What Are Johan Santana’s Chances of Recovery?

On Saturday, Steve Popper and Bob Klapisch of the Bergen Record dropped the bomb that Johan Santana’s 2011 season might be in jeopardy.

Well, it’s only a bomb if you don’t read MetsToday; we wrote off Johan’s 2011 way back in early September. But that’s just me being all “gloom and doom” … or a realistic view of the situation, depending on your outlook. Personally, I tend to have low expectations for pitchers returning from serious shoulder injuries, and didn’t see any reason to view Santana’s injury any differently. It made more sense, to me, to plan the 2011 Mets pitching staff without Santana — and if by some small miracle he made a comeback, it would be a wonderful and welcome surprise.

But planning without Santana doesn’t sell tickets, and the Mets are desperate for revenues. So, the team will continue to spin the fantasy of Johan’s return at some point in 2011.

Putting that aside for a moment, we must wonder if Santana will be able to return by 2012 — and if he does, will he be anything near the ace starter he was before shoulder surgery? The odds are stacked against him, heavily — if history is any indication.

This isn’t more “gloom and doom” from your pessimistic blogger. Again, I look at the facts. Shoulder surgery is nothing at all like elbow / Tommy John surgery. Pitchers generally take much longer to return from even minor shoulder surgery, and rarely return to be as effective as they were before. But don’t take it from me; Jerry Crasnick wrote an article about it last September. Also, consider the number of pitchers who had success after shoulder surgery, compared to those who were never the same. Following is an unofficial but somewhat reliable sampling of pitchers who have suffered major shoulder injuries in the last decade or so:

Successful:

Chris Carpenter
Freddy Garcia
Kerry Wood
Roger Clemens
Jesse Crain
Ted Lilly
Jon Rauch

Somewhat Successful:

Scott Olsen
Pedro Astacio
Rich Harden
Pedro Martinez
Joe Nelson
Orlando Hernandez
Aaron Sele
Gil Meche
Joey Hamilton

Unsuccessful:

Gil Meche
John Maine
Kelvim Escobar
Jason Schmidt
Mark Mulder
Paul Wilson
Mark Prior
John Smoltz
Curt Schilling
Brian Lawrence
Tanyon Sturtze
Mike Sirotka
Gary Majewski
Cliff Politte
Joey Eischen
Erik Bedard
Ben Sheets
Ramon Martinez
Yhency Brazoban
Chuck James
Henry Owens
Tony Armas, Jr.
Jaret Wright
Orlando Hernandez
Bartolo Colon
Jason Jennings
Matt Clement
Kris Benson
Matt Morris
Scott Elarton
Dave Fleming
Matt Anderson
Casey Fossum
Justin Thompson
John Rocker
Carlos Hernandez
Ryan Anderson
Chad Cordero
Rich Hill
Rocky Biddle
Casey Janssen

Jury is Out:

Chien-Ming Wang
Jake Peavy
Juan Cruz
Ron Mahay
Dustin McGowan
Jeff Francis
Chris Young
Brandon Webb

(You may notice that El Duque and Gil Meche are on two lists; that’s because they suffered major shoulder injuries at two different times in their lives — with the second time contributing to the end of their baseball careers.)

I certainly missed many pitchers who never made it all the way back from a major shoulder injury. I might have missed a few success stories — please add them in the comments. The point is, full recovery and true “success” is a rarity when it comes to major shoulder injuries and shoulder surgery in particular. What makes this more dismal is that nearly all of the pitchers on these lists suffered less-damaging injuries that required less-invasive surgeries; in almost all cases, the pitcher had a frayed labrum and/or torn rotator cuff that required arthroscopic surgery.

From Crasnick’s article:

“Superficially, 90 percent of scopes or rotator cuff surgeries are just a cleanup,” said Jamie Reed, the Rangers’ medical director and head athletic trainer. “You’re not repairing or fixing anything. It’s like when you take a rope and go over the corner of a table, back and forth, and get all that fraying. It’s the same when you get inside a shoulder. It starts to clog up and get inflamed, and that’s where a lot of guys have shoulder pain and discomfort. You’re basically getting that tissue that needs to be debrided out of the way.”

