CHICAGO – Anytime a pitcher misses a start and the word “shoulder” is involved, alarm bells should sound. A blown-out elbow is a speed-bump, typically a one-year Tommy John surgery followed by rehab with a tremendous likelihood of a return at full health.

A damaged shoulder? A badly damaged shoulder? That’s often a dead end.

That being the case, even when there is a so-called minor injury to a shoulder -- even if it involves just an extra modicum of rest for a start or two -- it’s a big deal.

So, yes, the fact that Josh Beckett’s scheduled start on Sunday will be skipped due to what manager Bobby Valentine described as “a little inflammation in his right shoulder” -- for now the pitcher will remain on the roster rather than going to the disabled list, with left-hander Franklin Morales filling in on Sunday -- qualifies as a “big deal.”

That is particularly true given the importance of Beckett in the Sox’ rotation. Though he’s 4-7 with a 4.14 ERA, Beckett has been victimized frequently by poor run support while putting the Sox in solid shape to win. He has eight quality starts, tied for the most on the team, and his 67 percent quality start percentage is the best mark among the members of the rotation.

He’s pitched at least seven innings in each of his last six starts. Overall, his eight outings of seven or more innings are tied for the fourth-most in the majors. He is tied with Justin Verlander for the second-most starts of seven-plus innings (8) in the American League, behind only CC Sabathia.

All of that is to suggest that Beckett has been the anchor of the rotation, the pitcher who is most capable of alleviating the demands on the bullpen. And so, his shoulder is a matter worthy of significant attention.

Here’s what we know about Beckett’s shoulder:

AFTER A “LITTLE REST,” THE RED SOX DO EXPECT HIM BACK

For now, it remains possible that the 32-year-old could be back sooner rather than later. The Red Sox have skipped him for one start. The suggestion by manager Bobby Valentine that the right-hander will remain on the roster “for now” means that the Sox haven’t seen something to suggest a longer-term injury . . . yet.

“The training room thinks that it’s best that he’s rested a little,” said Valentine. “Don’t think it’s serious. He’ll be pitching again, that’s for sure.”

According to an industry source, the Red Sox feel confident that by shutting down Beckett for a start or two, they will be able to keep him healthy for the greater part of the season going forward. The team will re-evaluate the right-hander Saturday before making a determination about whether he is more likely to miss one start or two.

If he will be sidelined for two starts, then the team would place him on the disabled list. If he will only miss Sunday’s start, then he will remain on the active roster.

So, the pitcher appears likely to come back without missing too much time. Even so, the fact that there is a shoulder issue of any sort cannot be dismissed simply because of his absence is expected to remain short-term. That is in part because…

THE VELOCITY ISSUE APPEARS A BIT MORE SIGNIFICANT NOW

All pitchers lose something off their fastball at some point in their careers. The shoulder is meant to withstand only so many bullets. Eventually, velocity erodes and pitchers must adapt.

Aside from a couple of terrible outings this year, Beckett has done that. He’s mixing his pitches as never before. He’s a different pitcher than he has been in the past.

“Everybody has to evolve. You’re not going to have that [high-90s] stuff for your whole career. You’re not going to see that anymore because obviously the steroid era is over,” teammate Jon Lester said earlier this year. “You’re not going to throw 95-plus for your whole life. Everybody has to adapt and figure out new ways that work for you.

“Over the past year, he’s had to do that. That’s the evolution of a pitcher after a lot of innings. It’s fun to watch. A lot of guys don’t accept it. I’m not saying that his stuff has really deteriorated. He’s still throwing 93-94, but it’s just not the 97 that we got used to when he first came over.”
Beckett’s velocity had gone down steadily and gradually over his time with the Red Sox. It was a steady progression. This year, the drop -- 1.4 mph on his four-seam fastball and 1.3 mph on his two-seamer -- had been larger than in any other single season since he came to the Red Sox.

Velocity is not a prerequisite for success, of course. However, the fact that there is a velocity drop and that Beckett is now dealing with shoulder issues makes the diminished radar gun readings potentially more significant.

Physically, Beckett acknowledges that there is a difference between pitching now and pitching a decade ago, when he was an up-and-coming phenom for the Marlins.

“My body feels a lot different [than it did at 22]. I don’t think it’s the age thing though, I think it’s the amount of innings. I think I’m probably getting close to 1,800-1,900 innings,” said Beckett, who has thrown exactly 1,800 innings in the big leagues and slightly more than 2,000 in his professional career. “If you ask anybody who has 1,800-1,900 innings vs. whenever you asked them if they had 200 innings in the big leagues, it is a lot different.

“The normal progression is the one I’m on -- maybe not the progression of so many years ago where guys maybe sustain[ed] their velocity a little bit differently. I think I’m more on the traditional arc than maybe some other guys.”

THIS IS NOT THE FIRST TIME THAT BECKETT’S SHOULDER HAS BEEN AN ISSUE

As a 19-year-old, Beckett was told that he had a torn labrum in his shoulder and needed surgery. If he had listened, there is a real possibility that his career would have been over before it started.

