Twice now in a little over two weeks, Glen Perkins’s shoulder is the subject of medical attention. This time, the Twins lefty and his agent, John Courtright of SFX, took matters into their own hands and elected to seek out an MRI. Judging by the organization’s mishandling of pitching injuries, I’d say their request is justified.
Perkins cited his decrease in velocity (which declined from an average of 91-mph in April to 89-mph since July 22nd) as Exhibit A and the inability to keep the ball down in the zone as Exhibit B. The loss of velocity is often a symptom of shoulder ailments and sometimes a prelude to a torn labrum. Using pitchf/x charts from brookbaseball.net, there is ample evidence that his release point has dropped in his more recent starts. This is noteworthy because if you are unable to maintain the same height of your previous arm angle/motion because of shoulder irritation, your elbow will naturally lower along with the rest of your arm. A lowered elbow translates into higher pitches. This makes perfect sense when you consider that since his July 22nd start, Perkins has allowed five home runs and an opponent slugging percentage of .694 in 13 innings.
There is a high probability that Perkins has ruptured a portion of his supraspinatus resulting in the inflammation of the shoulder (i.e., tendonitis). This would explain the rather mild-sounding discomfort that Perkins complained of which “felt like I rolled out of bed and went out on the mound." Perkins explained this sensation the same way every college student starts there day. A torn labrum, on the other hand, is more frequently described as repeated muscle tearing from bone when the arm is lifted overhead -- hardly a pain experience that one would compare to rising in the morning from their Sleep Number. The good news is that it is probably not a torn labrum. While not completely a career-killer, labrum tears and the long road of rehabilitation post-surgery produce a small percentage of pitchers who return successfully. Far too often pitchers return from the tear repairs to a noticeable decrease to their velocity or are forced to alter their mechanics which leads to a higher re-injury risk and/or less effectiveness (Jesse Crain comes to mind).
Kelly Theiser highlighted Perkins’s diagnosis from Dr Lewis Yocum after a visit following his one-inning debacle in Oakland in which the specialist ruled it a case of tendonitis. Dr Yocum, as you may have deduced, is, as it was so eloquently put in Anchorman when describing Ron Burgundy, the balls. Aside from Perkins, Yocum has welcomed the Indians’ Jake Westbrook, the Mariners’ Erik Bedard, the Nationals’ Jordan Zimmermann, the Orioles’ Rich Hill, and the Angels’ Scot Shields since the beginning of the month. His client list is nearly bottomless. If you have arm troubles, you see Yocum. So the verdict was that Perkins was suffering from “slight” tendonitis in his shoulder would appear to be an easily acceptable diagnosis and most likely be treated with rest and prescribed non-steroidal anti-inflammatory pills.
Tendonitis, of course, is a byproduct of overuse. The easiest fix for shoulder tendonitis would be rest, anti-inflammatory medication and monitoring of a pitcher’s workload once he bounces back. Combine the fact that he had a history of overexertion (he threw 185 innings in 2008 after tossing just 28 in 2007), it would be reasonable expectation to throttle down on the lefty by skipping a start or two. Unfortunately, starting pitchers in the midst of a pennant race do not have the luxury of using PTO and are often “cleared” to throw again and pushed back on to the mound. So instead of withholding Perkins from his next scheduled start the Twins had him throw 102-pitches five days later against the visiting White Sox.
This raises a whole other concern on a global-level for the organization and it is disturbing in its own right. In addition to not skipping Perkins, manager Ron Gardenhire tossed out rather skeptical remarks regarding the MRI saying "I'm not going to question [the decision for the MRI]. If that's what they want to do, do it and then see where we're at. I'm all for it if they feel something might be wrong, to make sure it's not. To make sure he's OK and go from there." Obviously without Kevin Slowey available and Francisco Liriano ineffective, the Twins and their manager were nervous about the possibility of using rookies Anthony Swarzak and Brian Duensing liberally without having to subtract Perkins. Nevertheless, pushing him when his shoulder has injury potential is downright dangerous.
The Minnesota Twins have long been painted as a “cheap” and “frugal” organization, however, with the medical bills association with arm injuries to Francisco Liriano, Boof Bonser, Pat Neshek, Jesse Crain and now Perkins (among others within the system), it would seem that the team could save a few pennies each year by implementing further preventative practices.