With the “typical” surgery performed above, it takes most pitchers a minimum of 10 months to a year to get back on the mound. Mind you, that doesn’t necessarily mean that they’re pitching effectively off of a mound; Freddy Garcia is a very typical example of the normal course of action. Since he’s a success story, and we want to be optimistic about Johan Santana’s future, let’s delve into the Garcia story.

Ironically, Garcia and Santana have a lot in common. Both are Venezuelan, both were originally signed by the Astros, both were dominant pitchers in the AL Central, and both were befelled by shoulder injuries that required surgery. Garcia had his surgery in late August 2007. Garcia finished his rehab and began showcasing his talents to MLB teams in August 2008 — just short of a full year later. At that time, his velocity topped out in the mid-80s and he signed with the Tigers, pitching 15 innings before leaving a game with a “stiff” shoulder and ending his season. You may remember that Garcia’s comeback continued unsuccessfully in Port St. Lucie the following spring, nearly retired after struggling to keep his velocity in the 80s, and was eventually released after pitching terribly in AAA Buffalo. A few months later he signed with the White Sox, was called up in August, and finally began pitching effectively again in the last month of the season. Mind you, that was September 2009 — a full two years after his shoulder surgery.

Something to consider with the case of Freddy Garcia: despite making 28 starts and going 12-6 last year, he wasn’t nearly the pitcher he was before, and his velocity was in the 85-86 MPH range. There are reports that he’s up to 89 MPH in Yankees camp this spring, and if so, that’s great — but it also means it took him over 3 1/2 years to get there. Also, I haven’t been able to pinpoint what type of surgery Garcia had; meaning, whether it was a simple arthroscopic procedure or a more invasive one, such as what was done to Johan Santana.

I’m fairly sure that all of the other success stories occurred after comparatively minor arthroscopic procedures, and only Garcia and Lilly were over 30 at the time of the surgery (Santana is 31 going on 32). Additionally, Clemens might have had some “special help” for all we know. If Garcia’s example is a point of reference, Santana will not be a reliable MLB starting pitcher until sometime in 2013, or possibly 2014. In case you’re wondering, Santana’s contract expires at the end of ’13, though there is a $25M option for ’14 that the Mets may exercise.

There are two players — both catchers — who reportedly suffered similar injuries to what Santana sustained, and who had similar procedures: Jorge Posada and Gregg Zaun (Santana himself made the Posada comparison). If you saw Posada play last year, you know he couldn’t throw out the garbage, much less opposing runners, and is slated to be a full-time DH this year mainly because he can’t throw. And as for Zaun, his shoulder wasn’t quite right after surgery and he retired last week because of it.

Sorry for the gloom and doom, but personally, I think it’s best to just write off Johan Santana for the rest of this year and hope he can make a return at some point in mid- to late 2012 — though with what effectiveness, no one can guess.

While researching the risk/reward articles posted earlier this winter, I couldn’t help but notice all the pitchers who were trying to come back from shoulder problems. I combined that list with others from the past, to try to get a handle on the recent history of pitchers returning from shoulder surgery.

Joe Janish began MetsToday in 2005 to provide the unique perspective of a high-level player and coach -- he earned NCAA D-1 All-American honors as a catcher and coached several players who went on to play pro ball. As a result his posts often include mechanical evaluations, scout-like analysis, and opinions that go beyond the numbers. Follow Joe's baseball tips on Twitter at @onbaseball and at the On Baseball Google Plus page.
  1. Mike March 14, 2011 at 11:06 am
    Good stuff Joe. Something I often debate with sports fans is the “Should he just wait until next year?” question. My answer is usually no. Unless we are talking one month or a few weeks, then yes, regardless of the team’s position in the standings the results on the field may not be worth the benefit gained to the player. But if Santana can get in five or more starts I’m not sure I can say I would not do it. The rigorous path to recovery is much easier to accomplish if it results in getting back on the field, instead of another 3 months of rehab/training. If he can be ready, getting him a few starts seems worthwhile especially considering the team’s likely place in the standings (i.e. the basement).

