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About Jon
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1) using profanity or any euphemisms for profanity
2) personally attacking other commenters
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5) discussing politics
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The Shawn Green of Old Will Not Return
2003-10-19 22:00
by Jon Weisman
Note: The Dodger Thoughts blog has moved to the Los Angeles Times.

"Successful" was the term given to the press to describe Dodger outfielder Shawn Green's shoulder surgery last week. This comes as no surprise. Not too many athletes wake up from the operating table to read in the paper that they've had "unsuccessful" surgery, the "first, do no harm" medical ethic providing some assurance of that.

Therefore, for most media outlets, the news of Green's surgery to clean up the labrum in the back of his right shoulder was little more than a footnote in the Dodger offseason. The Dodger press reported 1) the surgery occured, and 2) that Green is expected to be ready for Spring Training.

For baseball medical expert and dogged reporter Will Carroll of Baseball Prospectus.com, however, there was more news to convey - and it wasn't all that successy.

On Friday, Carroll wrote:

... instead of repairing the labrum, the damaged cartilage was removed. This is significantly more likely to cause future issues, and raises doubts that Green will recover to the level many expected from this great player.

I read this and went, "Whoa." And then I went, "Why?" It sounded like an either-or choice was made, and not a very good one at that.

I asked Carroll: "Can you give any insight as to why this decision would have been made? Would the doctors or the Dodgers dispute that it is more likely to cause future issues? Or is the type of surgery Green had less intense? Bottom line: what was the incentive for removing the damaged cartilage and not repairing the labrum?"

When Carroll replied, the first thing he did was clarify that the issue wasn't about doctors making a bad choice:

Man, I knew I was gonna end up having to explain that one more.

Honestly, when they went in, I'm reasonably sure the thought was repair (the labrum, instead of removing the damaged cartilage), but the tear was too big to suitably repair.

Okay, so the doctors did what they could. Still, this surgery doesn't sound like something so successful after all - at least in the eyes of any Dodger fans looking for 40-plus home runs from Green in right field again.

Carroll continued:

Doctors would say they did what was necessary and that [Green] should return to function, but doctors don't analyze baseball. I can't say for sure that he won't, but since he'll have bone on bone in at least part of the glenoid fossa now, there's a significantly raised chance of pain, and pain is never good for function.

Sure, he could feel loose and come back and play fine, but as one surgeon I know says, "Surgery isn't a fix; it's buying time until I have to do it again."

Surgery or not, Shawn Green still has a shoulder problem.

In the spirit of "teach a man to fish," Carroll gave me a couple of links to medical sites so that I could do further research. As someone who understands neither science nor fishing, this was problematic, but I waded in. After all, I did write an ER spec script once.

From Johns Hopkins, we learn:

1) "The labrum is a type of cartilage found in the shoulder joint." (This is apparently beginner's stuff, so you can see the level of expertise I bring to the pond.)

2) "The labrum has basically two functions.  The first is to deepen the socket so that the ball (of the shoulder - the humerus) stays in place. ... The second function of the labrum is as an attachment of other structures or tissues around the joint."

3) "A labrum tear can take several forms, and it is very easy to confuse these types."

4) "Because this cartilage is deep in the shoulder, it is very difficult to make the diagnosis of a torn labrum upon physical examination." (Just speculating here, but I find this significant in terms of the secrecy surrounding Green's injury throughout most of 2003.)

5) "If the labrum is frayed, usually no treatment is necessary since it doesn’t usually cause symptoms.  However, if there is a large tear of the labrum, the torn part should either be cut out and trimmed, or it should be repaired.  Which treatment is used depends upon where the tear is located and how big it is."

There was even more information from Carroll's second link, the Orthopaedic Research Institute, but for now, I'm compelled to give you one item in place of all others:

6) "Do not attempt any procedures described on this website unless you are fully trained. Otherwise, serious injury may occur."

Ah. Gotcha.

Anyway, having digested as much of this as I could, I went back to Carroll for some follow-up. Since time's getting short and this entry's getting long, I'll try to cut to the chase.

Carroll said that in 2004, Green will have some reprieve from the 2003 pain, but:

...you can imagine that the bone on bone will eventually become a problem - bone spurs or chips are inevitable. It won't be perfect, but it should be better.

and ...

Tear and fraying is degrees of the same problem. Green had a complete tear in the posterior aspect of his labrum. Bone on bone is NOT okay, but it's better than a torn labrum.

The Orthopaedic Research Institute also details the suture anchors that are often used to reattach the labrum. Carroll commented that many pitchers pitch with those anchors - however, as Green did not have a repair, he did not end up with one:

They merely excised the torn portion. Picture a tent. One corner of the tent comes up and flaps in the wind. You put in a peg and the tent is fine. That's what you do with a frayed labrum. If the tear is so bad that you have to cut off a section of the tent and hope that what's left keeps you dry, well, that's more like what they did with Green.

But eventually, it's gonna rain, right? Carroll says yes, although there's a limit to how wet Green will get. (When I'm not trying to be cute, this means that the next surgery will not necessarily be any more invasive than the last surgery was.)

Honestly, [Green] will probably have to have it cleaned up with a scope. They'll go in and catch some fraying, shave down the bone. Very similar to a "scrape and tape" on the knee that many get. He could also, were he not a baseball player, make it through his normal life with no problems.

Bottom line: This is why, as Carroll said at the outset, that while Shawn Green's operation leaves him better off today than he was during the 2003 season, the operation was not a cure. Green is likely to need more shoulder surgery in his career, and even more likely to have to contend with pain in the shoulder. If playing with pain is the reason for his performance decline in 2003, then the home run hitter of previous years is probably gone for good.

One final thing. I asked Carroll, "Is this as good a reason as any to move Green to first base? (And believe me, with the lack of gusto with which he has come to play right field, there are reasons to move him already.)"

Carroll said, "Yes."

Friendly postscript: If, after reading this article, you have come away with either of the following conclusions, I humbly recommend that you go back and read the article again.

  • Shawn Green's career is over. No. The article says that Green will have a recurring problem with his shoulder, a problem that is worth knowing about for people who have read that surgery was successful and are expecting Green to return to peak performance - 40-plus homers per year. The article does not say anywhere that Green will perform worse than he did in 2003 - in fact, with proper pain management, he could perform better.

  • Shawn Green's injury will require him to move to first base. No. There are reasons for Shawn Green to move to first base. They are reasons of debatable importance (read more about them here), and they are reasons that existed independent of this injury, which affects Green's non-throwing shoulder. I see now that some people interpreted the closing question of the article, "Is this as good a reason as any to move Green to first base?" as a recommendation or a sentencing, but I really meant the question literally. Is the injury as good a reason as any? Yes is the reply, meaning that the injury is as good a reason as any - however, none of the reasons necessarily require the move.
In retrospect, I'd have been better omitting discussion of position switching from the article entirely. The article is not meant to address what position Green should or will play next year. The article is not meant to indicate that Green is done. The article says that Green has a shoulder problem that is not resolved, and that shoulder problem could very well affect him in the future in ways similar to how it affected him in 2003.

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