Article: A Grim Prognosis For Glen Perkins

[Nick Nelson]

The Twins finally have some clarity on one of their many mysterious shoulder ailments, but it's not good news by any means.

 

After heading to California this week to see a specialist, Glen Perkins was diagnosed with a torn labrum, and the Twins have officially shut him down for the season. The three-time All Star will undergo surgery within the next week or so.It's nice that Perkins will no longer face the uncertainty and frustration of continual setbacks, but he now has a very long and challenging road to recovery ahead of him. Procedures to repair labrum and rotator cuff issues are far murkier than elbow surgeries like Tommy John, which has now become almost routine with a reliably standard rehab window.

 

Will Carroll, who has closely studied sports injuries and medicine for years, calls a labrum tear "baseball's toughest injury." Others have dubbed it "the career-ender." Dr. Neal ElAttrache, who examined Perkins in California this week and will perform the upcoming surgery, has likened fixing a damaged shoulder to trying to put a puzzle together without the box top for guidance.

 

Many pitchers, particularly those in their 30s, are never able to return as effective players.

 

That's not universally true, so there is still hope for Perkins. But the Twins need to come to terms with the somber reality that the lefty may be finished for all intents and purposes. At the very least, he'll be out through a portion of the 2017 season (his last under contract) with an extremely uncertain outlook thereafter.

 

That means the search for a future closer is no longer a consideration that can be placed on the back-burner. Right now, the available options are unappealing. Kevin Jepsen is clearly not the guy. Hurlers within the system who possess the requisite stuff -- such as Alex Meyer, J.T. Chargois and Trevor May -- have failed to distinguish themselves. Nick Burdi might be the best hope internally but his own injury issues have limited him to three appearances this season (naturally, he just had a setback).

 

In year that has been filled with unsettling developments for the Twins organization, this one has to rank near the top. As a hometown star who once bought a round of beers from the bullpen for a contingent of Twins Daily event-goers, Perkins is a natural fan favorite. Beyond that, his importance to the relief corps has been magnified by the unit's complete collapse this season. While most of us have seen it coming for a while, this development is nevertheless crushing.

 

Alas, this merciless 2016 Minnesota Twins season drags on...

 

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[LaBombo]

Best wishes for a speedy recovery, and more importantly the fullest possible restoration of his shoulder to good overall, non-baseball health.

 

Hope he gets the chance to pitch effectively again and leave the game on his own terms. If not, he seems like the sort of guy who'll be able to handle the transition.  If he's interested in coaching down the road, he's in the right organization to get a shot at it.

 

As for what it means to the Twins, it's a lost season anyway, and counting on a 34 year old reliever already in decline to close next season seems like exactly the sort of bad decision the Twins would make but no longer can.  Maybe Perk's injury will force them to make a smart decision for a change.

[jimbo92107]

The Twins must now operate under the assumption that Glen Perkins is done. That's actually good, because until now they were pretending it wasn't so. Now they can decide to plant Trevor May in the closer role, which they should have done a while ago. Once May has some certainty what his role is, he will work on picking the four corners with his heater, which he started doing last season. Four corners to get ahead, then hard slider away or 2-seam away to finish.

[jokin]

 

That means the search for a future closer is no longer a consideration that can be placed on the back-burner. Right now, the available options are unappealing. Kevin Jepsen is clearly not the guy. Hurlers within the system who possess the requisite stuff -- such as Alex Meyer, J.T. Chargois and Trevor May -- have failed to distinguish themselves. Nick Burdi might be the best hope internally but his own injury issues have limited him to three appearances this season (naturally, he just had a setback).

 

 

Does Mike Berardino know something he's not fully sharing yet?

 

 

Mike Berardino ‏@MikeBerardino 6h6 hours ago

 

1-2 3 9th for Tonkin.

 

He could be closing for this team very soon.

 

Wha...? Has it really come to this?

 

I get the fact that there really aren't any obvious solutions on the current 25-man- Tonkin has good AAA closing credentials, but what is there to suggest that his straight-line trajectories have translated to the majors in a closing role? OK.... maybe as a temporary caretaker assignment, but I really don't see this ending well.

 

Alternative??? (From worst to "best")

 

1) How about Hughes, presuming that he comes back with a fully healthy shoulder, might there be an outside chance that he could regain some semblance of his 2014 form- pitching one inning at a time?

 

2) Pressly. He's been regularly touching 98 MPH a few times in each of his recent outings. At times he looks like he's put it all together, and then, just as fast, he loses it again... he will remain intriguing... certainly worth a tryout in a lost season.

 

3) Berrios- he could temporarily change his SP successful career path that we've all envisioned for him- by starting over coming throgh via the Twins pen- he certainly projects maturity and fearlessness on the mound... and in the process,  he could elevate his velocity and MLB pitchability in more bite-size pieces.

 

4) Tyler Duffey- co-closer at Rice with Chagois, assuming the closer role is already imprinted in his DNA, he could quickly and comfortably take on the assignment in this lost season, his velocity and K% are sure to rise. Struggling mightily to maintain consistency this year as a starter- it's still worth noting that he has improved his overall control- lowering his BB/9 YOY by nearly 1 walk/9 innings- a switch to the pen might help him get back to basics and regain some focus on his pitching strengths early in the count and then dropping that hammer slider to rack up the Ks. And you get the added benefit of eliminating him getting exposed the second and third time through a lineup.

