Shoulder Labrum Surgery: an Inside Look at Baseball's Toughest Injury

Will Carroll@injuryexpertSports Injuries Lead WriterApril 3, 2014

Getty Images

In 2004, I wrote a piece about shoulder labrum surgery for Slate. Somehow, that's become my most enduring piece, referenced over and over again despite being outdated now. The technology has gotten better, and now, more players than Rocky Biddle make it back. In fact, Michael Pineda is making a bid to be one of the most effective pitchers in his return, though it did cost him all of 2013.

Why is surgery on the glenoid labrum still so difficult, even after a decade of medical advances and no shortage of pitchers to practice on? Simply put, the shoulder is more complex than something like the elbow. The elbow is a hinge and does more or less one thing in one way.

The shoulder does many more things and is put together with a seemingly endless network of muscles, ligaments, tendons, capsules, nerves and fascia. Dr. Neal ElAttrache once compared fixing a shoulder to trying to put together a puzzle without the box top.

While baseball fans understand how serious the injury can be to their favorite players, we seldom get an inside look at the process. The Yankees aren't going to detail exactly what Pineda went through, but we now have a chance to look inside the process with a pitcher that went through it.

Michael Schlact was a third-round pick of the Texas Rangers in 2004. He made 36 starts over three seasons for Frisco (AA) before injuring his shoulder. He fought through the injury for a couple more seasons but was released in 2010.

During his time at Frisco, he played alongside Elvis Andrus, Chris Davis and Matt Harrison. He faced players like Carlos Gonzalez, Justin Upton and Pablo Sandoval. He was ranked as high as No. 13 in the Rangers organization by Baseball America.

He pitched two more years for the Southern Maryland Blue Crabs of the Atlantic League, then lost the 2013 season to labrum surgery. He's prepping for a return in 2014, this time with the Wichita Wingnuts of the American Association. (Yes, I'll be following along, as will several big league scouts.) He and his wife, Jillian, live in Atlanta.

He's also uniquely suited to tell his story, having been a longtime blogger for MLB.com. Michael is also one of those pitchers that understands both the physical and mental processes of pitching. Since meeting him several years ago, I've long thought that he would be an ideal pitching coach. I still believe that. 

I asked Schlact to put together something of a diary of his process. In this first part, he explains why it took so long for him to find the real problem and how frustrating a process this can be, even before getting to the surgeon. Besides, any story that involves a top pitching prospect, Mark Trumbo and me is probably worth your time anyway! 


Photo courtesy Michael Schlact

In 2009, after five years of climbing the ladder in the Rangers minor league system, I finally had some opportunities to spend time with the big league club in spring training. Things were looking up in my opinion, and I felt that the years of development were beginning to click. I was assigned to Frisco, Texas' Double-A club after that spring training.

My first start of the season was on a cold, wet day in North Little Rock, Arkansas. The previous night’s game had been rained out, so it was a mid-day doubleheader and I was slated to pitch the night game. Just like every other game, I warmed up in the outfield, pitched in the bullpen and ran out to the mound in extreme anticipation of the outing. Once I toed the rubber, glared down to get the sign and decided on the pitch I was going to throw, I knew there was no turning back. 2009 was going to be a great year.

In the third inning, throwing to Mark Trumbo, I was confident that a slider was the best possible pitch to throw in that situation. Gripping the ball, I began my windup, rocked, fired and felt one of the most painful and unforgettable feelings thus far in my life. Imagine two knives stabbing you on either side of your shoulder. Imagine watching the ball fly in a direction nowhere near home plate. Sickening.

As the athletic trainer began his jog to my position on the mound, my entire career flashed before my eyes. In a profession where your arm puts food on the table, mine had just been rendered useless. At least that’s what the next two “let’s see how you feel tosses” went to the catcher.

Walking off the field and heading to the clubhouse felt like it took three years. I knew it was bad, but I didn’t realize that the slider to Trumbo would set off a five-year, two-surgery, four-rehab, three-team journey into the unknown.

