Henderson Alvarez and the sordid Miami Marlins history of shoulder injuries

Yesterday, Miami Marlins fans heard more terrible news about the failed 2015 season when they found out about Henderson Alvarez's season-ending arthroscopic shoulder surgery. For Miami, this is a difficult blow to an already tough year. For Alvarez, this is a major setback for a player who had been suffering from chronic throwing shoulder issues, with multiple disabled list stints in the last three years for the same problem. For fans, it is yet another sign of hard times for a troubled franchise.

The Marlins are not exactly strangers to shoulder injuries and shoulder problems. This would be the third Marlins starting pitcher since 2006 to be sidelined with shoulder problems that were significant enough to warrant large swaths of missed time. Prior to Alvarez, the sordid history of Marlins pitchers and shoulder injuries involved two other important names from the 2006 era, and both cases were difficult for all parties involved.

2007: Anibal Sanchez

Sanchez was one of the major pieces acquired in the Josh Beckett trade, and he made a name for himself in his rookie season in 2006 by throwing a no-hitter at the end of the year (sound familiar?). Sanchez appeared to be one of the bright spots of what was shaping up to be a terrific young rotation led by Josh Johnson. Sanchez, a former top prospect, figured to be the next best pitcher besides Johnson, but like most pitchers in 2007, he did not start off that way. Instead, he struggled in six starts, putting up a 4.80 ERA and a 5.71 FIP before being sent down to the minors for his poor play.

Little did the Marlins know (or did they?) that something was amiss beyond a mechanical problem. Sanchez was demoted from the Major League club after his May 2 start, but he never threw another pitch the rest of the season. There had been rumblings from 2006 that Sanchez had been suffering from shoulder tendinitis, and pain had recurred before the 2007 season. The Fish demoted him for poor play, but subsequently he was found to be injured after the demotion and, due to the timing of the transactions, ended up on the minor league disabled list rather than the big league list. This caused frustration on the part of Sanchez and his agent, who later fought to get Sanchez Major League service time during his extended DL stint.

And what an extended stint it was. Sanchez had a torn labrum, which is a cartilaginous piece that sits on the rim of the socket part of the ball-and-socket shoulder joint. The torn labrum knocked Sanchez out of all of 2007, and subsequent difficulty with the recovery claimed the majority of 2008 as well. Sanchez made just ten starts and threw 51 innings the following season. In 2009, he was still suffering from the ill effects of the dramatic shoulder injury. He missed about 91 games in 2009 season and threw just 86 innings that year thanks to repeated right shoulder strains. All told, the injury and surgery ate 334 of the potential 486 games in which Sanchez could have participated; that amounts to 67 missed starts if you work him every five days.

The good news is that, after all that missed time, Sanchez came back with a fury. He posted a full campaign for the first time in 2010 and put up a 3.55 ERA and 3.32 FIP, and since that 2010 season, he owns a 3.59 ERA and 3.21 FIP. In those years, he has been worth somewhere between 18 and 21 wins for his teams. It just took an extremely long recovery time until Sanchez was back to the form expected of him when he started out in 2006.

2011: Josh Johnson

Sanchez's story was ultimately one of recovery and redemption, as he earned a nice payday with the Detroit Tigers and has played well since his injury. Johnson suffered a similar fate with his Tommy John surgery in 2007, but he recovered faster and proved himself to Miami earlier on, so much so that he earned a four-year, $39 million extension before the 2010 season. The early portion of his story appeared to be a successful tale after recovery, just like Sanchez's.

After a great repeat campaign by Johnson in 2010, the injury problems arose again. Johnson threw nine spectacular starts before complaining of shoulder tightness and landing on the DL. After repeated stories that discussed his impending return and an MRI which revealed no structural damage, Johnson continued to suffer setbacks. He never recovered fully from the shoulder ailments and ended up sidelined for the rest of the season. He did not have surgery, not even the exploratory arthroscopic cleanout-style procedure that Alvarez likely underwent.

Johnson responded well in 2012, pitching a full season for the first time since 2009, but he was noticeably worse than he was pre-injury. In 2009 and 2010, Johnson was throwing 94-95 mph after Tommy John surgery. He was still throwing 94 mph before the shoulder problems in 2011. By 2012, he was down to just under 93 mph for the entire season, and his strikeout numbers suffered for it. His ERA ballooned up to 3.81 and his strikeouts were down to the lowest rate since his rookie season.

Johnson was dealt to the Blue Jays as part of the infamous fire sale trade, but he never took off there, having struggled mightily. By midseason, the Jays shut him down for right upper arm or forearm inflammations and strains. By preseason of next year, it turned out he had suffered another torn ulnar collateral ligament and needed a second Tommy John surgery. He has not thrown a pitch professionally since 2013.

The Lessons Learned

These two pitchers represent spectrums of concern for the Marlins and Henderson Alvarez. In Sanchez's case, the concern is that the recovery can be a long one. Sanchez too had prior issues with his shoulder and a previous negative MRI in 2006, but by the time he required surgery, significant damage had been done. As of right now, we do not know the extent of Alvarez's injury, but the fact that the Marlins have no timetable for return and are going to judge said timetable based on what they hear in terms of damage is troubling. We should find out the aftermath in the coming weeks, but even then, there is no guarantee. If the damage was as significant as Sanchez's, Alvarez could suffer a protracted recovery that eats into a significant amount of 2016.

This is compounded by the fact that the Marlins did not catch the same break with Alvarez as they did with the younger Sanchez. If Alvarez misses a huge chunk of 2016, he will still get paid his second arbitration year's worth of salary for it. There is no chance Miami non-tenders the injured pitcher, but they will still have to pay him a slight raise over his current $4 million deal.

In Johnson's case, the ever-present threat of a chronic or repeated injury is there. Alvarez is said to also have a "90 percent torn" UCL on his throwing elbow, and there is no telling what attempting to work through and recover from right shoulder pain, arthroscopic evaluation, and the chronicity of his problems only points to a potentially worse prognosis. What could happen to an already damaged ligament if other mechanisms in the same arm are in trouble?

Henderson Alvarez's shoulder injury is real, and it is concerning for the future of the Marlins. History is not on their side.