Wainwright has been a durable pitcher and among the best in the game the past two years, finishing near the top of Cy Young ballots. There were signs at the end of last season that there might be some issues. The Cardinals kept a close eye on the elbow, I'm told, and he passed exams in November and at the spring training physical, at least one of which included an MRI. According to the St. Louis Post-Dispatch's Derrick Goold, Wainwight said "it's not like it's ready to pop." It was.
Wainwright missed most of 2004, just after coming to the Cardinals, with an elbow issue. He's missed two starts in the major leagues with elbow-related issues as well. He also missed two months in 2008 with an unrelated finger injury. If Wainwright has Tommy John surgery, he'll miss the 2011 season while undergoing the nine-to-twelve month rehab. He should be able to come back without any real challenge, following the same path as Joe Nathan, the Twins closer who is returning from elbow reconstruction. Nathan tore his ligament at a similar part of spring training in 2010 and is throwing without limitations now. Hundreds of pitchers, including Chris Carpenter and Jaime Garcia in the Cards' rotation, have had the procedure first performed by Dr. Frank Jobe on Tommy John.
The Cards can't replace Wainwright's production, but they will have to fill in the rotation slot. Early candidates will include Ian Snell, signed in hopes that working with Cardinals pitching coach Dave Duncan will return him to the days when he was a hot prospect with the Pirates, and Lance Lynn, a high draft pick a couple years ago who was a high school teammate of Nats closer Drew Storen.