NAME: Justin Thompson
TEAM: Texas Rangers
INJURY: Torn rotator cuff on pitching arm
OTHER ATHLETES AFFECTED
Baseball: Eddie Perez, Atlanta Braves; Rodney Meyers, San Diego Padres; Dave Berg, Florida Marlins; Jamey Wright, Milwaukee Brewers
In the last 15 years, at least two other pitchers have had two shoulder surgeries within a year and come back to pitch successfully in the majors -- Bret Saberhagen and Mark Leiter.
HOW IT HAPPENED
Rangers left-hander Justin Thompson had surgery on August 27 last year -- while he was with the Detroit Tigers -- to repair tears in the edge of the shoulder joint socket and smooth out fraying in the rotator cuff.
Thompson felt no pain until he was in the final stages of his rehabilitation from the initial surgery. He went through spring training and through three minor league rehabilitation starts before experiencing any abnormal pain over and above the usual stress from conditioning. On April 25, in what was supposed to be his final rehab start before returning to the active roster, he threw more than 100 pitches for the first time. He felt significant fatigue after that outing. In every successive attempt to throw off the mound, the pain increased. Still, he was recalled from a medical rehab May 1 in the minor leagues, and appeared close to joining the Rangers until he continued to have soreness in his left shoulder.
Thompson underwent additional surgery on May 12 to repair the tear in his left rotator cuff. The decision for more surgery on Thompson's pitching shoulder was made May 10 after an MRI and examination by orthopaedist James Andrews, MD, in Birmingham, Ala.
Thompson made his major league debut with the Tigers on May 27, 1996. Since then, he has won 36 games and lost 43, with an ERA of 3.98. He has struck out 427 batters in 647 innings. He led the club in innings pitched, strikeouts, and complete games in 1997 and 1998. He was tops in the AL with 12 pickoffs in 1998.
The southpaw was 9-11 with a 5.11 ERA last year for the Tigers before going down with the rotator cuff injury on August 27. Thompson was part of the nine-player deal that sent Juan Gonzalez to Detroit before the 2000 season. He has yet to pitch for the Rangers.
WHAT'S INVOLVED IN A TORN ROTATOR CUFF?
The rotator cuff is a set of four muscles that motor the shoulder joint. These muscles originate from the shoulder blade (scapula) and turn into fibrous tendons as they approach the outer aspect of the shoulder. These four tendons surround the front, top, and back of the shoulder joint. When the rotator cuff muscles contract, they pull on the rotator cuff tendons, allowing the shoulder to move through a wide range of motion.
One of the common ways for a rotator cuff to be injured is by repetitive overhand activity. The rotator cuff tendons can be torn by a fall on the outstretched arm, which causes the rotator cuff to be pinched between the arm bone (humerus) and a part of the shoulder blade (acromion). The rotator cuff can also be torn by chronic impingement of the tendon on a bony spur from the acromion. The spur progressively breaks down the rotator cuff and may finally lead to a full thickness tear.
Patients with a rotator cuff tear often have pain with overhead activity and at night. However, some patients with a rotator cuff tear often have significant weakness in their arm and may be completely unable to lift their arm away from their side.
A rotator cuff tear is best diagnosed during a physical examination by an orthopaedist. An MRI (magnetic resonance imaging) may be obtained to confirm a full thickness rotator cuff tear. A full thickness rotator cuff tear often results in significant disability in the arm.
During the August 27th procedure, Andrews cleaned up some frayed ends around the rotator cuff but decided not to actually stitch up the small tear there. After Thompson complained of soreness, a preliminary MRI was done on May 8.
It was discovered that the tear had widened since the August surgery. John Conway, MD, the Rangers' team physician, said the tear appeared larger than first thought and now encompasses "more than 50%" of the depth of the tendon.
An arthroscope inserted into the shoulder joint is used to view the shoulder joint and document any injury to the surfaces of the shoulder bones and also to confirm the presence, size, and position of the rotator cuff tear. The arthroscope may also be used to remove any bone spurs that are present in the shoulder area. Current techniques for repair of a rotator cuff tear require approximately a two-inch incision over the outer aspect of the shoulder. Through this incision, the rotator cuff tear is identified and the torn edge is reattached to the humerus bone with stitches.
Conway said surgery was the best option for Thompson to have a chance to play in 2001. "We can continue to rehab and hope it gets better, but at this stage he will not be ready for this season anyway," said Conway in a statement to reporters.
Trainers and team doctors said that it's not unusual for pitchers to have abnormality in the cuff. Tears are unpredictable.
It requires approximately 4-6 weeks for the rotator cuff tendon to heal down into the bone. During that time, if active motion of the shoulder is carried out, the rotator cuff may be pulled away from its repair site. Patients begin a formal physical therapy program at approximately 10-14 days after surgery. For the first 4-6 weeks, patients are allowed to actively move their hand, wrist, and elbow. Shoulder motion, however, is purely passive during that initial period. This passive motion is carried out by the physical therapist or by the patient with the assistance of the opposite arm. At 4-6 weeks, the rotator cuff tendon has healed enough to the bone that active assisted and active range of motion may be started.
Strengthening of the rotator cuff muscles begins about 8 weeks after surgery and continues for 2-3 months. Because of the stress from pitching, full recovery often takes a year. According to Conway, the recovery time for Thompson will be 6-12 months. Thompson will miss the entire 2000 season.
Though Conway did not have medical data on players attempting to come back from two shoulder surgeries, he said the chances of Thompson coming back remain about the same. "Probably, the fact that he's had two surgeries won't affect his ability to come back," Conway said. "After the first surgery, he had about an 80% chance of being the same player he was before the operation. I would imagine it's about the same."
Thompson could be ready for spring training for the 2001 season.
As for the two other pitchers who had two shoulder surgeries:
- Former Cy Young Award winner Bret Saberhagen underwent his first operation after the 1995 season, while with Colorado. He had more surgery on May 28, 1996, to repair the problem. Saberhagen, who was 31 at the time of the first procedure, didn't return until Aug. 1997, 18 months later. After returning, he compiled a 25-15 record with Boston. He encountered more shoulder problems last year and hasn't pitched in the majors yet this season.
- Mark Leiter: Between June 1986 and November 1987, Leiter had three shoulder procedures, missing three seasons between 1986 and 1988. Leiter did reach the major leagues and pitched for 10 years with seven clubs, compiling a record of 63-72 and recording 26 saves.