Tommy John Injuries – Part 1

As winter gives way to spring and the smell of fresh cut grass fills the air, people will emerge from their winter hibernation and begin the trek to baseball and softball parks.  The crack of a bat, the pop of a ball hitting a mitt, and the chant of “here, batter, batter” will increasingly be heard as people of all ages turn their focus towards America’s pastime.

Most people who have spent much time around baseball have inevitably heard the words Tommy John injury.  When we refer to a Tommy John injury, we are actually referring to the Ulnar Collateral Ligament or UCL.  Prior to 1974, a torn UCL was a career ending injury to any high level baseball player.  Tommy John was a professional baseball player who began his career in the early 1960s and played in the majors until the early 1980s.  His career did hit a bump in 1974 when he was diagnosed with a UCL tear.  Up until that time, there were not any good options to repair or reconstruct this ligament.  Mr. John was evaluated by a Sports Medicine physician by the name of Dr. Frank Jobe in California.  Dr. Jobe ultimately reconstructed Mr. John’s UCL with a new surgical technique, and thus the Tommy John surgery was born.  Following the surgery, Mr. John was able to return to a high level of competition and resume his professional baseball career.

Today, over 40 years after the first UCL Reconstruction (Tommy John Surgery), there is almost an epidemic of UCL injuries in Major League Baseball pitchers.  Baseballheatmaps.com compiles the MLB’s injury data on their website.  According to that information, there were 17 UCL reconstruction operations in 2012, 28 operations in 2013, and 19 operations in 2014. The American Sports Medicine Institute’s position paper on Tommy John injuires states, this rise in professional UCL injuries corresponds to the sharp rise in adolescent UCL injuries that was seen in the late 90s and early 2000s.  It is believed by many that a torn UCL in a professional pitcher is often the result of accumulated stress that has worn the ligament out over time.  The injuries that are being seen now on a Major League level are likely related to the stresses these athletes underwent when they were in adolescence.

From time to time, baseball or softball players may notice some pain on the inside (medial side) of their elbow.  This may be a sign of ulnar collateral ligament or UCL injury.  The following may also be symptoms of a UCL or Tommy John injury:

•    pain with throwing
•    decreased velocity
•    numbness or tingling in the pinky and ring finger
•    tenderness on the inside of the elbow

Some athletes may hear or feel a “pop” during a specific throw, but not every athlete will describe this “Uh oh, I just hurt my elbow” moment.

If you are concerned that you or your young athlete may have an injury to their UCL, theyshould be evaluated by a Sports Medicine Physician who commonly evaluates the elbow of throwing athletes.  Often the use of Magnetic Resonance Imaging (MRI) is used to evaluate the integrity of the UCL and rule out any other causes of the elbow pain.

Having a torn UCL is no longer career ending to a professional or aspiring baseball player.  Our physicians at Elite Sports Medicine and Orthopaedic Center have vast experience with this athletic injury and the treatment options.  We would be happy to evaluate any athlete’s elbow pain and provide the corresponding treatment to enable them to return to activity as quickly and safely as possible.
Please call us at 615-324-1600 for an appointment.

Coming Soon—
One of our goals at Elite is to help individuals prevent injury while competing in athletics or pursing an active and healthy lifestyle.  New research has shown ways that throwing athletes, particularly baseball players, can reduce the risk of UCL injury.  Stayed tuned for more blogs exploring ways to reduce injury risk and address some common myths associated with UCL or Tommy John Injures.  In the meantime, enjoy the ball park!

Stephen Hasselbring, PA-C, MSM, ATC
Physician Assistant for Dr. Burton Elrod, MD
Elite Sports Medicine and Orthopaedic Center

Tommy John Injuries Part II

There is little debate that Tommy John or UCL injuries are a problem at both the major league and amateur levels of baseball.  However, there are some myths floating around the ballparks that are worth addressing.  Many of these misconceptions are addressed in the American Sports Medicine Institute (ASMI) recent position statement for Tommy John Injuries.

FACT or MYTH?

Having Tommy John Surgery allows me to throw better and harder than before.
MYTH. 
To some this notion may sound crazy, but surveys and studies have shown that between 25-50% of amateur players, parents, and coaches believe this.  There have been some reports of athletes electively having surgery on a healthy elbow in hopes of increasing ability.  Having surgery on a healthy elbow to increase ability is the wrong reason to have surgery.  Many athletes do return to a high level of play after surgery and some may throw harder post- surgery, but this increase in performance is more likely a result of fixing the damaged ligament and exhaustive work with physical therapists, strength coaches, and pitching coaches afterward.  If any athlete spent 6 months of dedicated time to work on mechanics and strengthening their arm, core, and legs there would likely be an increase in performance.  Most studies actually show that between 10-20% of pitchers don’t make it back to their previous pre-injury ability.  The good news is that if you have an injury 90% of pitchers can return to their previous level of performance.  It is time to have surgery if you have an injury and it is limiting your ability to play.  It is not a good idea to have surgery on a healthy elbow because you think it will give you extra ability that you would not otherwise have.

