The Miami Marlins received good news on Tuesday with regards to starting pitcher Henderson Alvarez, as the MRI of his shoulder revealed no structural damage. The joint appears to be clean structurally, leaving only inflammation in the area and making it extremely likely that he would not require any surgical intervention. For Alvarez, that is a blessing, as this shoulder has bothered him for some time and concerns were high when it reared its ugly head in his first start back from the DL.
However, this does not mean that the Marlins should remain unconcerned about Alvarez's shoulder and his recovery. The Fish already saw him take that setback earlier in the year when he made the start versus the Baltimore Orioles and had to rejoin the DL directly afterward. This should already make it obvious that Alvarez's shoulder is nothing normal, despite the lack of structural damage. In addition, this is not the first time that Alvarez has run into shoulder problems. He spent the first half of 2013 on the DL with shoulder inflammation and was out for half a month dealing with the same injury last year as well. In total, 141 days in the past three seasons on the disabled list for shoulder-related injuries.
The last time a Marlins starter dealt with significant shoulder injuries, it was 2011 and his name was Josh Johnson. Johnson missed part of the early season, having made nine fantastic starts in the year before innocuously going on the DL for right shoulder inflammation. After the injury was figured to be benign but was taking longer to rehab, Johnson underwent an MRI at the time. The results also mentioned no structural damage to the shoulder, and a return appeared imminent.
Johnson received a cortisone shot and won't throw for 10 days. He's expected to rejoin the rotation sometime after the All-Star break.
That would the typical treatment for an inflamed shoulder with a problem such as rotator cuff tendinitis. However, Johnson continued to have pain, his injury did not heal, and he eventually missed the rest of the season with this same undamaged shoulder that continued to nag.
Johnson never had the history of missed playing time for shoulder problems that Alvarez did. Recall that Alvarez also initially was slated to return early in 2013 from a shoulder injury before a setback occurred during a rehab start and forced him to miss another month of the season. This is not the first go-around for Alvarez, and he has already suffered through a lot of damage. It is possible that the inflammation that become subacute and recurrent may eventually lead to damage to that right shoulder. Tendinitis that occurs in areas like the supraspinatus muscle insertion in the rotator cuff can eventually lead to tears, and if there was one player who may be at risk for this, it would be Alvarez. Even without current injury, there may be something in Alvarez's pitching mechanics or function which is leading to chronic inflammation which could lead to future damage.
The other interesting point with Johnson is that he had been previously worked on for an elbow injury in the past. Johnson suffered a UCL tear in 2007 and underwent Tommy John surgery that year. He returned the following season and eventually was vastly improved after the surgery and spent two years as a prime ace. However, in 2011, he eventually succumbed to the shoulder injury and, two years later, he had a repeat Tommy John surgery with San Diego.
This is not as concerning for Alvarez, but it should be noted that Alvarez's elbow is not completely healthy. According to Jon Heyman of CBS Sports, Alvarez has been pitching with a 90 percent torn UCL for "years." Now, that does not mean that an impending elbow injury is imminent, but Alvarez is not exactly working with a full set of tools, and any injury to the shoulder could cause mechanical adjustments in movement that could put more strain on other parts of his body. Clearly, his UCL is not something he wants to strain any further.
The worst-case scenario is for something to occur like what happened to Anibal Sanchez in 2007, which kept him out of almost out of three years of baseball. Sanchez tore his rotator cuff, and his subsequent rehabilitation included two return stints to the DL in the following two years. He eventually returned with great success, but that injury took out almost three years of his career. The Marlins would rather avoid anything that could threaten Alvarez, who so far has been the best player to come to the Marlins in the infamous 2012 Toronto Blue Jays fire sale trade. The Fish need to be as cautious as can be with this ongoing shoulder issue.