The Bad News About Aaron Ashby And Shoulder Arthroscopies

Some 61.5% of specified arthroscopies on baseball players are for this specific issue, and they average just under a four-year career post-surgery on injuries operated on from 1998 – 2016. It’s a very serious surgery, and we don't know how it will affect Aaron Ashby moving forward.

The Procedure
An arthroscopy is a form of keyhole surgery used to check or repair joints, commonly used for anterior cruciate ligament (ACL) injuries, but also around the shoulder joint due to the complexity of the shoulder's composition. An arthroscope is an endoscope inserted through a small incision to see the inner workings of the joint, with accessory incisions made for the corrective surgery performed alongside it with specially-designed instruments.

The labrum is a rim of soft tissue or cartilage that surrounds the ball-and-socket joint, making it more stable, providing cushioning to the joint, and also the point at which the muscle fibers attach to the joint. There are so many fibers from various muscles along the deltoids, biceps, triceps, and rotator cuff, intertwining in such complex ways, that repairing the joint exactly is nigh impossible. This usually results in a shoulder that is tighter than before, with more restricted movement, a feeling heightened by the period of immobilization while the injury heals post-operation--a sensation doctors call a “frozen shoulder.”

The Recovery And Rehabilitation
After surgery, the shoulder is kept in a sling to minimize movement for three to four weeks while performing “passive range of motion” exercises (this is where the therapist moves the joint, the patient not performing any movement themselves) to try and limit the tension in the shoulder. After removing the sling, the athlete takes more responsibility for the motion and flexibility issues, eventually building up to strengthening the joint at about three months post-operation, with Massachusetts General suggesting it will take about six months before the injury is fully healed. That's why it could be season-ending for Ashby.

That is for the general public, and unfortunately for big-league ballplayers, Park et al. found that the average recovery period was closer to eight or nine months from 1998-2016, with an average return to play of only 63% across both the major and minor leagues. However, this increased to 82% if you included only major-league players. This may be due to minor leaguers giving up on their careers after the injury, something that won’t happen to Ashby due to his contract, but there’s still an 18% chance he may never pitch again.

It should also be noted that among pitchers specifically (who make up 60% of the sample), return to play was significantly longer again, averaging 413 days, per a report from Chalmers et al.

The Return To Play
Within baseball, this is an injury carefully managed even in the season after the injury occurs, often playing in 26.4% fewer games than the previous “healthy” season. Performance-wise, there is less of a drop off in MLB compared to the NFL, with an average 2-3% drop in performance metrics, but often returning to preoperative levels in season two after the surgery.

The worry is that the surgery massively shortened Ashby’s career length, with an average of 3.7 years post-injury played across major league baseball. However, there is a lot of volatility within this, with some players having just one year and others twelve years of playing time.

Why did the Brewers and Ashby wait so long to perform the surgery?

Torn labrums are tricky injuries; ideally, they have the ability, and greater recovery, if they can heal independently, depending on the severity of damage to the cartilage. If so, it can be assisted by injections, physical therapy, and anti-inflammatory medication. Surgery is the most difficult for recovery and would be seen as a last resort by the organization.

Reasons To Be Positive
The studies involved figures from 1998, and medical practices have evolved massively. Take, for example, the recovery from Tommy John surgery, deemed impossible until relatively recently, and we can be assured that Ashby will have access to the best medical services. This should likely improve both his recovery time and post-op performance metrics.

Ashby is also much younger than most players who get the injury, at 24 years old compared to the average 29. At a younger age, the body seems vastly more capable of recovering and repairing itself, and I’d expect the Brewers to want more than four years out of his arm. He might not have a long career, but I wouldn’t be surprised if he pitched into his thirties.

Comparative Pitchers
Michael Pineda - 2012 surgery, next played in 2014 but largely returned to previous performance levels

Ben Sheets – Effectively ended his career.

Chris Carpenter – Surgery mid-2002, returning to previous playing ability in 2004

Jack Flaherty – Notable decrease in performance since tearing his labrum, but he didn’t have surgery, instead healing on its own with platelet-rich plasma injections. Hasn’t shown the same “stuff” since.

Tim Lincecum – Career Ending

The injury road doesn’t look promising for Ashby, but medical advances and his age might allow him to be more successful than others who have needed the surgery in the past. We won’t know until we see him pitch again, and he’ll likely be a different pitcher in terms of his velocity and stuff than we saw pre-injury.