It didn’t take long for the Braves to suffer their first major injury of the season, with Reynaldo Lopez undergoing arthroscopic surgery on his throwing shoulder after just one start. That procedure has already taken place, and the club hopes he’ll be able to return at some point this season. But shoulder injuries for pitchers can be tricky. Sometimes, guys make a full recovery and come back even stronger. In other cases, they can be career-ending.
Because of how volatile these injuries can be, I recently sat down with Theodore A. Blaine, MD, Sports Medicine Surgeon at HSS, who provided a much clearer picture of what Reynaldo Lopez is dealing with, and what could be next for the hard-throwing right-hander.
What happens during an arthroscopic shoulder surgery?
Arthroscopic surgery is a minimally invasive approach to orthopedic surgery where small incisions are used to introduce a camera (arthroscope) into the shoulder joint, and arthroscopic instruments are used to perform work inside the joint. While it is unclear what type of surgery will be performed in this case, the most common injuries seen in baseball pitchers include injury to the labrum and rotator cuff.
The labrum is the lining tissue that circles the socket (glenoid) and the rotator cuff is a group of four tendons (supraspinatus, infraspinatus, teres minor and subscapularis) that stabilize the shoulder joint and power the arm through its movement. Labrum tears are defined by position on the glenoid socket. Tears in the front (anterior) are called bankart tears, tears in the back are called posterior labral tears, and tears at the top are called SLAP (superior labrum anterior to posterior) tears. The biceps tendon (long head) also originates from the superior labrum.
The length of recovery after surgery will depend upon the extent of surgery that is required. In many cases, debridement alone can be performed to remove inflammation and synovitis in the joint. The recovery for debridement procedures is typically faster than when repair of either the rotator cuff or labrum is necessary.
What are the best-case outcomes of this procedure?
The best-case scenario is that no repair will be necessary, and debridement of inflammation alone can be performed. Rotator cuff debridement, in fact, is the most common procedure performed in professional baseball pitchers. While return to play at prior level of performance can be unpredictable in the setting of rotator cuff repair, many players can expect a full recovery and return to play after debridement.
Players who return to play after shoulder surgery have also been shown to have comparable performance metrics (Earned Run Average and Innings Pitched.) After debridement, players can expect increases in volume metrics (IP), which may indicate increased stamina and workload. With no repair, recovery may be as short as six to eight weeks. However, if repair is necessary, recovery can range from four to six months to as long as a year.
What are the potential risks or worst-case scenarios?
The worst-case scenario is that structural damage will be discovered and will need repair. Rates of recovery vary depending on the type of repair (rotator cuff, labrum, SLAP, biceps.) In general, return to play is highest with debridement, lower with labral repair, and even lower with rotator cuff repair.
While return to professional play at prior performance level can be as high as 100% depending on the type of injury and repair needed, return to professional play in the setting of rotator cuff repair can be less than 30% in some published series. In general, it is also more difficult for pitchers to return to play at their previous level as compared to other position players. Since the reported preoperative imaging for Reynaldo Lopez did not demonstrate a full thickness rotator cuff tear, it is less likely that a tear needing repair will be discovered at the time of surgery.
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As of now, the Braves seem rather non-committal to Reynaldo Lopez returning this season, which is worrisome. For a recent example that Braves fans should remember quite well, Kyle Wright won 21 games in his breakout season for the Braves back in 2022. The following year, he was shut down with a shoulder injury and then traded for a bag of peanuts. Wright has not appeared in a game since the beginning of the 2023 campaign; although, he has recently just started facing live batters again.
Reynaldo Lopez returning this season should tell us a lot about his future. The Braves just signed him to a three-year, $30 million extension this past offseason, so his recovery is very important for the future of the organization as well.
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Photo: Melissa Tamez/Icon Sportswire
