Every time a baseball pitcher plants his front heel and whips the ball toward home plate, the odds rise that a 1.5-inch long ligament in his elbow will split, fray or, at worse, tear away from the bones that anchor it.
The result over time: Pain, and often an operation in which surgeons drill holes into the bones around the elbow and anchor in a replacement ligament, usually taken from the wrist or the leg. A year later, in 85 percent of cases, professional players can once again throw the ball at least as hard as they did before the operation, doctors say.
The New York Mets said Aug. 26 that Matt Harvey, a 24-year-old pitcher who was chosen as the National League’s starter at the All-Star Game in Citi Field in New York, has a partly torn ulnar collateral ligament, or UCL, in his right elbow. He is considering whether to undergo surgery that would probably keep him out of baseball next season, the team said.
It’s become “a lot more common surgery” at all levels of competition, offering “a pretty predictable return to the same level of play,” said John Wilckens, an associate professor of medicine at Johns Hopkins Medicine in Baltimore and the team doctor for the Baltimore Orioles.
The tear in Harvey’s UCL is one of the most common injuries for professional, college and youth pitchers, caused by massive, repeated torque, Wilckens said.
About 40 Major League athletes have, in the last two years, undergone a procedure named for Tommy John, the former New York Yankees pitcher who became the first player to undergo it in 1974, according to Mike Teevan, a spokesman for Major League Baseball. It’s a list that includes Stephen Strasburg of the Washington Nationals, who had a similarly successful start as Harvey, and Adam Wainwright of the St. Louis Cardinals, according to Teevan.
The decision by the Mets and Harvey will probably depend on the severity of the tear and whether it responds to rest and physical therapy, said Frederick Azar, a sports physician and vice president of the American Academy of Orthopaedic Surgeons.
“I’m still very optimistic,” said Harvey, who has a 9-5 record with a 2.27 earned-run average and 191 strikeouts, in a Aug. 26 news conference. “I’m going to do everything I can so I don’t have to get surgery.”
While Tommy John surgery has become a staple for professional players, Azar said it is increasingly common for high school pitchers who are “playing the sport year-round and not giving their body time to rest.”
From 2008 to 2011, more than a quarter of the procedures at the Andrews Sports Medicine & Orthopaedic Center in Birmingham, Alabama, one of the top centers for the surgery in the country, were on amateur athletes, according to information on center’s website.
When Lyle Micheli, director of the division of sports medicine at Boston Children’s Hospital in Massachusetts, sees a child with even a small a tear in their UCL he stops them from throwing for about three months, sending them in for physical rehabilitation and work with a pitching coach.
It is up to the parent to monitor how much a young athlete is throwing, after that. “I want the father to be a pitch counter,” he said in a telephone interview.
Micheli disputes the idea he’s heard from some parents that undergoing surgery even when there is no pain might improve a child’s competitive performance. He calls it a myth.
One reason the surgery is so often used is that the ligament, which is about the width of a shoelace, doesn’t heal well on its own, Azar in a telephone interview. That may be because it gets less blood flow or is surrounded by less soft tissue than others, which can help with healing, he said.
The innings-limit debate for pitchers has become a hotly-contested issue in baseball as a result of the growing number of young players who undergo Tommy John surgery. Miami Marlins rookie Jose Fernandez, for example, is on a limit despite his 2.30 ERA, third best in the National League.
Harvey threw 135 2/3 innings in 2011 as a minor leaguer, his first as a professional, and 169 1/3 innings in the major and minor leagues last year. This year he was up to 178 1/3 innings with the Mets planning to hold him to a 200-inning limit.
Other teams, such as the Texas Rangers, refuse to set ceilings, either for total innings or for in-game pitch counts, saying that better conditioning and techniques can help keep ligament tears at bay.
Doctors first began detailing pitching elbow injuries in 1941, according to the National Institutes of Health. In the 1960s and 1970s, about half of professional baseball pitchers were found to have elbow or shoulder pain. By that time, sports physicians were also using medical imaging technology to find evidence of joint damage.
The 1974 surgery to reconstruct the UCL on John occurred when he was a player for the Los Angeles Dodgers. Afterwards, his surgeon, Frank Jobe, gave John only a 1 percent chance of returning to play. Two years later, he returned to the major leagues and played for 14 more years, winning 164 games and making three All-Star teams.