Friday, March 17, 2006

how to spin a loss into a win

the results of mark prior's mri have hit the wires a day before they were supposed to, and the cubs are making hay. prior has been diagnosed with a moderate strain of the subscapularis, and the team expects that surgery is not required.

Cubs athletic trainer Mark O'Neal said Prior will be shut down from throwing for seven to 10 days. O'Neal will meet with the pitcher, orthopedic specialist Dr. Lewis Yocum and the Cubs medical staff on Saturday to discuss the next phase for Prior. The subscapularis is part of the rotator cuff group of muscles, located under the arm pit behind the pectoralis muscle.

"By no means would it [require] any kind of surgery," O'Neal said of Prior's shoulder problem.

great, right?


well, it could certainly be worse -- but put aside joy at the prospect of no surgery and examine what a "moderate strain of the subscapularis" is. it's a grade 2 tear of the rotator cuff.

while the cubs are talking about 7-10 days of missed time and a resumption of throwing from a lower level afterward -- which would probably mean a may return, with no timetable yet set -- this writer (while not being a doctor, of course) finds that to be a very optimistic prognosis. as was pointed out by commenter maddog, a harder-to-locate version of this injury cost jose contreras half of 2003.

moreover, this injury is very likely the result of stress put on the muscle some time ago -- prior has simply not done the kind of work this spring needed to force this injury. rotator cuff injuries are usually not merely the result of a single act; significant tissue degeneration over time with use is most often prerequisite -- that is, this is a repetitive-stress injury.

A rotator cuff tear can occur at the muscle belly, the muscle-tendon junction, the tendon, or the insertion of the tendon to one of the bones, scapula, or humerus. The symptoms that commonly occur with rotator cuff injuries are pain, weakness, and loss of motion in the shoulder. Some athletes will feel a pop in their shoulder after which they cannot lift their arm very well. Others will report a gradual onset of shoulder symptoms, like grinding or clicking, but may not experience any loss of motion.

A significant traumatic force is required to tear a healthy rotator cuff. Most often, however, rotator cuff tears result from a combination of trauma and degenerative changes.

Degeneration causes muscles and tendons which should not normally be working to assist in producing the equivalent net force and power that the activity demands. The degenerative process usually starts with swelling and inflammation in the bursa from repetitive motion activities at or above shoulder level. This process causes compensatory muscles to engage during the activity to produce the required forces for the sport. This process continues until the rotator cuff tendons fight for space and develop a tendonitis. Continued overuse due to the tendons’ weakened state leads to further degeneration.

Think of a rope fraying from friction around a sharp edge, and the movement of the rope causing further breakdown of the rope’s strands. Eventually the fibers tear at the surface where the point of excess friction is applied.

degeneration in the rotator cuff group destabilizes the shoulder joint, which may well help to explain much of prior's reduced effectiveness late last year, when he lost his fine control and some velocity, laboring with high per-inning pitch counts as a result. whatever prior complained of at that time is in every likelihood what motivated the cubs' queer handling of him this spring, in futile hopes of not reawakening the ghost in his shoulder. the secrecy surrounding his throwing sessions -- none of which were open to the public -- further confirms that prior was probably showing some outward signs of continuing injury, such as decreased velocity.

this damage hasn't healed in the intervening five months; indeed, it would seem that his subscapularis tear is probably a feature of a larger degenerative problem in his rotator cuff resulting from overuse. it seems rash to hope that this can now rectify itself in the next ten days.

taken in this context, and knowing that the cubs are reflexively putting the best possible face on the diagnosis and prognosis, it would be reasonable to expect that this team will be without prior until june is within a stone's throw, if that soon. if he resumes throwing in early april, expect setbacks.

prior will now join the frayed labrum crowd in his training table endeavors, leaving the cubs with a rotation of zambrano, maddux, rusch, williams and a minor league pitcher for what will probably be the first third of the season.

is that great? with this rotation, this page submits that the 2006 cubs may well be too deep a hole by june 1 for whatever comes after to matter. the games played in april matter every bit as much -- and usually more -- than the ones played in september.

the cubs are trying to spin this diagnosis as positively as they can, but this page sees precious little to be happy about. an optimist would say that prior is at least not going under the knife -- and indeed, that is something. but conversely and just as truly, this is not good news for prior or the cubs.

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