Chris Carpenter: injury outlook

To say that Chris Carpenter’s career since 2003 has been a whirlwind of heartbreak would be a mammoth understatement.

In 2003, he had right shoulder surgery to repair a torn labrum, then missed the 2004 World Series against the Red Sox due to nerve irritation arising from compression in his right biceps muscle.

The next couple of seasons were considerably more positive. He won the NL Cy Young Award in 2005 with a 21-5 record and 213 strikeouts in 241-plus innings. But his workload in 2005, followed by another heavy-volume season in 2006 (22-plus IP), was likely a major factor in the physical problems he has faced since.

He lasted only one game into the 2007 season before succumbing to right elbow pain and subsequent Tommy John surgery. Attempting to return in 2008 about 12 months after his operation (at the early end of the normal 12-15 month return time frame), Carpenter again lasted only a short period (three games, 14 IP) before a triceps strain (later found to be a teres major strain) shelved him for the balance of the season.

The offseason brought news of nerve compression in his shoulder, primarily to the musculocutaneous nerve. Could this be the same problem that causes him to miss the Series in 2004? It sure sounds similar—especially since this nerve serves the biceps muscle, the very same muscle that apparently caused his nerve irritation in 2004.

As a result of his symptoms, surgery was being considered as an option to release the nerve from its compression. But after Carpenter received four opinions from various specialists, it was decided that he would not have the surgery because there was no guarantee that it would alleviate his symptoms. In addition, the specialists felt that the risks were too great.

It was then determined that Carpenter needed ulnar nerve transposition surgery, which is performed at the medial elbow, and is often done during a Tommy John surgery. The surgery was performed on Nov. 4, by Dr. George Paletta. The team said Carpenter’s elbow surgery was not expected to “interfere with or prolong” his current shoulder therapy and rehabilitation.

I look back to earlier in the 2007 season, when there was concern that he had ulnar nerve irritation, and wonder if there was anything that could have been done then to address this situation. Obviously, you never want to rush into an invasive surgical procedure, but if there is smoke there is usually fire. Extinguish the fire if it is present.

Outlook for 2009 and beyond

Carpenter is among the highest of injury risks in fantasy drafts for 2009 and for the years beyond. The biggest concern is that he has dealt with numerous pitching arm/shoulder injuries over the past five seasons. In addition to having a labrum repair, he has suffered nerve irritation (from many locations) as well as muscle strains that are likely in part due to secondary muscle weakness from the nerve involvement, as well as time spent sidelined.

Once nerve tissue is inflamed or scarred, it is highly reactive to becoming aggravated once again. Since it is likely that there are some areas of nerve compression in his shoulder, I find it hard to imagine that Carpenter will be able to make it through any meaningful volume of outings in 2009. I will not be drafting him in any mixed league, but NL-only managers might want to gamble on him as an end-of-the-rotation type starting pitcher.

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