What is the Success Rate of Shoulder Surgery?

In 2014, when Danny Duffy walked off the mound after throwing just a single pitch, much of Kansas City was holding its breath, awaiting and half expecting what are possibly the most ominous two words in baseball: “elbow pain.” Later that day, the Royals reported that Duffy was dealing with a shoulder problem, and there was a collective sigh of relief among fans. The phrase “at least it wasn’t an elbow injury” was uttered countless times. This seems to be a common feeling around baseball: the worst possible injury for a pitcher is to the elbow. That’s because any elbow problem is seemingly connected to a torn ulnar collateral ligament, and the dreaded Tommy John surgery. The sentiment that Tommy John surgery is the most damaging surgery for a pitcher is completely wrong, though.

The most widely accepted success rate for Tommy John surgery today is estimated at about 80 percent (or the percentage of players that return to throw at least one pitch in the big leagues following surgery). The fact that about 20 out of every 100 pitchers that suffer a torn UCL never toe the big league rubber again is not a comforting statistic. With that in mind, it’s quite understandable that the words “elbow pain” are terrifying for a baseball fan. However, this number is actually good when compared to another arm injury for a pitcher—the shoulder.

Shoulder pain, not elbow pain, deserves to be the most feared condition in baseball. The success rate for any type of serious shoulder surgery is far lower than that of an elbow injury. While it’s not a death sentence—after all, Danny Duffy survived his shoulder scare—certain shoulder surgeries come close to being career-ending injuries more times than not. Although elbow injuries deserve their bad reputation, shoulder injuries deserve a worse rap. This is something that is especially important to keep in mind in today’s game, and even this offseason, with three notable pitchers coming off major shoulder injuries. Mike Minor and Henderson Alvarez, promising young starters for their respective teams, were recently non-tendered, hitting free agency. Hyun-jin Ryu, who the Dodgers are expecting to be a savior for their weakened starting rotation, is returning from surgery on his labrum. What fans of these three pitchers will be wondering as we approach the 2016 season is, what is the success rate of shoulder surgeries?

Finding the success rate of shoulder surgeries was not an easy task. The relative rarity of specific surgeries—from labral repairs to rotator-cuff surgery—makes it impossible to try to calculate an accurate number. So, it was necessary to widen the accepted injuries to all shoulder surgeries to a pitcher. In addition, given the typical recovery times involved in shoulder surgery, only data from before 2014 could be accepted. As a result, for this exercise only, surgeries from 2010 to 2013, a span of four seasons, will be used. This takes into account the 27 different pitchers listed under MLB transactions for shoulder surgery.

Studies looking into the success rate of Tommy John surgery defined “success” as a pitcher throwing at least one pitch in the major leagues following his surgery. This is a relatively sad definition of success, because a pitcher coming back to throw just one inning of baseball certainly doesn’t feel like success. But, this is the accepted way to define it, so that’s what was used here.

Of the 27 major league pitchers to undergo shoulder surgery from 2010 to 2013, 15 returned to the big leagues. In other words, the success rate of shoulder surgery was 55.5%. To put it lightly, that return rate is pretty awful. It’s approximately a 50/50 chance of a pitcher returning from any type of shoulder surgery to throw another pitch—and that’s not taking into account effectiveness.

After returning from surgery, these 15 pitchers threw 1548 total games and 3976 innings. In other words, these pitchers averaged 91 games following the surgery, and 234 innings. Once again, this is discouraging data. But, it’s challenging to glean any great conclusions from this, given that some of these pitchers were starting pitchers, and some were relief pitchers. To clear these numbers up, I went ahead and calculated the averaged innings for a starter and reliever, separately, following surgery.

A starter undergoing shoulder surgery came back to throw an average of 368 innings, while a reliever threw 116 innings. Obviously, not all of these pitchers have retired, so the numbers aren’t as grim as they appear. Of the 27 pitchers, seven are still pitching. That said, it’s not comforting to see that pitchers at either position averaged about two seasons following shoulder surgery.

What may be more important than how long a pitcher lasted following the injury, though, is his effectiveness. Overall, pitchers averaged a 4.04 ERA before going under the knife. Upon return, this number rose to a 4.28 ERA. That’s not terrible, but at the same time it shows that these pitchers generally showed decreased effectiveness upon returning.

I’m not going to pretend that these numbers are perfect—active pitchers, different severities of shoulder surgery, and age (though the average wasn’t very old—just 28) can skew the results. This data isn’t set in stone, and it has plenty of flaws. But, it’s useful for the purpose of approximating just how serious shoulder surgeries are. It’s worth repeating that of these 27 pitchers, an astounding 12 never pitched in the big leagues again, and another two didn’t throw more than 11 innings after returning. A shoulder surgery is one of the worst things a pitcher can deal with; it’s significantly worse than Tommy John surgery, and there’s not another injury or surgery that is so detrimental to a pitcher.

Applying this to current baseball players isn’t a very optimistic thing to do. Between Hyun-jin Ryu, Mike Minor, and Henderson Alvarez, a success rate of 55.5 percent indicates that one of these players won’t ever make it to the big leagues again. This isn’t a guarantee, and obviously I hope that they make it back to their old forms, as all three pitchers were a pleasure to watch while at the top of their game. But, given the nature of shoulder surgeries, it’s tough to envision these pitchers returning to their previous states.  The shoulder injury is a prevalent threat, and it should be replacing the UCL as a pitcher’s, and baseball’s, biggest fear. As technology advances, there is little doubt that pitchers will be able to bounce back from shoulder surgeries more quickly, more frequently, and more effectively. But for now, it is one of the worst things that can happen to a pitcher.

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