All Things Bubba

From Science Daily:

Comeback To A Pre-injury Level Disappointing For Professional Baseball Players

Only 45 percent of baseball players were able to return to the game at the same or higher level after shoulder or elbow surgery, according to new research released March 8 during the 2008 American Orthopaedic Society for Sports Medicine Specialty Day at The Moscone Center.

"In an ideal world, of course, we would get 100 percent of the players back to their pre-injury level or higher," says Steven B. Cohen, MD, assistant team physician for the Philadelphia Phillies and director of Sports Medicine Research at the Rothman Institute in Philadelphia. "But the fact of the matter is at this elite level of the sport, the physical demands of throwing have much higher requirements than the regular person on the street. The average person who has shoulder or elbow surgery can return to their regular activities. Throwing a baseball at the professional level puts a significant amount of stress on the shoulder and the elbow."

Over a four-season period, Cohen and colleagues studied 44 players from one professional baseball club (major league, AAA, AA and A) who underwent 50 shoulder and elbow operations by a variety of surgeons. There were 27 shoulder surgeries performed on 26 players and 23 elbow surgeries performed on 21 players. A key finding of the study was that players returning after elbow surgery were more likely to comeback to the same or higher playing level than those who had shoulder surgery. Thirty-five of the players were pitchers with 43 percent returning to the same or higher playing level.

The researchers found that overall, only 20 of the 44 players (45 percent) returned to the same or higher level of professional baseball. For ballplayers at the major league, AAA, or AA level, the study found only 4 of 22 (18 percent) were able to return to the same or higher level.

"As a surgeon, obviously these statistics were disappointing and somewhat lower than what we would like them to be," said Cohen. "This may give us cause, however, to look at how we evaluate and treat these injuries to the throwing arm. Our goal is to get these elite athletes back to their premier pre-injury health. This is important both to the player who is making a living off his athletic ability and the organization that wants its players in top shape. We may need to examine if there is a way to 'fine-tune' these procedures to customize them for the demands of a professional baseball player."

At first blush, that's extremely alarming. Only 20 out of 44 players (45 percent) had successful comebacks from shoulder or elbow surgery. For players at the higher levels (AA to major leagues), only 4 of 22 (18 percent) had successful comebacks. And players who had shoulder surgery fared worse than players who had elbow surgery.

There's more data from the study here:

Twenty-six players had shoulder surgeries -- one of them had two shoulder surgeries. Eighteen of these players were pitchers. Four were in the major league, three were in AAA, four were in AA and 15 were in the A league. After surgery, just seven players returned to their pre-surgery level of play, and two advanced to a higher level. Five players returned to a lower level of play, one has not returned from his injury, and 11 retired from baseball. Only one player from the high professional level of AA or above returned to the same level of play.

There were 23 elbow surgeries performed on 21 players, and 20 of them were pitchers. Six were in the major league, three were in AAA, three in AA and nine in A league. Of the 12 players at a high professional level, just four returned to the same or higher level.

"Just 45 percent of injured players needing surgery returned to the same or higher level, and if you look specifically at pitchers, 43 percent returned to the same or higher level," Cohen said.

He said those with elbow injuries were more likely to return to the same level of play, with 52 percent in this study attaining their previous or an even higher level. For shoulder injuries, however, that number was just 35 percent.

Yikes.

So, does this study mean Bubba - and Craig Wilson - would be bucking the odds to return to playing at their former levels? Not quite. Most of the players in the study were pitchers, and it's harder for pitchers to bounce back from arm surgery. Crunching the numbers thrown about in the article...nine of the players studied were position players, and five out of those nine came back to play as well or better than they had before. That's 55.5% - still not great, but better than even odds. Almost all of the position players in the study (8 out of 9) had shoulder surgery, so this study doesn't really have anything to say about shoulder vs. elbow surgery for a position player.

Also, the study didn't say what kind of surgery. I suspect there's a big difference between relatively minor impingement surgery, and more complicated procedures like repairing a torn rotator cuff or labrum. (Though position players are less likely to suffer those more serious injuries.)

In any case, it's a very small sample size. You can't read too much into it. Especially since it was done over a period of four years - which means many of the players involved didn't get the advantage of the latest advances in medical knowledge.

Still...it's rather sobering. Shoulder surgery is almost routine for an ordinary person. But for a baseball player, it's a last shot at saving your career.

And I guess this puts paid to the idea that Tommy John surgery will make you a better pitcher.

Labels: science of sports