It's safe to say that Matt Cain isn't coming back anytime soon. Limited to 15 starts this season by three separate stints on the disabled list, the 29-year-old Giants righty is heading to see Dr. James Andrews about the most recent of those complaints, his inflamed elbow.
Cain came into the year with a reputation as one of the game's most durable pitchers. From 2006 through 2013, he served only one stretch on the DL, that last year for a bruised forearm sustained via a batted ball. In that span, only Bronson Arroyo, Justin Verlander and Dan Haren made more starts than his 258, with CC Sabathia matching that total. In a year that's seen Arroyo and Sabathia succumb to season-ending surgeries and Verlander and Haren struggle to find their old form, perhaps it's just par for the course that Cain has battled so many injuries, but even so, his first two trips to the DL were for a lacerated index finger and a hamstring strain, not for arm trouble.
Masked somewhat by AT&T Park’s run-suppressing environment, Cain's effectiveness has diminished considerably. After posting a 3.30 ERA (120 ERA+) from 2006-2012, he slipped to a 4.00 ERA (84 ERA+) last year, and declined further to a 4.18 ERA (82 ERA+) this year. Via career-worst in homers and strikeouts per nine (1.3 and 7.0, respectively), his 4.59 FIP is by far the worst of his career, as is his 40 percent quality start rate.
After going on the DL on July 21 via a retroactive move, Cain underwent an MRI that showed no damage to his ulnar collateral ligament. Nonetheless, he's known to have been pitching with several bone chips and spurs in his elbow since at least 2010, and the Giants fear that his current situation may hint at deeper trouble. Via the San Jose Mercury News's Alex Pavlovic:
[A] team source said the bone chips could be a precursor to a more serious procedure. The worst-case scenario is what happened to Detroit Tigers closer Joe Nathan several years ago; he had bone chips removed in October, 2009 and then had Tommy John surgery the following March after his ligament tore.
Even if Cain's UCL gets a clean bill of health from Andrews, his inflammation and declining effectiveness suggest that it may be time to have the chips removed, though any procedure would sideline him for three to four months, ending his season. Given that he's owed at least $67.5 million beyond this season — their third-largest financial commitment after those of Buster Posey and Hunter Pence — getting him back to full health may rate as the higher priority than watching him grind through the remainder of the season in his current shape.
General manager Brian Sabean already appeared to be braced for such an outcome, having acquired Jake Peavy from the Red Sox over the weekend in exchange for a pair of pitching prospects. Whether it's Peavy, Cain or some pitcher to be named later, the team is in desperate need of help from their rotation given that Madison Bumgarner and Tim Hudson continue to be the only two starters preventing runs at a better-than-average clip. Hudson has a staff-best 2.65 ERA (129 ERA+), while Bumgarner is now at 3.41 (101 ERA+), having been rocked for a 4.55 ERA over his past nine starts, just three of them quality starts. Ryan Vogelsong (3.94 ERA, 87 ERA+) and Tim Lincecum (3.96 ERA, 87 ERA+) have both been subpar, with the latter's recent hot streak — a 0.96 ERA over a five-start span — ended by a shellacking from the Dodgers, who over the weekend swept a three-game series at AT&T Park, retaking first place in the NL West in the process.
At 57-49, the Giants came into Tuesday night two games back in the division race and in a virtual tie with the Cardinals for the second Wild Card spot. They still have time to rebound from the 15-28 slide that's dropped them 12 1/2 games in the standings since June 8, but if they're going to do it, in all likelihood it will be without Cain.