O's, Benson plan shoulder rehab

Benson putting off shoulder surgery ... for now

FORT LAUDERDALE, Fla. -- Kris Benson and the Orioles finally agreed on a course of action, even if they don't agree on the state of the right-hander's shoulder. Benson will commence a rehabilitation program to strengthen the muscles around his partially torn rotator cuff, but the two sides differ on whether he'll ultimately need surgery.

Agent Gregg Clifton said the program was explained to him as a "long shot" to avoid surgery, but Baltimore executives claimed that they got no such diagnosis from Dr. James Andrews, who delivered the third opinion on Benson's shoulder. Benson had previously seen a team physician and a surgeon affiliated with the Mets.

"We know that Dr. Andrews agreed with the course of treatment our doctors [suggested]," said Jim Duquette, Baltimore's vice president of baseball operations. "I spoke to the agent, but we haven't spoken to Kris yet. We told him that it's our expectation that [Kris] come down here and perform his physical therapy and rehab."

Clifton said that Benson would likely be in camp Wednesday, but he also underlined the similarity and differences in the three medical opinions. The first doctor, according to Clifton, ruled out surgery altogether. The second one prescribed an operation without rehab, and the third called for rehab with the possibility of surgery.

Benson has a history with each of the doctors. The first, Dr. Andrew Cosgarea, is Baltimore's head orthopaedic surgeon. The second, Dr. David Altchek, is familiar with Benson from his time with the Mets. And the third, Andrews, performed Tommy John elbow ligament replacement surgery on Benson in 2001.

"Our thinking all along was that this needed to be the case," Duquette said. "He has the right under the Basic Agreement to seek a second opinion and then we worked through a third opinion. Our whole feeling from the very beginning was that is the way we thought it should go."

"There are a lot of variables," Clifton said. "A perfect example would be the three doctors Kris has seen during the last few weeks -- all confirming the exact same thing, that there's a tear -- but all three of them prescribing completely different scenarios. One being the Orioles doctor saying no surgery is necessary at all. Another doctor, who's a well-respected surgeon, saying he should have the surgery right away, and another well-respected surgeon saying, 'Let's give it a few weeks and see if we might be able to avoid surgery with some aggressive rehab.'

"Obviously, with those three choices, Kris would much rather avoid the surgery and feels as though it's worth the shot, as do Jim and the Orioles people, to see if he might be able to rehab it."

Clifton also said that he's not "optimistic on a personal level," but he also noted that the rehab can't really hurt. Even if Benson's arm doesn't respond to treatment, he can have the surgery a month later. Otherwise, if he undergoes the procedure without even attempting the rehab, his season is finished before it even starts.

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"Dr. Andrews gave Kris a small amount of hope that surgery still can be avoided by doing, as he put it, an aggressive rehab for the next few weeks," Clifton said. "[Then] we'll assess where we're at, and if no progress has been made then, he'll probably recommend surgery at that point. But right now, he felt as though he would just like to see Kris take one more shot at a little more rehab.

"Obviously, Kris is kind of searching for the needle in the haystack and hoping for anything to avoid surgery and be able to participate this season."

There is some confusion as to when the injury originated. Clifton said the ailment came about when Benson started his offseason throwing regimen, but Duquette said it's something that Benson has struggled with in the past.

"It's not an issue that just materialized from the end of the season -- the tear, I'm talking about," he said. "We certainly would've liked to have known sooner if it was bothering him three months ago, but we didn't have that indication from the exit physical and from speaking with him. It really wasn't until he started his long toss and his actual training program to get started for Spring Training."

"I think the difference now is that when he's had the pain in the past -- let's say last year -- it was already 150 or 160 innings into the season," said Clifton in response. "Here's a situation where he had not done anything, at least from my perspective, to aggravate it. It wasn't like he was out there throwing games. He was just preparing for the season when the pain returned, and I think that's what was of great concern to him."

There are several cases of similar injuries in recent years. Clifton cited one of his own clients -- Mark Mulder -- who attempted the rehab and ultimately had the surgery. And he also mentioned Bartolo Colon, who is still trying to strengthen the muscles around his rotator cuff and isn't expected back until midseason.

"Again, unfortunately, Dr. Andrews confirmed the tear but he said, 'Let's just give it a shot here to avoid surgery," Clifton said. "So Kris is cautiously optimistic, and obviously that's what he'd love to hear -- the fact that he doesn't need surgery and the fact that he could go out there and pitch this year. That's his goal.

"He'll have tempered enthusiasm as he comes down tomorrow and keeps his fingers crossed and hopes against the odds that he might be able to avoid surgery and get back on the mound as soon as possible."

Spencer Fordin is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.