Hyun-Jin Ryu’s Shoulder, A Scary Situation

Jayne Kamin-Oncea-USA TODAY Sports

The brunt of the concern right now amongst Dodger fans has to do with the health, more particularly the stability involving Hyun-Jin Ryu’s left shoulder. In case you weren’t acquainted, Ryu was sent back to Los Angeles to be examined by team doctor, Dr. Neal ElAttrache because of “stiffness” in his left shoulder.

This is terrifying because of the very nature of shoulder injuries. Modern medicine is amazing, it has the ability to completely reconstruct the elbow of somebody and help that person nearly return to the level he was pitching at before the surgery. Tommy John is the pinnacle of medicine in baseball that has saved the baseball lives of so many, and if there were ever a direct counterpart to the elbow injury, it would be the shoulder injury.

Hyun-Jin Ryu has experienced shoulder problems in the past, of course. Last season in April, and August he went on the disabled list with shoulder inflammation, he missed 23 days each time and was at full strength for the playoffs where he was solid. The problem, like some have pointed out, is the fact that his shoulder appears to be the weak link in his arm, if Ryu’s injury is anything like it was last season, the Dodgers should be okay going forward, and losing Ryu for an extended amount of time wouldn’t exactly doom the team (not considering any other potentially likely injuries), but with 3 shoulder issues in an 11 month timespan (with a few more back in Korea), there has to be worry that the injury isn’t just inflammation, it’s something significantly worse than that.

A torn labrum, It was once described as the “worst injury in baseball“. The injury almost killed Matt Kemp‘s career (and he was a hitter!), the surgery single handedly ended the successful careers of Ryan Webb and Ben Sheets and countless others. Here’s an excerpt from an important article discussing the injury (keeping in mind that Schilling and Clemens are historical outliers in and of themselves)

"The average for that group is 21.8 WARP post surgery, but that’s drastically skewed by Clemens and Schilling; among the other nine, it’s 10.0 WARP. That leaves another 17 pitchers (25 percent) floating somewhere in between those two poles, with seven of those 17 still active; the average post-surgical WARP for this group is just 1.8."

And this is the optimistic side of the coin! The paragraphs preceding this details a 58% rate of pitchers never being the same. Basically, torn labrums are really bad, heck, any surgery that counts Dustin McGowan, he of the 107.2 IP/ 8 games started/0.6 RA-9WAR since that article was written, as a success, is really scary. And the thing is, Will Carroll wrote about that injury way back in 2004, 11 years later, success rates have maintained themselves as fairly unlikely and stagnant. And yes, the success stories are there, Clemens, Schilling, Carpenter are all guys who have been great post surgery, but the odds are skewed hilariously against the pitcher.

But if the labrum is the worst injury in baseball, the rotator cuff has an argument for being one of the most destructive injuries in sports.

Another quote from that baseball prospectus article:

"As Yankees team physician Dr. Chris Ahmad noted, Pineda’s rotator cuff is undamaged, a key detail when it comes to his outlook: “When the rotator cuff is damaged as part of the injury problem, that has a much worse prognosis and influences velocity and ability to pitch. His rotator cuff looks great, and this is isolated to his labrum, and that’s why we feel more optimistic about him having a good result.”"

And boy Ahmad is right. This study is a great look at success rates for pitchers who have undergone rotator cuff surgeries:

"Seventy-three percent (24/33) of pitchers returned to MLB play at a mean of 17 months after surgery. No pitchers in the RCS group returned to MLB play during the index year. Twenty (61%) pitchers in the RCS group returned to MLB play during postindex season 1. Three (9%) pitchers in this group returned to MLB play by postindex season 2. One (3%) pitcher in the RCS group returned to MLB play by postindex season 3."

The good news is that over half returned the year following their surgery, while 12% underwent rehab that took over 2 years after their injuries with 27% never returning. And yeah that might bode well for pitchers as far as pitching on a major league mound (plus the fact that it was written in 2011 so techniques have advanced), but it also never mentions performance until the conclusion:

"In contrast to what we expected, they did not have a greater attrition rate than their control counterparts, but their performance did not return to preindex levels over the course of the study."

The first part is obviously a solid sign, and Ryu is young enough to where his attrition rate should be considered low, but the performance factor is the cautionary tale: pitchers with rotator cuff tears just don’t return to previous levels of performance like tommy john survivors do, or even labrum tear survivors do. For all we know, Ryu’s shoulder problems might just be inflammation that he has to deal with, similar to his teammate, Brandon McCarthy, but Hyun-Jin’s arm isn’t exactly pristine either, he underwent tommy john surgery as a high schooler, and has dealt with several shoulder problems over the years, so the longer these issues persist, the more worried the Dodgers are going to be about the overall structure of his shoulder. Considering how good he is when he’s right, everybody involved should hope that Ryu’s shoulder situation is similar to the disabled stints he endured last season, and not at all like non roster invitee, Mike Adams‘ shoulder.