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Jon Niese should reconsider having shoulder surgery

If rehab alone continues to be ineffective, Niese may have no choice but to go under the knife.

Otto Greule Jr

For the past two seasons, Jonathon Niese has been placed on the disabled list due to a partial tear of his rotator cuff and related soreness in his shoulder. He returned from the DL last year to post a 3.28 xFIP in 66 innings pitched, but went on the DL again this year on July 6, despite experiencing “no discomfort” and “no pain,” according to manager Terry Collins. Niese was experiencing pain in his triceps during spring training in Port St. Lucie and was sent to New York for an MRI on February 26. His shoulder concerns will likely pose the largest obstacle to his future with the Mets, so Niese should reconsider undergoing rotator cuff surgery.

Rotator cuff surgery is less proven than even Tommy John surgery, but Niese is running out of options. According to a 2011 case study done by the Journal of Athletic Training, only 27 MLB pitchers elected to have rotator cuff surgery over a period of 33 years. It’s not strange that Niese decided on rehabilitation rather than surgery, but he’s now facing the same shoulder issue for the second year in a row.

Yankees team physician Chris Ahmad emphasized the severity of rotator cuff injuries while discussing Michael Pineda’s injury to his labrum in April:

“When the rotator cuff is damaged as part of the injury problem, that has a much worse prognosis and influences velocity and ability to pitch. His rotator cuff looks great, and this is isolated to his labrum, and that’s why we feel more optimistic about him having a good result.”

Clearly, there’s a connection between Niese’s rotator cuff injury and his loss of velocity. His velocity would return if he had successful rotator cuff surgery, though he’d likely never get back to his previous level. As a pitcher with a career 2.76 walks per nine innings pitched, however, Niese does not have to blow the competition away to remain valuable. He just needs his shoulder to cooperate for a full season.

Adam Rubin noted on August 6 that Niese has changed his delivery to compensate for soreness in his shoulder, so he’s heading into the unknown.

“No pitcher wants to go out there and pitch with a sore shoulder. You’ve got to figure out a way to make the arm feel better. And I did. But now I just have to figure out how to locate my pitches.”

Continuing to pitch with an injury to his rotator cuff could lead to further injury for Niese. The spring training injury to his triceps, which is connected to the shoulder, is very alarming and should raise a red flag about his ability to rehab without surgery.

In the Baseball Prospectus article, “Rounding Up the Usual Suspects: Rotator Cuff Tears,” Corey Dawkins and Ben Lindbergh highlight the danger of pitching with rotator cuff injuries:

“Without a healthy rotator cuff, a significant cascade effect culminating in shoulder instability and/or tears of the labrum is possible, if not inevitable.”

Niese’s future is uncertain regardless of whether or not he has surgery, though it seems probable that he will damage other parts of his shoulder if he continues to pitch. He is only 27 years old, so he can have surgery and get close to a full recovery by the time he is 30. Though he might spend a few seasons getting back to where he once was, he is already missing significant time.

Johns Hopkins’s Division of Sports Medicine provides a guide to shoulder injuries that asserts that surgery is often chosen when all else fails:

“In a vast majority of cases the decision to have surgery is made because nothing else works...There are other factors that should be considered before having shoulder surgery. One is the severity of the symptoms. Another is whether the player thinks he/she can make it to the end of the season for a much needed rest.”

Resting during the offseason has not improved Niese’s shoulder. He can pitch effectively for a time, as we saw in the first half of this season, when he posted a 3.81 xFIP; but he hasn’t started 30 games since 2012.

New techniques in arthroscopic shoulder surgery have improved patient outcomes, according to an extensive study done by the Journal of Athletic Training. The study compares 33 pitchers who have had rotator cuff surgery to a control group of 117 pitchers who have not, and the results may be surprising:

“Players who underwent rotator cuff surgery were no more likely not to play than control players...Pitchers who had symptomatic rotator cuff tears that necessitated operative treatment tended to decline gradually in performance leading up to their operations and to improve gradually over the next 3 seasons.”

Niese signed a five-year, $25.5 million contract with the Mets on April 4, 2012. The contract included team options worth $10 million in 2017 and $11 million in 2018. The Mets can buy out Niese’s contract for $500,000 in 2017, but he may be worth $10 million at that point.

In 2006, Bartolo Colon saw his effectiveness drop precipitously after injuries to his rotator cuff and elbow. He tried rehabbing from 2006 to 2010, and looked all but finished with baseball until he had his own stem cells injected into his elbow and shoulder by a Florida doctor, Joseph Purita, who flew to the Dominican Republic to perform the surgery. Colon struggled to stay healthy before the controversial procedure and it appears that Niese could be heading toward a similar future, minus the trip to the Dominican Republic.

The fact that Niese cleared waivers recently should point to concerns about his shoulder. His strikeouts will likely remain low after surgery for a while, but they have already dropped since his rotator cuff injury. He posted an fWAR of at least 2.2 in both 2011 and 2012. With a healthy shoulder and the ability to make 30 starts, Niese can contribute substantially to future Mets teams.