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Sunday, June 15, 2008

Carpenter to get second opinion

By Joe Strauss
Cards Carpenter
Cardinals pitcher Chris Carpenter stretches at spring training camp earlier this season in Jupiter, Fla.
(Chris Lee/P-D)

Cardinals ace Chris Carpenter will seek a second opinion from Birmingham, Ala., orthopedist Dr. James Andrews on Monday regarding his problematic right elbow, club and industry sources confirmed Saturday.

The club has not confirmed the findings of an examination performed Friday by team medical supervisor Dr. George Paletta, but a source familiar with Carpenter's situation said Paletta focused on a potential nerve condition that could result in additional surgery to move, or transpose, a nerve near Carpenter's surgically repaired elbow.

General manager John Mozeliak spoke Saturday to Carpenter's agent, Bob LaMonte, to determine the pitcher's choice of doctors. Carpenter opted for Andrews, one of several orthopedists who examined the 2005 NL Cy Young Award winner before he submitted to ligament transplant surgery last July 25.

The club apparently suggested that Carpenter seek an outside opinion after Friday's examination, which ruled out structural damage to the elbow or to the transplanted ligament.

Four doctors, including a neurosurgeon, examined Carpenter in St. Louis on Friday. Results were "inconclusive" enough, according to Mozeliak, to warrant an additional consultation.

Lingering uncertainty about Carpenter's condition and treatment has caused the club to modify earlier projections that Carpenter could return to the rotation around the All-Star break.

"That's a tough break for him, a tough break for us," manager Tony La Russa said. "I've been saying based on the progress he'd been making that he would pitch before the first half was over. But the guy that's going to take it the hardest is Chris. Whatever it takes to get him 100 percent, he's got plenty of a great career left. I'm plenty disappointed for him and a little bit for us."

Yet the prospect of additional surgery is not enough for the club to scrub the righthander's potential return later this season.

"If this is something they determine does not need to be moved, then he likely can pitch through this," Mozeliak said. "If it does have to be moved, we estimate it as a two- to four-week setback for when he might be able to return."

If Andrews recommends a procedure, it will not be performed immediately. Carpenter and LaMonte are expected to meet with Mozeliak and the team's medical consultants before finalizing his decision and a time for potential surgery.

The suspected condition is common among pitchers who have required ligament transplant surgery. Transfer of the ulnar nerve is performed in a significant percentage of so-called Tommy John surgeries, but not in Carpenter's case.

The condition derailed what team medical and training staff considered a seamless progression. Carpenter threw with impressive velocity with only moderate effort during spring training and had continued to progress until experiencing what one club source called "a hiccup" last month at the team's spring training headquarters in Jupiter, Fla. Carpenter resumed after a brief shutdown, only to endure forearm discomfort within the last two weeks. After another brief hiatus, Carpenter experienced more discomfort following Wednesday's throw and returned to St. Louis to be seen by the medical team.

Cardinals relievers Russ Springer and Kyle McClellan had required nerve transfers following elbow ligament replacement.

Springer threw within two weeks. McClellan's more elaborate procedure followed a 2005 ligament replacement. He made only three starts for Rookie League Johnson City in 2006 before returning last season to work 40 games, all but one in relief.

Carpenter has made only one start since signing a five-year, $63.5 million contract extension in December 2006.

Fellow starting pitcher Mark Mulder and Matt Clement appeared in opposite ends of a Saturday doubleheader for Double-A Springfield, and Mozeliak confirmed that Clement is in the mix to start this week should Todd Wellemeyer be bumped with elbow discomfort. Mulder also helped his case with a strong showing in the first game.

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