A UCL tear or strain requiring surgery is a devastating injury that can put a player out of action for a year or more. Most often associated with baseball pitchers, it involves damage to the ulnar collateral ligament, and can mend itself through rest, but is most often addressed through surgery.
Reconstruction of the UCL doesn't make a pitcher better, and there is no guarantee that with surgery, one will ever pitch again. If the procedure is successful, the recipient will at least be able to continue to pursue baseball as a profession, but if it isn't, it means the end of a pitching career. This problem has been all too frequent of late, and many recent pitchers have gone under the knife for the operation, better known as Tommy John surgery.
More than one-hundred major and minor league pitchers have had UCL reconstruction surgery in the past five years or so; more than ten of them have had it twice. Conventional wisdom suggests that improper conditioning, pitchers throwing too hard for too many pitches and innings, and lack of cross-training, contribute in varying degrees to the problem. It doesn't afflict every pitcher who throws very hard or for high pitch counts, but since no one can predict who will fall victim, every pitcher should learn all he or she can to try to prevent a UCL strain or tear.
The latest victims of this condition are two of Major League baseball's top prospects – Shohei Ohtani and Michael Kopech. Ohtani was a highly-touted rookie signed in 2017 by the L.A. Angels out of the Japan Pacific League after he starred as a pitcher and outfielder. His value is essentially double, as when he's not a starting pitcher, he is a formidable hitter. Kopech was a 2014, 1st round amateur draft pick by the Boston Red Sox (33rd overall), out of Mount Pleasant (Texas) High School, and recently made his first big league appearances for his new team, the Chicago White Sox. Ohtani continues to play for the Angels as a designated hitter, and apparently, no timetable has been determined for surgery. Kopech reportedly, will soon undergo the procedure.
Some of baseball's best pitchers have suffered a UCL tear and have endured the surgery and the lengthy recovery, including Tommy John (the man the procedure is named after), Hall of Famer John Smoltz, and Jim Morris, of The Rookie film fame. Other recent, well-known pitchers with a torn UCL include Johnny Cueto, Yu Darvish, Carlos Carrasco, Matt Harvey, John Lackey, Charlie Morton, Roberto Osuna, Jacob deGrom, Stephen Strasburg, and the late Jose Fernandez, among others. Some of them returned to the Major Leagues after surgery, and others are still recovering.
The injury involves a tear or stretching of the ulnar ligament on the inner elbow of the throwing arm. It causes pain, and prevents a pitcher from properly gripping and throwing a baseball with any kind of velocity or accuracy. In effect, it makes it impossible for a pitcher to do his job. A stretched or partially torn UCL may repair itself with rest, but in most cases, surgery is required, especially if the damage is severe. While there is no guarantee that TJ surgery will restore a pitcher to his previous ability level, or even enough to compete professionally; without it he is usually finished as a pitcher.
It should be noted that a UCL tear or strain is not confined to pitchers or even just baseball players. It is unlikely to occur outside of sports, but can happen in any sport where violent arm motion is part of the action (including tennis and volleyball, or a contact sport like football, where a fall on an outstretched arm can cause the damage.) Baseball pitchers though, are by far the biggest group susceptible to a UCL injury because of the nature of what they do.
The surgical procedure was developed by Dr. Frank Jobe, an orthopedic surgeon who worked with the Dodgers, Angels, the NFL Rams, and NBA Lakers. He first performed the surgery on the man whose name is most closely associated with it, pitcher Tommy John. Jobe performed John's elbow surgery in 1974; it was successful, and he returned to the mound in 1976, playing until retirement in 1989.
The surgery involves taking a piece of tendon from another part of the player's body, and grafting it in place of the damaged ligament. It is attached via holes drilled in the upper arm bone and a forearm bone, and threaded through the holes, something like how one laces a shoe. Because the replacement is a tendon, which in the body attaches a muscle to a bone, the recovery period must be sufficiently long to allow the tendon to strengthen enough to take the place of the ligament, which connects bone to bone. The procedure may be conducted as outpatient, but it takes a year or more to recover enough to pitch again, as the tendon must be strong enough to endure the violent motion associated with throwing fastballs, curves, sliders, and any pitch that puts stress on the arm.
For Ohtani, the young phenom from Japan, and a rare two-way player, it could end his career as a pitcher, but allow him to continue to play as a DH/outfielder. He is a talented hitter, and as DH, would never be required to throw a baseball. Ohtani, as a rookie in 2018, made ten pitching starts for the Angels, throwing 51.2 innings. The Angels placed him on the DL on June 8, with what was called a UCL sprain, hoping time off would allow the ligament to repair itself. He was activated on July 3, and played solely as DH until September 2, when he returned to the mound. He lasted only 2.1 innings in that game against the Houston Astros, and a few days later, the Angels announced the severity of the injury. For now, the team plans to allow their young star to DH for the rest of the season, with a decision on the torn UCL to come later.
Kopech, MLB's #13 top prospect, and the Chicago White Sox #2 prospect, threw 134.1 minor league innings this season for the Triple-A Charlotte Knights, before being called up on August 21 to the White Sox. After only four appearances for Chicago, Kopech was sidelined with the UCL tear. He seemingly has little or no choice; without the surgery, his Major League career would be over after four games.
While so many pitchers have suffered a UCL tear, it does not happen to everyone. Some sources estimate that one of every four pitchers may experience the injury, but every pitcher should takes steps to prevent it.
According to Dr. Chris Ahmad, New York Yankee team doctor, and his co-author Frank Alexander, "there is a 500% increase in risk for surgery for those players that pitch more than 8 months per year and a 400% increase in risk is observed for those that throw more than 80 pitches per game." (From an un-dated post on Mike Reinold.com.)
Glenn S. Fleisig, PhD, and James R. Andrews, MD, writing for Sports Health, indicate: "The main risk factors for elbow injury from overhand throwing include number of pitches per game, innings pitched per season, months pitched per year and poor pitching biomechanics which may increase torque and force on the elbow." (Prevention of Elbow Injuries in Youth Baseball Pitchers.)
Dr. Peter Wenger, a Primary Care, Sports Medicine Specialist said in a 2015 Joe Zedalis/N.J.com article: "It’s more important they focus on form and conditioning. Control and mechanics are far more important than velocity, especially for younger pitchers."
"Kids don't just play catch, and they throw curveballs wrong," said former major league pitcher Mark Leiter in the Zedalis article.
For young, aspiring pitchers, it costs you nothing to heed the advice of professionals if you want to maintain a healthy arm and UCL. Follow proper conditioning techniques, especially for the throwing shoulder and arm. Take time off from baseball for at least several months of the year, and play other sports that do not involve violent arm motion. Don't overthrow, and avoid throwing curveballs and sliders, at least before your body has a chance to develop strength and resilience. If you're going to throw those pitches, be certain your mechanics are correct. Otherwise, if you need an out pitch, develop a changeup, which won't put as much stress on your arm as would an improperly thrown curveball or slider. Don't try to throw through arm pain, and be careful with pitch counts.
You owe it to yourself and your family to take care to avoid what could be a devastating and career ending injury.
Larry Manch is an author, teacher, guitar player, freelance writer, and columnist. His books include: 'Twisted Logic: 50 Edgy Flash Fiction Stories', 'The Toughest Hundred Dollars & Other Rock & Roll Stories','A Sports Junkie', 'The Avery Appointment', 'Between the Fuzzy Parts'. His books are available in paperback and e-book.
He writes about sports for Season Tickets, food and travel on Miles & Meals, and music/guitars on The Backbeat.
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