After the last few outings, in which Brad Radke's velocity has slipped like a car with clogged fuel injectors, we are all wondering whether Brad will return to form. And, if so, when? So I thought it a good topic for discussion.

The problem is, the shoulder joint is the most complicated joint in the human body. It's an intricate system of muscles, tendons, ligaments, labrums connecting a ball and socket joint with the largest range of motion in the body. Any one of these things goes wrong and the whole system goes haywire, particularly for pitchers. So I did a little research on Radke's particular injury, and this is what I found. I interspersed what I've read in the papers and heard ad nauseum from the booth, and combined that with the research to do some analysis. Feel free to chime in if my info is off (the Internet being what it is) or if you have anything to add.

Here are my questions:

What is a torn labrum?
There are two major labrums in the shoulder. They both act like the meniscus in the knee: shock absorbers for the joint. The inner labrum cushions the ball and socket, the outer labrum is more like a spring for the biceps tendon and rotator cuff. The inner labrum is typically only injured through extreme shock. The outer labrum is injured through overuse.  That is the injury that Radke suffers from.

What are the symptoms?
Basically, the tear causes friction and pain near the point of the shoulder. Every time Radke moves his arm, the tear rubs against the biceps tendon or rotator cuff ligaments, causing pain in the labrum itself and in the tendons or ligaments, depending on the location and severity of the tear. Many pitchers pitch through minor tears, but Radke's appears severe, and it appears to be getting worse the longer he pitches with it.

What are the treatments?
Barring an operation, the treatment is typically rehab and medication. The rehab involves strengthening the muscles around the shoulder to overcome the injury. Radke tried doing this, but he found the pain was too great, especially when he pitched. So he tried to back off all inter-start work.  He basically doesn't even use his arm except when he pitches, so his arm is getting progressively weaker, and the injury's effects are getting progressively worse. The pain and anti-inflammatory meds are not doing enough to allow him to rehab, so it's a slow decline. Unless he can somehow get strength back in the critical muscles in the shouler through throwing and exercising between starts, he will not improve.

What is the prognosis?
The only thing that can possibly bring him back is a cortisone shot, which drastically reduces painful inflammation around the tear and allows him to strengthen the arm with some throwing between starts. Cortisone has many side effects, so it can only be administered every six weeks, and then only a few times a year. The last time he had one, in July, it allowed him to do some throwing on the side and he came back strong. But on July 29th, he had a major setback and stopped all side pieces. He's battled through valiantly, but he can't continue losing strength in the shoulder, particularly in the rotator cuff muscles, and pitch through this. He will have a cortisone shot today, and see if it allows him to do some long tossing and perhaps a bullpen or two before his next start. If he still can't work through the pain to get some strength back before his next start, he could be scratched.

Meanwhile his next start is scheduled for the New York series. Because of the off day Monday, Gardy is able to move the other pitchers up one game and put Radke at the end of the rotation. Assuming he can do some side work or weight work, he will give it another shot, but if he performs like he did last night, my hunch is that will be the end of his career. They might try to shut him down and get him some rehab work in hopes for a playoff appearance. But that is unlikely.

What are the options?
It's interesting that Liriano's injury is minor relative to Radke's, but Radkes pitches without side work and Liriano must basically start from scratch with a rehab and throwing program. Such is the state of their respective careers: Radke's done one way or another after this year; hopefully Liriano has a long career ahead of him. Liriano is making progress and I expect him to throw off a mound before the end of this month, pitch a simulated game in early September; do a  rehab start or two in minor league playoff games; and come back strong on September 15 or so. But, if Radke can't go after the New York start, the Twins will have a gaping hole in their rotation for three or four turns before Liriano returns.

So that leaves Scott Baker or Dave Gassner as alternatives. The Twins can't bring both up until after Rochester is eliminated or wins the International League championship. So they will try to pick one. I think Baker is the better of the two, but the Twins brass might give Gassner another chance because they feel Baker is not making enough strides in keeping the ball down and sharpening his breaking ball. A lot depends on how they both start this week.

Another alternative is to promote Matt Guerrier to the rotation. Perhaps you get him up early in the Radke start in New York and insert him at the first sign of trouble, as they did last night against Chicago. In the likely event that Radke has another short start, you give Guerrier four innings, building up his arm to take over for Radke in the rotation.

Of all the options, I like this last one the best. Guerrier has paid his dues in the bullpen and has been consistently effective in his role. He has four pitches that he throws for strikes and he has shown that he can get good major league hitters out. He even pitches like Radke, or like Radke did when he was healthy anyway. Meanwhile Willie Eyre has of late shown that he can take over for Matt in the long role. And the Twins can probably call up a reliever from Rochester on September 1 to take Willie's mop-up innings without putting as big a dent in Rochester's playoff hopes as they would if they called up Gassner or Baker. I would nominate Beau Kemp for that job (you could make room for him on the 40 man by putting Radke on the 60-day DL). But Kevin Cameron and Bobby Korecky are also good candidates.

Don't fret. The Twins depth will be tested, once again. But as I wrote at the start of the year (Jesse, a little help with the archives please), the Twins depth will get them through another injury crisis. And at least Twins fans will know one way or another when the Twins face the Yankees next weekend what will become of the rotation without our beloved Bradke.