Throwing too many curveballs leads to Tommy John / UCL injuries:
MYTH. 
Lots of research has been done on the biomechanics of pitching and throwing curveballs.  That research hasn’t shown a big correlation between curveballs and elbow injury.  This is assuming that the athlete is strong enough and mature enough to throw a curveball with good mechanics.  Some youth pitchers may have received proper coaching and may be physically mature enough to throw curveballs, but there are many that don’t fall into this category.  The ASMI recommends that young pitchers and players follow these simple steps to help avoid injury related to curveballs.
1.    Learn basic throwing
2.    Learn fastball pitching
3.    Begin change-up pitching

If we lower the mound we can reduce stress and injury to the elbow:
MYTH.
There is still some debate when it comes to this.  No clear evidence proves that throwing from a mound puts a significantly greater amount of stress on the elbow.  The link to elbow injuries is likely more related to the amount of maximum effort throwing (pitching) instead of the mound height.  Lowering the mound height won’t by itself decrease injury if young pitchers are still throwing as hard as they can too often.  You can reduce this “max effort throwing” by playing other positions and playing other sports.  I like the way the ASMI puts it.  If a child has the goal of becoming a successful adult pitcher, then they should focus on being a young athlete who is a good pitcher, not just a youth pitcher.

Too much pitching leads to Tommy John injuries:
TRUE. 
This one is actually true.  Generally when an Orthoapedic Surgeon operates on a torn UCL they find a ligament that has been frayed and repetitively injured over time.  Elite Sports Medicine and Orthopaedic Center’s founding physician Dr. Burton Elrod describes it like this:

You have seen those cartoons where the character is hanging off the edge of a cliff while hanging on to a rope.  While he is hanging there the rope is popping strand, by strand, by strand.  Eventually the rope tears.

Repetitive maximal effort throwing can “fray the rope”.  In our current culture many players play in the traditional spring season, then play summer ball, then play fall ball, then take lessons, and repeat.  There has been a strong link shown between too much competitive pitching and injury.

If all this information leaves you feeling like throwing athletes are destined to injury, rest assured this is not the case.  There are ways to pitch competitively and compete at a high level while protecting the throwing arm.  We will address some of this in our third and final Tommy John blog coming soon.  Stay tuned…

Stephen Hasselbring, PA-C
Physician Assistant to Dr. Burton Elrod
Elite Sports Medicine and Orthopaedic Center

Elite Sports Medicine and Orthopaedic Center treats the injuries of baseball and softball athletes from the very young player through the major leagues.

If you need us please call 615-324-1600 for an appointment.

Please also read Tommy John Injuries Part 1- our first blog on Tommy John injuries.
https://www.eliteorthopaedic.com/blog/tommy-john-injuries-part-1

Tommy John Injuries – Part III

Ultimately the goal with pitchers of all levels is to prevent injury to the arm. Elite Sports Medicine and Orthopaedic Center’s Dr. Burton Elrod explains that with high level athletes (amateur or professional) there is a fine line between maximum performance and injury. The goal is to maximize your ability and potential while at the same time taking the necessary precautions to avoid injury. The American Sports Medicine Institute has come with recommendations for both professional pitchers and youth baseball pitchers to reduce the risk of Tommy John injury.

The following recommendations are taken directly from the American Sports Medicine Institute’s (ASMI) position paper for youth baseball pitchers:

•    Watch and respond to signs of fatigue (such as decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing.
•    No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year.
•    Do not pitch more than 100 innings in games in any calendar year.
•    Follow limits for pitch counts and days rest. (See Below)
•    Avoid pitching on multiple teams with overlapping seasons.
•    Learn good throwing mechanics as soon as possible. The first steps should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.
•    Avoid using radar guns.
•    A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury.
•    If a pitcher complains of pain in his elbow or shoulder, discontinue pitching until evaluated by a sports medicine physician. Inspire youth pitchers to have fun playing baseball and other sports. Participation and enjoyment of various physical activities will increase the youth’s athleticism and interest in sports.

I find the recommendation to avoid radar guns particularly interesting. As a culture we tend to like statistics in sports. We often ask about athletes- how much can they lift, how fast are they, how far than they hit it, how hard can they throw, etc…I am guilty of this too. Often when an athlete comes to our office I ask how hard they can throw. I really just ask because it is a conversation starter. The answer to that question will likely not affect the course of treatment or my evaluation of that player. However, by asking the question I have placed an emphasis on velocity. Velocity should not be a pitcher’s (or my as a medical provider) number one priority. The number one priority should be placed on getting batters out. Chris Heston of the San Francisco Giants recently threw a no hitter against the New York Mets while never topping 91 mph on the radar gun, proving you do not have to throw in the upper 90 mph’s to be an effective pitcher.

Below is a table with recommended guidelines for limiting the number of pitches thrown in games. This is taken directly from the American Sports Medicine Institute’s position paper for youth baseball pitchers:

Chart

In addition there is a very helpful smart phone app available. Throw Like a Pro: Throw Faster, Stronger, and Safer (by Abracadabra Health) is a $10 app designed by Dr. James Andrews and physical therapist Kevin Wilk. The app includes in season and off season strength work, pitch counters, and long toss programs that are in line with the ASMI’s recommendations.
It is my hope that over this three part Tommy John series you more informed about what exactly a Tommy John injury is, why we have seen an increase among Major League players, common myths associated with this injury, and ways to help prevent this injury.

One last thing – Let us help! I know that people generally get anxious about going to see a doctor. There is always a fear that the physician may give you bad news or recommend that you to stop doing something you really enjoy. That is not our goal at Elite Sports Medicine and Orthoapedic Center. Our mission is to provide unsurpassed orthopaedic care to our patients so that they may pursue and maintain more active and healthy lifestyles. Ourgoal is always for you or your child to continue participating in the sports and activities you enjoy, but we want that participation to be as safe and injury free as possible.

If you have any orthopaedic need please contact our office at 615.324.1600 and schedule an appointment with us today!

Stephen Hasselbring, PA-C
Physician Assistant to Dr. Burton Elrod.