Notes: Schmidt has tough road ahead

Notes: Schmidt faces tough road

LOS ANGELES -- Major League pitchers that prospered after undergoing Tommy John elbow reconstruction surgery dot the landscape, but the same can't be said for victims of the type of shoulder injury suffered by Dodgers pitcher Jason Schmidt.

Shoulder injuries are the ones that really threaten pitching careers. The only other current Dodgers pitcher who has undergone shoulder surgery is Chin-hui Tsao, who had torn labrum repaired and debridement of his rotator cuff in May 2005. He missed the rest of 2005, the entire 2006 season and has already been disabled with a different shoulder injury this year.

Schmidt also underwent surgery to repair frayed labrum and rotator cuff in 2000, but there are seven more years of wear and tear in that shoulder now. He will be 35 next year and is a 13-year veteran, but club officials are cautiously optimistic his chances for recovery will improve because of the operative techniques and strategy utilized by Schmidt's surgeon, Dr. Neal ElAttrache of the Kerlan-Jobe Clinic.

"The Tommy John success rate is 82-85 percent for returning to the previous level, while the success rate for labral tears is about 70-75 percent," said Stan Conte, Dodgers trainer and medical director. "The qualifier is that the studies only focus on labral tears and a lot of pitchers have a combination of injuries."

As did Schmidt, who had scar tissue removed from a bursa sac and fraying of the biceps tendon repaired, in addition to the anchoring of labrum torn off the rim of the socket. ElAttrache, director of the sports medicine fellowship at Kerlan-Jobe and a trailblazer of cutting-edge procedures, did not discuss Schmidt's surgery specifically but said multiple instances of damage are common in shoulder injuries for pitchers.

Repeated throwing motion coupled with fatigue stretches connective tissue and the instability of the joint results in traumatic damage to the surrounding structure, including the labrum, a cartilage material that lines the inside of the shoulder socket. ElAttrache said his research has found that the key to a pitcher's return can be not only what doctors find and fix, but what they find and choose not to fix.

"Labral tears are the low-hanging fruit, but they almost never live alone," said ElAttrache. "They appear with rotator cuff tears, chondromalacia [arthritic deterioration of the bone lining], bursa scaring, tendon fraying. But we're finding that after some repairs, the tissue winds up too tight, the range of motion is restricted and velocity is lost. Our most recent studies show that certain lesions in certain areas should be fixed. But some fixes can have the effect of reducing range of motion, and for a pitcher to return to his previous level, loss of range of motion is pivotal. So, our decision making has to improve for the pitcher to have a better chance of returning.

"The dilemma, when you get an MRI that shows more than one problem, is determining whether all -- or just one, or some combination of pathology -- is the cause of the pain. How you answer that determines how you deal with it and your chances of success. As a surgeon, you have to control yourself. Sometimes, fixing everything you find is not the best solution. The decision making is not always straightforward. You have to exercise surgical discipline and be a student of the problem."

Specifically with torn labrum, ElAttrache now uses suture anchors to reattach and strengthen labrum. Earlier procedures were limited to trimming ragged portions.

Martin rests, Lieberthal celebrates: All-Star catcher Russell Martin, after the first four-hit game of his career on Monday night, took a planned day off on Tuesday night. He was replaced by former All-Star catcher Mike Lieberthal, whose locker was festooned with balloons and flowers to mark the rare event.

It was Lieberthal's ninth start in the Dodgers' 84th game. He was 4-for-5 with a home run and three RBIs against Atlanta starter Kyle Davies entering Tuesday night.

"I have very special teammates," said Lieberthal, who wasn't sure which were responsible for the sarcastic gifts.

Manager Grady Little narrowed down the culprits to either Luis Gonzalez or Olmedo Saenz.

Also sitting was third baseman Nomar Garciaparra (0-for-3 against Davies), replaced by former Braves third baseman Wilson Betemit (who homered in his only previous at-bat against Davies).

Tough times for Tomko: Little said he believes a loss of confidence has contributed to the prolonged slump of Brett Tomko, who has allowed runs in five of his last seven appearances.

"Right now, his confidence level is down," said Little. "We need this guy. He has a very good arm, and he needs to step it up. We'll keep running him out there."

Coming up: Mark Hendrickson (2-3, 4.08 ERA) returns to the starting rotation on Wednesday night when he faces Chuck James (7-7, 4.08) in a Fireworks Night game that starts at 6:10 p.m. PT.

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