Injury update: Adam Wainwright

The St. Louis Cardinals have to be relieved to learn that Adam Wainwright's elbow soreness is not due to injury to his recently reconstructed ulnar collateral ligament. Now the question is just how problematic the current elbow condition will be for their ace.

Wainwright underwent Tommy John surgery in 2011 and has been stellar since his return; his performance has been easy for all to see. His commitment to returning to peak performance and to maintaining the health of the support structures for his newly reconstructed elbow, while not as outwardly visible, may be equally, if not more, important.

For instance, during spring training prior to his 2013 season, Wainwright told me he was aware that many pitchers who underwent Tommy John surgery subsequently experienced shoulder problems. He was determined to do everything possible to avoid becoming one of those statistics, so even after he was deemed “healthy” upon returning to pitch, he maintained a series of rotator cuff strengthening and flexibility exercises to ensure he would stay that way. Despite his outstanding 2013 campaign, Wainwright wasn’t satisfied that he had achieved his maximum point of return following his elbow ligament reconstruction. During spring training prior to this season, he told me that while he was pleased with what he was able to do last year, he was working on improving his ball movement toward the right side of the plate. And, yes, he was keeping up with a regimen to ensure that his shoulder, core, legs and everything else supporting his throwing elbow remained healthy.

But alas, no matter what efforts a pitcher makes to protect his throwing arm, there is still the fact that he throws overhead repeatedly for a living, placing abnormal stresses on the upper extremity. And Wainwright’s success may actually have translated to extra throwing stress on the arm. Beyond his pitching effectiveness post-TJ surgery, Wainwright demonstrated his endurance, going not only deep into games but deep into the postseason, accumulating more than 275 innings in 2013 in the process. This season, he has been the Cardinals’ most reliable pitcher when it comes to maximizing his innings per outing, simultaneously outpacing the rest of the National League in wins. We are now learning that in recent weeks his elbow has not felt completely comfortable, yet remarkably, he has continued his success on the mound, even this past Tuesday with seven scoreless innings. Wainwright later told reporters he was pitching with “average stuff” and manager Mike Matheny saw enough of a dip in his performance, albeit a subtle one, to remove him from the game.

Wainwright returned to St. Louis on Wednesday to undergo further examination from the Cardinals’ team physician and an MRI, which thankfully showed no structural damage to his surgically reconstructed ligament. According to general manager John Mozeliak, Wainwright is dealing with a “tennis elbow”-like condition. The big clue that this is not related to Wainwright’s recently reconstructed ligament is that tennis elbow, or lateral epicondylitis, refers to inflammation or irritation on the outer aspect of the elbow, not the inner side where the ulnar collateral ligament is. The extensor tendons -- those that extend the wrist and are important for grip control -- attach at the lateral epicondyle (located on the arm bone, just above the elbow joint). For a pitcher, the condition is often associated with the fingertip grip and/or control of the wrist and elbow on ball release during particular pitches.

The good news is that the condition should respond to conservative treatment, particularly if it is being addressed in the early phase. Wainwright has already received an injection and can surely be counted on to carry out the prescribed regimen of stretching and strengthening. Still, this may mean a skipped or delayed start or two in the interest of preserving him for the long haul. Although no one from the Cardinals, including Wainwright, has spoken of it, it could mean the All-Star pitcher would pass on an All-Star appearance, should he be selected.

After all, as Mozeliak told the St. Louis Post-Dispatch, “We want to be extra cognizant of what he needs to stay in the rotation and be healthy from here. We are going to be cautious with this."