A Grim Prognosis For Glen Perkins

I feel bad for Perk, I always liked him, but I'm afraid he might be done for good. crappy way to go out, if thats what happens.

On another note, it seems like every aspect of the Twins organization is catching flack, maybe except for the medical staff. They need much, much more criticism. It seems like there are a lot of injuries that get misdiagnosed and then turn out to be much worse than initially thought. I get that medicine is an inexact science (I'm a physician myself) but this is ridiculous

Maybe other teams have this happen too, I dont follow them closely enough to know, but it does seem like the medical staff for the Twins misses an awful lot.

JT Chargois hasn't distinguished himself? I know he had 2/3 of a bad inning in the majors but we can all agree that's a small sample right?

That sample size becomes much much larger when you include all the guys he faced, and not just the two outs recorded. Seemed like an entire season's worth of plate appearances.

It's a very difficult injury to diagnose, the tears don't often show up in an MRI.  So you tell him to go in and have the surgery right away, and his career is likely over... or you see if rehab will work and try to hold off on the surgery.  The Twins medical staff has deserved blame for how they've handled injuries in the past, I'm not seeing it here.  

 

*Perkins should not have been pitching the opening week, or in the 2nd half last year. I'm not sure if that's on him or the staff

I thought I might add just a little bit to this discussion, as it is likely I look at more shoulder MRI's than most on TD (I am an orthopedic surgeon). Alarp is correct, these are difficult to diagnose. Sometimes it is because they don't show up on MRI. In other cases it is because nearly every pitcher's shoulder (particularly by the time they reach the professional level) shows signs of 'wear and tear' on MRI. So trying to differentiate 'normal' wear and tear from 'troublesome' wear and tear is also very difficult.

 Also, I thought a brief discussion of shoulder anatomy may be helpful for some. Many times while discussing the throwing shoulder, people lump the rotator cuff, labrum, and SLAP tears together, while in fact they are really separate (though potentially related) issues. 

 I like to use the analogy of a golf ball sitting on a golf tee when discussing the shoulder with my patients. The shoulder is a ball and socket joint, and in many ways similar to the golf ball analogy. The rotator cuff is a group of muscles/tendons that comes off of the shoulder blade and attaches to the ball. It's job is mainly to pull on the golf ball to keep it in the center of the golf tee as the larger muscles move the arm around in space. The labrum is cartilage that runs around the circumference of the golf tee. It's job is to act as a 'bumper' to keep the golf ball centered on the golf tee. It also serves as an attachment point for ligaments that help to keep the golf ball on the golf tee (the muscles and ligaments work in concert to do this). The top of the socket is where your biceps tendon attaches and becomes confluent with the labrum. Anatomically, we call this the 'superior labrum'. So a SLAP tear (which stands for 'superior labrum anterior to posterior') is an injury where the labrum has become separated from the rim of the golf tee at this area where the biceps tendon attaches. 

One can also get a labrum tear at other points around the rim of the golf tee (that don't involve the biceps tendon attachment area). These injuries can commonly be in the front (anterior) or back (posterior) of the shoulder, thus often being referred to as 'anterior labrum tears' or 'posterior labrum tears' which are different than SLAP tears. However, certainly a thrower can (and often does) have more than one of these issues at a time. 

 To add to the confusion (as if all of this wasn't confusing enough already, right?), different people can pitch with different amounts of damage/injury in the shoulder. I have seen shoulder MRI's that look TERRIBLE, and the player is still pitching at a near All-Star level. I have conversely seen MRI's that look essentially normal, and a pitcher is completely unable to throw. 

 I hope this was helpful to some, and I apologize if it is covering known material for others. I really enjoy this site and like to pitch in here and there where some of my medical knowledge may be helpful to others. I know I have certainly learned a lot from many here- just trying to return the favor.

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It's a welcome change to read a post by an actual expert as opposed to one by a self-proclaimed expert. Thank you for adding your expertise to the discussion.

I hope you don't mind if I pose a question. Many people have suggested that Perkins' injury or injuries have been the result of poor conditioning, with some pointing out that his waistline measurement has appeared to be larger during the last couple seasons than it was in past years. Do you feel that his overall physical conditioning had any bearing on this most recent diagnosis?

Happy to answer questions as best I can. Your question re: Perkins conditioning is a good one, though obviously difficult to answer with much certainty. I would say in general that MLB pitchers are in less 'good shape' than position players, though obviously there are exceptions. In many ways, being overly muscular can be detrimental to hurling a ball 95 mph. 

 Also, I would say there is a difference between a pitcher keeping his arm in shape but perhaps gaining some weight in the midsection, and neglecting an offseason throwing/strength program altogether. To me, the latter is more likely to be problematic than the former. 

 All of that being said, it seems reasonable to me that significant weight gain (not sure how I would define significant) has the possibility to change mechanics, which could in turn lead to injury (I am not aware of any studies that have specifically looked at this). Another possible explanation is that the cumulative 'wear and tear' on Perkins shoulder simply became too much, and would have been problematic if he had shown up to spring training in the shape of his life. Personally, I have come to believe that every thrower's shoulder/elbow has only so many 'bullets'. For every MLB pitcher, there are 100 who were great in HS or Legion ball, but simply ran out of bullets much sooner. Sometimes the gun is just empty.