In September of 2009, after two different rehab attempts, I decided to have surgery on my shoulder to repair some tears in my rotator cuff stemming from the initial injury in my April start. (The surgery was performed by Dr. Keith Meister, the Rangers' orthopedist. - WC) The rehab following the surgery was one of the most painful, arduous activities I’ve ever done, baseball or otherwise.

Many days during rehab are the exact same, which causes them to run together. It makes the yearlong process seem like three. In June of 2010 I was deemed healthy, and the feeling of taking that mound in a game again was nothing short of emotional for me. The hard work had paid off. The blood, sweat and tears led me back to the mound, and I had overcome the dreaded “shoulder surgery.” At least I thought I had.

In 2010, once I was cleared for game action, the process began to rebuild arm strength and to redefine the word "normal." For all of my baseball life, I had been the guy who could show up to the yard, stretch a little, throw and never have even the slightest arm pain.

After my first surgery, all that changed. I was going through a process just to get warm that consisted of 25 minutes of stretching, 15 minutes of weighted ball exercises on a mini trampoline, 15 minutes of throwing and long toss and at least 30 pitches in the bullpen before considering myself game ready.

The new normal for me was slightly decreased velocity, much more soreness the next day and an overall feeling of tightness in my shoulder most of the time. I had accepted this, realizing that I was no longer the 90-93 mph guy with a plus sinker. 

Photo courtesy Michael Schlact

The Rangers saw it as well, and after 2010, I wasn't re-signed. I moved ahead with my career carrying a "prevent another injury" mindset and physical routine. I signed an independent ball contract with the Southern Maryland Blue Crabs of the Atlantic League in 2011, feeling strong and confident that I would prove myself again. I made the All-Star team that year, put up some decent stats and loved being a pitcher again.

As the season wore down, so did my shoulder. I was shut down again in August of that year, and some of the same pain that I thought was in my past began to resurface. I took the offseason to rehab again, I received a few cortisone injections and worked hard to put the most recent episode of shoulder pain to rest for good. 

Despite the solid season, the negative signs were there and I wasn't able to get back into affiliated baseball. I re-signed with Southern Maryland in 2012, felt completely healthy again and looked forward to overcoming the recent shoulder issues.

However, once my workload increased, the pain did as well. Within three weeks, the ball wasn’t reaching home plate and I was sitting at home wondering where it all went wrong, what I needed to do and struggling to wrap my head around what was happening to my career.

The next year was a consistent barrage of pain with a few glimpses of hope. I would feel great throwing long-toss, hop on the mound for a few weeks and the pain would return. Rinse and repeat. The questions began to circulate in my head like, “Is this really worth it? Where is my career going? Will my shoulder ever feel normal again? What’s next? Who would take a chance on me now?”

I was one shoulder surgery, four cortisone injections, four rehab stints, and five failed throwing programs deep into this journey from a Little Rock mound to my couch.

In May of 2013, I began to realize that my dream of being a Major Leaguer may be over and that I was going to be another “shoulder surgery statistic.” At the same time, my friend Will Carroll asked me if I would be willing to take a road trip to Cincinnati to see Dr. Tim Kremchek.

“Trust me," he said. "There’s no one better.”

It didn’t take much convincing for my wife and I to pack the car and go see what “Doc Hollywood” was all about. A good friend of mine, Chris "Disco" Hayes, had Kremchek do his Tommy John surgery and raved about him. Anything and everything I could find turned up positive and downright impressive on the man.

If there was any hope of resurrecting my career, Dr. Kremchek seemed to be the man for the job. Driving toward Cincinnati with no idea what the cause of my shoulder pain was, no idea who this doctor was and no idea what the outcome would be or if I would ever throw a baseball again. The only certainty I could cling to was that I had an appointment to see him.


Next time, Michael undergoes surgery and begins the long and sometimes painful process. I'm sure that as he prepares for his upcoming season, he'll be watching as Pineda makes his first start for the Yankees on Saturday. In the meantime, you can follow Michael on Twitter