Baseball wonders why pitchers' elbows keep tearing

By Ronald Blum

Associated Press

Published: Friday, May 16 2014 5:01 p.m. MDT

FILE - In this April 29, 2014 file photo, Miami Marlins starting pitcher Jose Fernandez sits in the dugout after pitching eight innings against the Atlanta Braves, in Miami. More than a dozen major league pitchers have needed Tommy John surgery this year, a group that includes All-Stars Patrick Corbin, Josh Johnson and Matt Moore. NL Rookie of the Year Jose Fernandez is among three others headed to elbow ligament-replacement surgery, joining an illustrious group that includes Chris Carpenter (2007), Stephen Strasburg (2010), Adam Wainwright (2011) and Matt Harvey (2013).

File, Associated Press

All of baseball is focused on a most precious 2 1/8 inches — the average length of the ulnar collateral ligament.

This year, more than a dozen major league pitchers already have undergone Tommy John surgery — which involves replacing the elbow ligament with a tendon harvested from elsewhere (often the non-pitching elbow or forearm) in the patient's body. All-Stars Patrick Corbin, Josh Johnson and Matt Moore have had the surgery, and NL Rookie of the Year Jose Fernandez was scheduled to have his operation Friday.

"It's a problem. There's no question about it," baseball Commissioner Bud Selig said. "I'm almost afraid to pick up the paper every day because there's some bad news."

The surgery forces a player to miss at least a full season, but many power pitchers — including Chris Carpenter (2007), Stephen Strasburg (2010) and Adam Wainwright (2011) — threw as hard with their repaired elbows as they did before. Matt Harvey is still recovering from surgery last year.

The league hopes it can find ways to protect these million dollar elbows before surgery is required.

Dr. James Andrews, one of the world's top orthopedic physicians, will be meeting with a research committee Monday at Major League Baseball's headquarters.

"We're going to put together a research project to help figure this out. We don't know quite what to say at this point," he said. "But, yeah, it's got everybody's attention."

A 2013 survey showed 25 percent of big league pitchers and 15 percent of minor leaguer pitchers had undergone the procedure.

"This does not include the guys who didn't make it back. These are the success stories," said Glenn Fleisig of the American Sports Medicine Institute, who conducted the survey with Stan Conte of the Dodgers.

With the advent of high-tech scans such as MRIs, doctors usually can pinpoint exactly what's wrong. And with pro pitchers under the watch of radar guns whenever they throw, the slightest drop in velocity triggers scrutiny.

But for more than a century, pitchers came up with "sore arms" and "dead arms," trying to pitch through pain.

"Back then, you could be on your deathbed and you never told anybody because if you said, 'God, my arm hurts,' there were 15 guys waiting to take your place," Tommy John said. "So I kept my mouth shut and just kept pitching, kept pitching, kept pitching."

UCL reconstruction has increased 10-fold in the first decade of the 21st century, Andrews and Dr. Jeremy Bruce wrote in the May issue of the Journal of the American Academy of Orthopaedic Surgeons, citing a paper by J.R. Dugas. Experts think young pitchers throw far more often now than they did a decade or two ago.

"Baseball, once considered a seasonal sport, has become a year-round event in some regions of the United States, with increased team travel play and sponsored tournaments," Andrews and Bruce wrote.

An ASMI study published in 2011 examined 481 pitchers ages 9-14, and then checked with them 10 years later. Those who threw more than 100 innings in a year were 3.5 times more likely to need elbow or shoulder surgery or were forced to stop playing baseball.

New York Mets medical director Dr. David Altchek says he's performing the procedure more often among teenagers, who are not as strong as professionals and are trying to impress with high velocities.

"When you're throwing year-round, you don't have much time for all this fitness stuff," Altchek said. "So you're fitness gets sacrificed, Your arm is overloaded. That's a recipe for disaster."

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