As colleague Rob Bradford detailed here two years ago, instead of going under the knife, Beckett got a second opinion from Dr. James Andrews and was told that he could avoid rehab the injury. That prognosis worked.

From the story:

“I probably would have had surgery on my labrum, and that was back when they were still shrinking capsules, so it wouldn’t have been good,” Beckett said at that time. “But my agent said we should get a second opinion before we do anything. That’s when I saw Dr. Andrews and he told me to rest it. He always took the cautious route first. ‘Let’s rehab this thing to see if we can get it stronger, and if it doesn’t we’re not losing anything.’ He spoke my language, too, and a lot of doctors don’t. When I went to the rehab clinic (after seeing Andrews in 2000), that’s when I knew.”

While blisters proved the biggest stumbling block for Beckett throughout his time with the Marlins, the shoulder concerns wouldn’t go away. After Beckett missed his final start of the 2005 season with shoulder stiffness (although there was some debate as to if the absence was related to injury or the team saving potential bonus money), the company Beckett was attempting to secure insurance from informed him that they would insure every part of his body but his shoulder.

By the time the Red Sox approached Beckett with a contract proposal midway through the 2006 season, the insecurity of not locking in insurance still was weighing heavily on the pitcher.

“I think if I had that insurance policy it would have been a little easier to go to [the Red Sox] with a hard number,” Beckett said in 2007. “The way it happened was that we both sat down and hammered out something that made us both happy. I got that insurance with the contract.”

While the subject of his shoulder never exited Beckett’s psyche, there has been encouraging signs since coming to the Red Sox. He was told after the initial rejection by the insurance company that he could get insurance if he pitched 600 innings from the time of his arrival in Boston if there were no shoulder issues. (He has pitched 792 regular-season innings for the Red Sox.) Beckett also underwent an MRI following the 2007 season as part of the process to potentially getting insurance, which he also identified as not raising any new red flags.

A VISIT TO DR. JAMES ANDREWS SEEMS LIKELY -- BUT THAT DOESN’T NECESSARILY MEAN BAD NEWS

When Beckett has questions about his health, he goes to a doctor whom he has referred to in the past as “my guy.” That is Dr. James Andrews, the renowned orthopedist who spared Beckett from shoulder surgery in 2000.

"I've (referred) to him on everything I've ever had with my shoulder or elbow," he said in this story. "I've had other doctors check me out for physicals and things like that, but when it comes to, 'I need this done,' or 'I need an MRI because I'm hurt or injured,' I'm going to see Dr. Andrews."

For now, manager Bobby Valentine said only that Beckett is likely to go for some tests, referring to “baseline” determinations. But when the pitcher wants to be confident that he can pitch without jeopardizing his long-term health, he has historically gone to see his guy. Given the sensitivity of the shoulder, a visit to Alabama should not come as a surprise.

THE FACT THAT BECKETT KEEPS DEALING WITH INJURIES REPRESENTS AT LEAST A YELLOW FLAG

Just before the season, it was Josh Beckett’s right thumb that demanded the attention of specialists in San Antonio and then Cleveland. Then, in late-April, there was some minor stiffness in his lat muscle. Now, the shoulder.

That comes on the heels of a 2011 season in which Beckett was unavailable for part of the final month of the season with a calf injury, and a 2010 season in which his campaign was derailed early by a back injury he suffered in May, the numbness he felt in his arm in 2008 and then the intercostal injury he suffered just prior to the start of the postseason that year.

A history of Beckett’s injuries is starting to resemble, increasingly, a game of Operation, with buzzers sounding a bit more frequently on different regions of his anatomy. Most of the issues have been minor, yielding a missed start here and there but only on rare occasions a longer period of missed time.

All the same, with the mileage that Beckett admittedly has accrued, the likelihood goes up that there will be more significant issues going forward. For now, the Red Sox feel they have stayed in front of what they view as a manageable health situation. Whether that will remain the case over the remaining two and a half seasons of his four-year, $68 million contract is another question.

A REMINDER ABOUT THE IMPORTANCE OF JOSH BECKETT

Even so, if the Red Sox have managed to limit Beckett’s absence to a start or two, then they have done quite well for themselves. For as much as there are growing concerns related to his ability to stay healthy, his importance to the rotation is undiminished.

He remains the pitcher capable of giving the Sox reliable, quality innings. That trait is something that -- in a year in which Jon Lester has yet to dominate, and Clay Buchholz has been inconsistent, and Felix Doubront has only started to break through the six-inning barrier -- remains desperately necessary for a team that is desperate for quality starts.

Already, prior to this injury, the Red Sox viewed their rotation as an area of potential upgrade in the trade market. The idea that they might have to find a way to replace what Beckett has given them would represent a task almost too daunting to contemplate.

And so, Beckett’s progress will be monitored carefully, his shoulder eyed with a mixture of hope and anxiety.