 

Either of the latter two moving to closer will obviously require the other to quickly elevate their current MLB starter status in order to bolster and solidify the rotation.

 

Let's face it, as of today, June 17, it doesn't appear that there is going to be any immediate, or even an intermediate, time frame scenario when help in filling the closer role in the form of May, Meyer, Burdi, Chargois is going to manifest itself.

Edited June 17, 2016 by jokin

[ThejacKmp]

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?

 

In 26.1 minor league innings this year he has an ERA of 1.02 and has struck out 36 (12.3 K/9) and walked only 9. Last year he put up a 2.62 ERA with a 9.9 K/9 and only 25 walks in 48 innings.

 

There is absolutely no reason to think that JT Chargois will not be the Twins closer of the future. He has better stats than Nick Burdi and is closer to the bigs.

[BobAzar]

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.

Edited June 17, 2016 by drbob524

[mikelink45]

How many years and how long to diagnose his problems?  Even the medical staff is part of the system failure.

 

In a year where there are very few save situations its time to give a few rookies a chance.  Burdi - Chagois and others really cannot induce a worse record that our rotation has.

[alarp33]

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

Edited June 17, 2016 by alarp33

[HitInAPinch]

 

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 or 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 was going to post something similar, but different   

 

It's pretty well known that in the off-season, Perkins will work with his own choice of trainers.  Pretty sure all pro athletes do the same.  Question are:

1. was there any labrum / overall shoulder exam during pre-post season workout planning?
2. what were those workouts like?  Did they cause further damage to his labrum?
3. is there any coordination between Twins medical staff and the outside trainers?

In this new Strib article, Twins management was hoping for the best and it just didn't work out that way.

 

http://www.startribune.com/twins-closer-glen-perkins-to-miss-remainder-of-season/383299501/

 

I'm really not seeing issues on how Twins medical staff.  Perkins went into Spring Training saying he was good to go and pitched well.  Obviously, aggravated the now known issue.

 

Edit:  Very sad to hear this happen to Perkins.  At 33, I hope he can still make a comeback.

Edited June 17, 2016 by HitInAPinch

[Mike Sixel]

Good luck to Mr. Perkins, and hope for a good recovery.

[Otto von Ballpark]

 

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

Well said.  I probably came off as a little hard on Perkins in the other thread, but shoulder injuries suck.  If it was an elbow, one could make a case they waited too long -- that surgery is generally not a career-ended in modern baseball.  Shoulders are a different animal, though.

 

Does seem like someone should have forced more rest and rehab earlier, namely the second half of last season, and of course we should have added another reliever in the offseason so both Perkins and the team wouldn't have felt as much pressure to not open 2016 with Perkins on the DL.  He had enough issues last year and in the spring that we would have been justified in doing so, if the ultimate goal was to avoid shoulder surgery.

[NapoleonComplex]

As someone that suffered a partially torn rotator cuff in my early 20's, now in my mid-30's, everyday tasks have become problematic. Carrying groceries, holding a kid, even doing yard work, all cause discomfort and pain. I can't begin to imagine the pain trying to throw 95+ MPH fastballs with movement. 

 

I've always been a fan of Glen. I wish you a speedy recovery, good sir.

[ashbury]

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.

[BD57]

Best wishes for Glen - here's hoping surgery & rehab goes well and he regains full use of his arm & shoulder . . . if he can pitch, great, but what matters most is the rest of his life.

 

 

[jokin]

 

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?

 

In 26.1 minor league innings this year he has an ERA of 1.02 and has struck out 36 (12.3 K/9) and walked only 9. Last year he put up a 2.62 ERA with a 9.9 K/9 and only 25 walks in 48 innings.

 

There is absolutely no reason to think that JT Chargois will not be the Twins closer of the future. He has better stats than Nick Burdi and is closer to the bigs.

 

 

Uhh, the Twins probably have more than one reason... given that they were so impressed with Chagois' no-pressure first outing, that they quickly shuffled him back to Rochester and claimed a recently twice-cut guy, Neil Ramirez, who's at a major crossroads in his career to take Shag-Wa's place on the roster- IOW, a guy who looks like all roads left in his career track lead to dead ends is preferable to giving Chagois an immediate second chance.

 

Chagois certainly has lofty MiLB numbers, but it doesn't appear that he has as yet impressed the Twins brass enough to assume that he is the automatic heir apparent as the Twins' closer any time soon.... perhaps he will acquit himself better in his next recall... but there's no doubt he's dug himself a big hole to dig out of in order for the Twins to feel comfortable to hand him the closer role. My guess would be that assuming all things go very well, this would not transpire until mid-2017, at the earliest.

Edited June 18, 2016 by jokin

[Heezy1323]

 

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.

 

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwjD7KGjvLHNAhWF8z4KHeiuDJMQjRwIBw&url=https%3A%2F%2Fwww.shoulderdoc.co.uk%2Farticle%2F1399&psig=AFQjCNFMBoj1JIDKkxv2TwQBWh7JPROf-w&ust=1466335474059527

[spinowner]

 

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.

 

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwjD7KGjvLHNAhWF8z4KHeiuDJMQjRwIBw&url=https%3A%2F%2Fwww.shoulderdoc.co.uk%2Farticle%2F1399&psig=AFQjCNFMBoj1JIDKkxv2TwQBWh7JPROf-w&ust=1466335474059527

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?

 

[Heezy1323]

 

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.