    Joe, is it better to get him a few starts if he can do it? Or is it better to have absolutely no risk of rushing him and re-injury/setbacks? It seems to me like getting starts is the way to go if possible.

    • Joe Janish March 14, 2011 at 1:01 pm
      Of course, every individual is different, so it’s hard to comment. But generally speaking, and based on past case histories, I’d be inclined to say that it’s NOT better to get a pitcher back on the mound in MLB games if it’s unnecessary — but particularly in the case of more serious “reconstructive” surgeries such as what Santana experienced.

      I look at all the setbacks suffered by Mark Prior, Freddy Garcia, Ben Sheets, etc., and with most of them, it was a situation of the player going back on the mound too early — be it because of their competitive juices, financial reasons, whatever. Further, I don’t believe that the typical rehab program of an MLBer includes significant study — by a scientist — of what caused the injury in the first place, and what can be done to prevent it from happening again in the future. As a result, most if not all of these pitchers return to their same awful mechanics (see John Maine), which may contribute to a longer rehabilitation period, setbacks in the process, and/or reinjuring the arm in the future.

      Maybe if the team decided right now that Santana would be out for the entire season, they would take the time to get the opinion of both qualitative and quantitative biomechanic experts to find out why Santana destroyed his shoulder and help him make changes to his motion that will get him back to being an ace pitcher — or at least, a usable MLB starter.

  2. Walnutz15 March 14, 2011 at 2:02 pm
    Whether or not Santana’s “on-schedule” really means very little to me at this stage of the game.

    These guys can type ’til their fingers fall off, and all it is right now is speculation.

    Truth be told, I didn’t expect to see him until after the ASB – more trade deadline, anyway. Even still, expectations for 2011 are tempered for me.

    - torn elbow flexor (2001)
    - minor clean-up surgery for elbow (2003)
    - torn meniscus in knee / surgery (2008)
    - season-ending arthroscopic surgery for bone chips (2009)
    - surgery to repair torn anterior capsule (2010)

    Why would anyone want him to rush back for anything this year – unless he was feeling as close to “healthy” as he could potentially be?

    The true test will be 2012. How he holds up for the duration of this contract is key.

    He’s owed a TON of money:

    11:$22.5MM
    12:$24MM
    13:$25.5MM
    14:$25MM club option ($5.5MM buyout)

    At this point, I just think everyone’s looking to go nutty with the long-term state of the Mets.

    We can’t be worrying about this right now (on March 13th), simply because anything he provides in 2011 is gravy, anyway.

    Prediction: I think this will finally be the year that sends Santana over the edge with the Mets. The state of the team won’t be worth him rushing back….and as more details come out about this shady ownership squad; I think he’ll start expressing “things” a bit more as his rehab/the summer progresses.

    Owed a lot of money, yes…..but does he want to sit here with this team constantly rebuilding?

    I know I wouldn’t.

  3. NormE March 14, 2011 at 2:03 pm
    This was an eye-opening article. Good work.
    It seems to me that one of Santana’s major problems is his
    ultra-competitiveness. I’m not sure that his psyche will allow him to avoid overreaching and try to take the mound before he is truly ready.
    • Joe Janish March 14, 2011 at 4:25 pm
      Thanks Norm.

      I think you are quite right about his competitiveness — and again, I point to The Chief Garcia as an example of what happens when competitors make their way back perhaps too early, and as a result suffer setbacks — the main trouble is a myopic view of reality; the athlete will always want to feel he is better than he is, and/or shrug off warning signs.

      • Curtis March 14, 2011 at 9:40 pm
        That happens with race horses, too. Horses are born to run, and they can’t understand why they’re not allowed to. They usually end up shooting them. (Sorry — ‘giving them the needle’.)