Tommy John Surgery: The Epidemic

          One of the most common injuries in the sport of baseball to primarily pitchers, and some catchers, is the replacement of the Ulnar Collateral Ligament, also known as Tommy John Surgery. The injury has long been a part in the past time of baseball, not officially being diagnosed until 1974, when Tommy John, a left-handed starter whom the surgery was named after, underwent the procedure. It is almost a sure thing to believe that even though the surgery didn't exist before 1974, previous pitchers in the history of baseball must've been effected by the tear of their UCL, and had they undergone the procedure, perhaps their careers would've successfully been extended. To say Tommy John Surgery is complex is an understatement, and there are many precursors that lead to the surgery, helping todays physicians identify the early red flags, and attempt in some cases to stage off the surgery. There are a bevy of different reasons as to why a player may experience a torn UCL, and we'll hit off on that right below.
          Many who commonly watch the sport of baseball understand little about what pitchers undergo when they have ailing elbow and forearms. The words "Tommy John" are probably two of the worst pitchers hope to never here when being examined for a possible baseball-related injury. Of course, in most cases, there are red flags that eventually lead up to the ultimatum of having to go under the knife, but for some, it may come out of nowhere. Often explained as a sudden "pop" in the elbow, immense pain and numbness in the pinky and ring fingers are obvious signs of the ligament being torn. Leading up to the injury though, swelling around the elbow, forearm tightness, bicep tightness, and fatigue in the elbow are just a few of the most common signals a replacement of the UCL is needed. In most severe cases, numbness of is experienced along the ulnar side of the arm (the inside portion), with reports of limited range of motion in the elbow area as well. The procedure itself lasts only roughly an hour to an hour and a half, where a new ligament is inserted into the elbow, and often fastened in a figure eight pattern for elbow stability.
          The Ulnar Collateral Ligament is a combination of the anterior, posterior, and transverse bundle located on the inside part of the elbow, connecting the ulna and the humerus to one another. Without the ligament, pitchers would experience catastrophic pain and even be unable to grip a baseball, let alone throw one ever again. The success of the procedure now-a-days is well over 90%, with a recovery time of 12-16 months for pitchers, and a little less for position players. Tommy John recipients often start of with light toss on a flat ground surface, while undergoing physical therapy and slowly building arm strength back up to an optimal point. Light toss will turn into long toss over time, while after a lengthy period of time such as half a year to nine months, a player may start throwing off a mound. If the injury is sustained within the season, the pitcher will not return that season, and is also very unlikely to return next season as well, as recovery periods are often very sporadic and random.
          Many false accusations that many people make about Tommy John Surgery is that kids and young adults should undergo the replacement of their perfectly fine Ulnar Collateral Ligament, for a new one, just to "strengthen" their elbow. This is completely false information, and by no means will ever be suggested by a doctor. If a persons original ligament is still perfectly in place, and no out of the ordinary things are occurring while using the elbow, then it is not recommended to undergo the surgery. Another, which is heavily researched and still being discussed about, is the fact players who have higher velocity's and max out their arms have a higher probability to undergo Tommy John Surgery eventually. There are two parts two this; just throwing hard is not always a reason to believe TJS is more likely, but the arm angle at which someone may release a ball may put more pressure on the elbow. Pitchers who use more arm strength, less lower body strength, and throw from three-quarters to side arm release points may have a higher probability of having elbow trouble in the future. One way to help strengthen the ligament is to go old-fashion and do long toss often. The baseball community is a bit split on this, depending on what person you ask, some believe it naturally strengthens and keeps the arm healthy, while others believe it is unnecessary stress placed on the elbow. Whatever the case maybe, it is different for every which person who experiences arm fatigue or pain.
          Throwing hard versus throwing too many hard pitches may be a determinate in the frequency that Tommy John Surgery occurs for major league pitchers. Stephen Strasburg, Yu Darvish, Jacob DeGrom, José Fernandez, and Zach Wheeler are just a few of the big names to have had the procedure performed on them. One of the common traits amongst the group listed above is the amount of hard pitches thrown over the course of their early careers, as all are considered to be "hard-throwers", but the real questions come down to the percentage of time that each and everyone of them relies on throwing their fastball. With medical data becoming more and more informative and leading to better prognosis and treatment, there is hope for the future that not only the surgery can be performed more effectively, but that TJS can ultimately be performed less and less. Players will always throw hard, but by educating people on the red flags produced just by the simple action of throwing a baseball, efficiency can be increased in a players throwing motion, and the probability of a torn ligament can be reduced. Over the past two years, the amount of TJS recipients has been the highest ever in the history of the sport, and the commissioner of baseball, Rob Manfred, has indeed given notice to this rising problem. With TJS becoming ever so more likely in the careers of young baseball players, the sport itself will focus more data analytics on probability and research for decreasing the amount of ligaments torn or shredded. With the current group of Major League Baseball pitchers featuring high-octane velocity on a regular basis, when may question whether we have an epidemic or a case of velocity-happy mad-hatters out on the mound.