right elbow.

Although an initial MRI of his elbow conducted last week came back negative, Wainwright requested additional tests and the findings of a second MRI resulted in the decision to undergo today’s procedure.

Wainwright is scheduled to begin physical therapy in two weeks and he may resume his throwing program eight weeks from today."

The initial reports regarding bone spurs appear to have been off base as the Cardinals' press release makes no mention of them.

So what happened? How did we go from Mozeliak asserting on Monday that Wainwright needed rest and not surgery to the club issuing a press release late Friday afternoon setting the record straight on a surgery Wainwright underwent earlier in the day after news of the procedure broke? It's right there in the press release. Wainwright had an MRI last week and underwent "a battery of tests." The conclusion: rest and not surgery was appropriate. But Wainwright sought a second opinion, had a second MRI, and elected to undergo surgery on Friday.

This isn't the first time the Cardinals haven't been on quite the same page as a pitcher regarding the decision to have surgery.

In July, lefty Jaime Garcia opted to have thoracic outlet release surgery and informed the media before the Cardinals, per the reporting of Derrick Goold and Joe Trezza in the St. Louis Post-Dispatch:

Although he was offered a menu of rehab options before having surgery, Cardinals starter Jaime Garcia alerted the Cardinals this morning that he intends to have a procedure this coming week that will end his season.

Cardinals general manager John Mozeliak confirmed the informal announcement made to the media this morning by Garcia that he will have surgery to address thoracic outlet syndrome.

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Mozeliak said the thoracic outlet syndrome did not come up as a possibility until the past couple weeks. Garcia will seen a local surgeon Monday as a pre-surgery consultation, and Mozeliak said he expects the lefty to have the procedure shortly thereafter. The player has the right to tell the team of the treatment he would prefer to receive.

The club was irritated by how Garcia notified them.

"It could have been handled a little different," Mozeliak said. "This (injury) appears to have generated itself in the last couple weeks."

St. Louis Post-Dispatch columnist Joe Strauss provided more detail about the fissure between the Cardinals front office and Garcia regarding his decision to have thoracic outlet release after seeking other medical opinions:

In this instance, the player consulted with some of the same specialists who examined Carpenter, including the Texas doctor who performed Carp’s surgery. The team endorsed Garcia’s out-of-state search for answers but wanted him to more strongly consider less aggressive remedies.

"From a medical (standpoint) we felt like there were some other options he could consider before taking this step," said Mozeliak, who allowed to the Post-Dispatch on Thursday that it was difficult "to count on him for anything" this season.

Given the odd communications strategy employed by the Cardinals this week—with Mozeliak stating on Monday that surgery was unnecessary and Wainwright would simply need rest before issuing a late-Friday afternoon press release after the media reported that Wainwright had undergone a different surgical procedure earlier in the day than the one he apparently did in fact have performed—one wonders if there is a disagreement between the club and player similar to the one that stemmed from Garcia's decision to undergo thoracic outlet release surgery. Could Wainwright be the second Cardinals player to opt to go against the recommendation of the team's medical provider in favor of a course of treatment prescribed by another doctor? If not, why didn't the Cardinals announce the surgery sooner?

At least we can take heart in the fact that Mozeliak hasn't publicly ripped Wainwright's decision to undergo surgery in the press like he did Garcia. Of course that may have as much to do with the invasiveness of the surgery as anything else. Garcia's thoracic outlet release ended his season if not his Cardinals career (and came after injuries cut short prior seasons) while Wainwright's procedure will apparently only prevent him from throwing for a couple of months or so. Hopefully the procedure fixes whatever ailed Wainwright this season and we see vintage wagonmaker on the hill come spring.