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06/27/08 3:06 PM ET

It's up to Schilling to shoulder the load

Level of recovery from surgery varies; return could be possible

BOSTON -- The end of an athlete's career usually comes with pain. Sometimes it's the emotional pain of being told you no longer have what it takes and your services are no longer needed. Often it's physical, with the body doing the talking -- groaning, creaking and sending out sharp reminders that it has been pushed well beyond the limits that it was designed to withstand. At some point, you've just got to listen.

Over the course of his 20 years in the Major Leagues, Curt Schilling has done plenty of listening. He's listened to trainers, to doctors, to his body and often to that voice that said, "Not yet." That's why it's impossible to determine whether, in the wake of his most recent right shoulder surgery, on Monday, Schilling has thrown his last pitch.

"Honestly, who knows?" says Dr. Arun Ramappa, chief of sports medicine in the department of orthopedic surgery at Beth Israel Deaconess Medical Center in Boston. "Recovery is very patient-specific. Everybody is different. Typically, people who have extensive shoulder surgery don't come back at 100 percent, but we already know Curt Schilling is not typical."

Dr. Ramappa was referring not only to the pitcher's willingness to play through the pain of a sutured tendon in his ankle during the 2004 World Series, but two previous procedures on Schilling's right shoulder, in 1995 and '99. The surgeon who performed those operations, Dr. Craig Morgan, reportedly said the latest surgery, which involved three structural repairs or changes, revealed a "best-case scenario" for the 41-year-old pitcher. However, everyone knows a functioning shoulder doesn't automatically lead to effective pitching.

Dr. Morgan told the media Schilling's frayed biceps tendon was separated from its attachment point in the shoulder. The diseased portion was removed and then the tendon was reattached outside the joint. Surprisingly, that may not affect his throwing that much.

"It's more about pain relief," says Dr. Ramappa. "The bicep muscle isn't that involved in generating velocity in a throw."

Dr. Ramappa offers up an example involving quarterback John Elway, who had an inflamed bicep tendon back in 1997.

"It is going to hurt. ... [But] we're talking about a guy who would have to throw a baseball past Major League hitters."
-- Dr. Arun Ramappa

"He had a cortisone shot and then, during a preseason game, he tore his bicep tendon," Dr. Ramappa said. "Not only was he able to play that season, he led the Broncos to the first of two consecutive Super Bowl championships. He said his shoulder felt better after the tendon tore."

Schilling also had a repair done on his labrum, the lip of cartilage which rings the shoulder socket, and a one-stitch fix to his rotator cuff. That might be the best news with regard to the pitcher's possible return.

"Unlike Tommy John surgery on the elbow, which has a good success rate, studies have shown that athletes with extensive rotator cuff damage rarely come back at a competitive level," Dr. Ramappa said. "Less injury is a more hopeful scenario."

But it is still a painful one. Patients sometimes have to sleep in a recliner or even upright because of the post-surgical pain. Stiffness is also a concern.

"It is going to hurt to move the joint, but it has to be done in order to recover full range of motion and function," says Dr. Ramappa. "Remember, we're not talking about a person who wants to carry a briefcase to work and be able to lift it onto a desk. We're talking about a guy who would have to throw a baseball past Major League hitters. "

It's a long rehab, even for desk jockeys, so Schilling will have plenty of time to listen when his body asks, "Haven't you had enough?"

He's the only who can decide, "Not yet."

Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of the Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.