An MRI scan last week revealed that Capuano has a torn ulnar collateral ligament, and at best he will choose to skip surgery for a three-month rehabilitation. But the overwhelming odds are that Capuano will instead opt for the second season-ending Tommy John elbow ligament replacement surgery of his career, then a year-long rehabilitation.
Capuano suffered the injury on Monday against the Mariners and underwent an MRI later in the week that, on Sunday, was read by head team physician William Raasch, who confirmed the tear. Capuano tore the same ligament in 2002 and underwent his first elbow reconstruction, a procedure in which a tendon from his wrist replaced the torn ligament in his elbow.
That time, 11 months passed before Capuano pitched competitively again.
Now Capuano, who turns 30 in August, faces the same long road, though there is a slim chance he will opt to rehab the elbow without surgery. The MRI films from this week, plus images from 2004, when Capuano suffered a bout of tendinitis, will be sent this week to Birmingham, Ala.-based orthopedist James Andrews for another opinion. Andrews performed Capuano's 2002 Tommy John surgery.
"It's very daunting to think about going through another rehab," said Capuano, who just spent a whole offseason working back from surgery on his non-throwing shoulder. "I just rehabbed all winter to get my shoulder strong, and [it's difficult] to think about going through that again."
But he will do it, if Andrews concurs with Raasch that surgery offers the surest route back to the Major Leagues. According to assistant general manager Gord Ash, the success rate of a non-surgical rehab of a torn UCL is less than 20 percent.
Either way, Capuano probably will not pitch for the Brewers in 2008.
"I think I'd like to just get one more opinion on it, and then try to make a decision in the next couple of days," Capuano said. "I want to have someone else look at it, someone else tell me that I need to do this."
If he opts for surgery, it would be performed immediately, likely by Andrews. Tommy John surgery has become relatively routine, according to Ash, but only a handful of pitchers have returned from a second procedure. One of them is former Brewers reliever Chad Fox.
Capuano was given an idea of the extent of his injury on Saturday by the radiologist who performed the MRI scan. But he held out hope of a different diagnosis from Raasch, whose trip from Milwaukee to Phoenix was delayed by Friday's Midwest snowstorm.
"I know for a fact that I can come back to 100 percent," Capuano said. "The key when you go into any rehab is 100 percent believing that you can be stronger and better than you were before you had surgery. If you don't fully commit to that idea, you're not going to heal as good, I don't think.
"But just the notion of the time itself, and the disappointment. I have worked so hard to get this arm feeling good, and my left arm had felt so good. I just feel really disappointed and it's not fun to watch the other guys out there doing something as simple as playing catch. You're an outsider immediately. You're not part of that group anymore. That's the part that's tough to deal with."
He would probably rehab at Maryvale Baseball Park with Kenny Patterson, the Brewers' physical therapist, or in Tempe, Ariz., with private physical therapist Keith Kocher, who is popular among professional athletes.
"It wouldn't be practical to be in Milwaukee," Capuano said. "I don't want to take up the team's time, when they are worrying about people who are actually contributing and playing."
The Brewers acquired Capuano as part of a blockbuster trade with the Diamondbacks in December 2003 that sent first baseman Richie Sexson to Arizona. In parts of four Brewers seasons, Capuano is 40-44 with a 4.38 ERA, including an 18-win campaign in 2005 and a 2006 season in which Capuano made the National League All-Star team.
But after beginning the 2007 season at 5-0, things went sour for the left-hander. He lost his final 12 decisions, and the Brewers dropped the final 22 games in which Capuano pitched, a streak that was equal parts poor performance and plain bad luck, as manager Ned Yost saw it.
"I don't think he pitched as bad as it was all built up to be," Yost said. "He would make a mistake or two. He got inconsistent with command of his fastball, and it led to a very costly mistake. And the games he was pitching in, they were all very close games. He had no leeway for mistake. Four or five times, he left with the lead, and we wouldn't even be talking about this, if the bullpen had held the lead. It's all a lot of nonsense, really."
Capuano will be paid $3.75 million this season. He has one more year of arbitration eligibility remaining before becoming a free agent.
"The only thing you can say," Yost said, "is that he's young enough, his work ethic is phenomenal and he can bounce back from this."
Capuano's injury further tests the Brewers' pitching depth. The team opened camp with eight starting pitchers for five spots, only to lose right-hander Yovani Gallardo to knee surgery and now Capuano to the elbow injury. Gallardo is expected to be healthy by mid-April.
"This is why you have seven or eight guys instead of five guys," Ash said.
Adam McCalvy is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.