Throughout the Spring, LHP Zach Britton has been in recovery mode for shoulder inflammation. At the end of May 2011, Britton's ERA sat at 2.93, but his numbers began to decline soon thereafter. He was sent back to AA Bowie after a shellacking in Boston on July 8, with his ERA now at 4.05. He returned to the big leagues after 3 minor league starts, made two more disastrous starts giving up 10 earned runs in 5.2 innings, and then landed on the disabled list with shoulder inflammation.
At the time, Britton said he had been dealing with shoulder discomfort since June 28th against St. Louis. The Orioles' doctors diagnosed him with inflammation and was prescribed rest. He came back off the DL after 17 days and then pitched straight through the rest of the season, making 8 starts with a 4.47 ERA.
The wisdom of having him pitch at all in September is certainly something to question, but at any rate Britton has still been dealing with the soreness and inflammation in his pitching shoulder this spring. It has gotten to the point that he has been to see noted surgeon Dr. James Andrews - doctor to the baseball stars! - who found no structural damage in the shoulder. That's good news; there will be no surgery for now. Instead, Dr. Andrews prescribed a relatively new treatment called Platelet Rich Plasma (PRP) Therapy.
PRP Therapy involves taking a sample of the patient's blood, separating the platelet-rich plasma in it via centrifuge, and then injecting the plasma into the patient's injured area, which for Zach Britton would be his left shoulder. Platelets are very small blood cells created in bone marrow which are a principal partner in physical healing of wounds, facilitating clotting to form seals around injuries as well as increasing tissue regeneration and - to the point at hand - reducing inflammation. The platelet-rich injection theoretically adds a lot of healing ability to areas of the body that normally have a poor blood supply.
According to this Scientific American article, PRP Therapy has been in use since the mid-90s to promote healing of bone tissue following spinal surgery, as well as soft tissue recovery after plastic surgery, and has recently become a trend for sports-related injuries. Toronto-based Dr. Anthony Galea was one of the PRP frontiersmen, treating high-profile cases including Tiger Woods. You might remember Dr. Galea, as he was arrested in 2009 and investigated by the FBI for potentially supplying athletes with illegal performance enhancing drugs (notable Yankee Alex Rodriguez was connected to that case, as Galea treated A-Rod when he was recovering from hip surgery in 2009). He eventually pleaded guilty to bringing mislabeled drugs into the United States.
PRP Therapy, as you can imagine, has a somewhat controversial history in the sports medicine world. The World Anti-Doping Agency had the therapy banned until January 1, 2011. The fact that a doctor with as large a reputation as Dr. James Andrews is recommending the procedure is telling of its growth into mainstream medicine. However PRP has not grown into a magic bullet for Zach Britton to take two and call the doctor in the morning. Its efficacy is up for debate despite its growing popularity, and at least part of the problem is our favorite saying in the sports blogging community: the number of studies done so far on PRP Therapy is a small sample size.
In short: Britton will be shut down for a few weeks before being reexamined. He may or may not be better off by then, and that may or may not be due to the extra platelets in his shoulder.
So, we know Zach Britton will be on the disabled list on Opening Day. He may not pitch in the big leagues until after the All-Star Break, given how the healing has gone so far. Heck, his entire future career is in jeopardy, such is the danger of shoulder injuries to pitchers. There isn't much to do on the Orioles or the fans' part except wait and see what happens next. In the meantime, it looks like Brian Matusz's spot in the Opening Day rotation, when mixed with his encouraging Spring, just got stronger. And hey, maybe that's the silver lining: Britton finally gets the rest he clearly needs, and Matusz gets the opportunity he clearly deserves.