Why Jurickson Profar and the Rangers Are Taking the Right Path With His Shoulder

Sports DayThe exciting 2B prospect for the Texas Rangers recently underwent surgery on his right shoulder, essentially ending his 2015 campaign before position players even reported to Surprise, Arizona for Spring Training.  The 22 year old native of Curacao will spend this year recovering from surgery and rehabilitating the shoulder in the hopes of resuming baseball activity in time for Caribbean winter ball or the Arizona Fall League, to prepare him for what the Texas Rangers hope is a healthy and productive 2016 season.

It has been a frustrating two years for Rangers fans and no doubt, for Profar, too.  He hasn’t played in a game for Texas since September 23rd…of 2013.  The 2014 season was filled with shoulder rehab, a setback, more rehab, and more setbacks.  It might be easy for the average baseball fan to wonder why it took them until now to finally operate on the shoulder.  The average baseball fan probably thinks surgeries are more successful than they really are.  They also aren’t fully aware of exactly what is required of the player and the team of athletic trainers and physical therapists AFTER the operation.  In short, how the Rangers have handled Profar’s case is textbook.  And here’s why:

When a baseball player suffers an injury to the glenohumeral labrum (a ring of cartilage that surrounds and deepens the glenoid fossa, or the “tee” that the “ball” of the humerus sits on) or a serious injury to the rotator cuff muscles, they are typically presented with several options from the medical staff.

labrum 2

The team orthopedist and athletic training staff will present the options, what to expect with each one and give their professional recommendations.  It’s usually wise to follow their recommendations, by the way.  But ultimately, the player is in control of his own health.  Option A. will likely involve a period of being shut down from throwing (and, in the case of a position player, hitting).  This period is to allow inflammation to naturally run its course.  This period of no throwing is also where the athletic trainers can address soft tissue abnormalities throughout the body.  This is to prepare the player for rehabilitation.  Option A is strictly a rehab/treatment option.  The prognosis depends on the severity of the injury and other individual factors that may come into play.  Typically the timetable for possible return is much shorter than following surgical intervention.

Labrum

Option B. would be to shut things down and have surgery.  Depending on when this occurs, it may end the current season or keep a player out through the following season.  Labral repairs typically have a 10-12 month return to play timetable, that may extend even farther beyond a full year, depending on circumstances.  It’s not uncommon for players rehabbing a labral repair to experience minor setbacks during the rehabilitation process.  The important thing is that they finish the race, not how fast they run, so to speak.

The best surgeons are the ones who recommend rehab first, unless it is absolutely necessary to operate.  And this is typical of the orthopedic surgeons affiliated with major sports teams.  Teams will almost always recommend the conservative route first.  The rationale is that right now, you have two options: rehab or surgery.  If you attempt rehab, you may have a setback.  You can try again.  You still have surgery as a backup plan.  If a player opts for surgery right away, he essentially only has one option.  And surgery had better work!  The success rates of conservative physical therapy as opposed to surgical intervention are not well established and may vary widely across sports and different positions within baseball itself.  There as many ways to rehab and treat a shoulder as there are individual clinicians.  So when you look at the timeline of Jurickson Profar‘s last 17 months, you can see that the Rangers really wanted the conservative route to work.  There may also have been a combination of Profar, himself, not wanting to have surgery (for whatever reasons).  Eventually, after several failures, surgery became the better option.

Research supports this approach, as well.  A retrospective case review study by Fedoriw, WW, et. al, that was published in the American Journal of Sports Medicine in May 2014, investigated RTP (return to play) and RPP (return to previous performance) rates for professional baseball players dealing with persistent shoulder pain and MRI-diagnosed SLAP tears (superior labrum anterior-posterior).  68 players had identified labrum tears.  21 pitchers successfully completed a non-surgical rehab plan and attempted a return to play.  Their RTP rate was 40% and their RPP rate was 22%.  For 27 pitchers who underwent surgery, their RTP rate was 48% and RPP was 7%.  10 position players were treated non-surgically with an RTP rate of 39% and RPP of 26%.  13 position players underwent surgery with an RTP rate of 85% and RPP of 54%.

What does this mean for Jurickson Profar and other players like him with persistent shoulder pain and possible labrum tears?  The research summarized above does not reflect the specific injury and surgery that Profar had, but the expected outcomes are relatively similar.  This means that the conservative therapy approaches DO have a relatively high success rate (at or above 40%).  It shows that for this sample of position players in the study, those that had surgery tended to return to play (85%) and a slight majority returned to their previous level of performance (54%).  However, what this also shows is that surgical intervention is not a 100% fix with a guarantee affixed to it.  Even for a position player, around 15% will not make it through post-surgical rehab.  As for returning to previous level of performance or exceeding it, you’re facing a 50-50 proposition.  This is why the medical staffs will often take a more conservative approach to injuries that eventually require surgery.  Can it backfire and cost a player an extra year of missed time?  Yes, as evidenced by Profar’s case and as we’ll soon see with Masahiro Tanaka‘s elbow.  What’s important to understand is that the medical staffs and the surgeons are well aware of the potential risks associated with surgery.  Teams should be willing to take the time to attempt a non-surgical intervention in almost every case before surgery is indicated.  Again, not all cases are the same and each player is different, both physically and mentally.  Rangers fans should respect the care that the team is giving to Profar and understand that a 22 year old is young enough to take an extra year to get healthy if that is what’s required.  Fans may have this “win right now” type of tunnel vision, but luckily those charged with keeping the players safe and healthy understand the bigger picture.

 

 







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