Paragon Press – June 2014

Ouch, My Elbow Hurts!

Tommy John surgery proves very successful; Why so many Elbow problems begin at young ages

Many people have elbow issues, especially at older ages, simply from overuse. Once the elbow discomfort reaches a point when you cannot function, surgery is considered. In the last 10 years, there has been a sudden increase in elbow surgery mainly in athletes, and of those, mostly baseball players. Baseball pitchers of every age are throwing harder and starting at younger and younger ages. These two factors alone add a lot of stress to a very delicate ligament in the elbow, known as the ulnar collateral ligament, or UCL. The surgery to reconstruct this ligament is called Tommy John surgery, named after the former major league pitcher who was the first to have this surgery. When the UCL is damaged, there is often pain and instability with throwing, thereby making accurate, fast pitching impossible. This can be corrected with surgery, where the ulnar collateral ligament is replaced with a tendon from elsewhere in the body. Many collegiate and professional athletes from many sports have this surgery, but it’s most notable in baseball.

So why the sudden increase in the number of people having Tommy John surgery? Since 2004, the number of these surgeries has tripled in the major league pitching community, from 12 in 2004, to 36 in 2012. The surgery has proven to be so successful that pitchers want the surgery done as soon as possible, and the MLB boasts a long list of pitchers who have successfully returned to pitching afterward, earning tens of millions of dollars post-surgery. There is the lure of believing it’s a guaranteed fix, and for major league pitchers, a lot of money is at stake.

The downside: It’s not fool-proof

There’s no injury that can’t be made worse with surgery. A study in the American Journal of Sports Medicine showed a 97.2% rate of return to pitching in the pros. The rate of return is much lower in amateur or college athletes. The typical rehabilitation period is a year, but can be longer. Athletes can spend a long time on the disabled list and some might never see a return to full function. Pitchers are throwing higher velocity baseballs and something has to give when they keep this up over time. It seems it’s the elbow that takes the brunt of the force.

Younger and younger ages – A lesson for all kids

Kids these days seem to be forced into choosing a specific sport, which doesn’t allow any period of healing for parts of the body that are stressed. Well-meaning parents start a child in baseball at 5 or 6 as a pitcher, then a coach might encourage playing on a travel team in the off-season to continue improvement. As a result, studies show the child becomes three times more likely to end up requiring surgery than those kids who don’t play baseball year-round. Parents have to be careful about overuse in the body, paying attention to a child’s complaint about soreness and providing rest for that part of the body. More is not always better.


#1-The injury happened suddenly or from overuse in a game.

These are myths because tests have shown the ligament becomes torn and frayed over years. The years of abuse take their toll and the ligament snaps.

#2-Some pitchers have found that they throw harder after the Tommy John surgery.

Indeed, they might, but the results are not from the surgery. Pitchers throw harder as a result of the rigorous work they did for rehabilitation.

Question: How can you expect a ligament, that doesn’t have as much blood supply as the muscles, to endure repeated wear and tear from excessive, high velocity throwing, such as that which happens in pitching?

The answer: You can’t.

Pitchers have developed their musculature to deliver a pitch that maximizes their potential, but the ligaments and tendons simply can’t keep up with that force. We can’t expect that major league pitchers will slow down, but we can be aware of the demands we place on the Little Leaguers and other young athletes who compete or pitch in year-round travel teams where a lot of stress is placed on the elbow. We need to respond to their complaints of elbow pain with ice and rest.

The insights we’ve gained from the studies on Major League pitchers can be applied to many other people with elbow issues. Any elbow injury is initially treated with rest, nonsteroidal anti-inflammatories (ibuprofen), and ice. Patients then go through a physical therapy regimen to strengthen surrounding muscles. In some cases the injury will respond well to a cortisone or platelet injection. There are those candidates who prove to benefit from immediate surgery. These patients have not responded to non-surgical treatments and they want/need to resume strenuous throwing as soon as possible. In most cases these are elite high school, college or professional athletes who specialize in throwing. Orthopedic surgeons often recommend a non-surgical approach for weekend athletes as they will likely do just fine without “Tommy John” surgery.

The following articles were referenced for this newsletter: