The Epidemic You Haven’t Heard About: The Tommy John Epidemic

By: Jason Comeau

While the world continues to deal with and address the issues brought forth by the COVID-19 pandemic, one sense of normalcy that has returned is professional sports. As the Major League Baseball playoffs and World Series begin, we will see some of the hardest throwing and best pitchers continue to dominate the sport. The New York Yankees Pitcher, Gerrit Cole, will continuously throw an average fastball of 97.6 mph while Yankees closer Aroldis Chapman averages a 100 mph fastball and has thrown the fastest pitch in Major League history at 106 mph. However, while you may be cheering on your favorite team and the players on the field, you will not be seeing Yankee pitchers Luis Severino or Tommy Kahnle, who have missed the entire season due to Ulnar Collateral Ligament (UCL) tears, an injury that is occurring to baseball players at an alarming rate.

An ulnar collateral ligament tear, commonly referred to as a UCL tear, is a tear in the elbow of the ligament that connects the humerus to the ulna. The ligament is extremely important in motions such as throwing a baseball, and provides stabilization of the arm under severe stress such as pitching. Under repetitive severe stress, the UCL can develop micro-tears which later develop into large tears. These large tears of the UCL lead to extreme pain and make it impossible to throw a baseball at high velocity and difficult to throw effectively without undergoing surgery.

Ulnar collateral ligament reconstruction, often known as “Tommy John surgery”, was originally pioneered by Orthopedic Surgeon, Dr. Frank Jobe. In 1974, Jobe reconstructed the ulnar collateral ligament of former Los Angeles Dodgers pitcher Tommy John, for whom the surgery is named. Originally, Dr. Jobe believed there was a one percent chance of success in the surgery, however Tommy John went on to have another 14 successful seasons in the MLB, and today, in 2020, the surgery has become so successful that 82% of all pitchers who have the surgery recover. The rehabilitation process takes an average of 12-15 months for a full recovery, leading to players missing at least one year of baseball. It is estimated that in the 2018 season, according to the Washington Post, UCL tears cost teams more than 200 million dollars in lost playing time from the surgery.

Although the surgery has become more successful, it does not explain why pitchers are increasingly tearing their UCL and the need to undergo the surgery. In 2018, renowned orthopedic surgeon Dr. James Andrew’s stated that, “more pitchers underwent Tommy John surgery in just 2018 than had been performed in the entire 90’s decade .” In addition, it is not just pitchers in professional baseball, but the rate of college pitchers and high school athletes who are undergoing UCL reconstruction has also risen. According to the American College of Sports Medicine, in the decade of 2000-2010, 88% of surgeries were performed on professional baseball players. However in the year 2019, only 7% of Tommy John surgeries were performed on professional athletes while 57% are performed on high-school athletes. A major concern among physicians and baseball teams is how an injury, that is mostly due to chronic overuse, is now primarily afflicting high school teenagers and prospects instead of older professional athletes. This is what experts are calling the “Tommy John Epidemic.”

Like many sports, strategy in baseball has changed overtime. Previously, accuracy and effective pitching in pitchers such as Greg Maddux or Tom Glavine were more valued by professional baseball teams compared to pure velocity. However, over the past decade the emphasis on control and a wide array of effective pitching has been replaced by high-velocity pitching. In 2008, only 11 pitchers across all of professional baseball averaged 95 mph or higher. In 2018, only ten years later, 74 pitchers averaged 95 mph and above, a 670% increase. According to Glen Fleisig of the American Sports Institute, “this increase in high velocity pitching leads to pitchers increasing torque in their arms, effectively leading to more stress directed towards their elbow.” This increased stress on the elbow is one of the major reasons experts believe professional baseball players are injuring their arms at an alarming rate, however it does not directly explain the increase in younger athletes.

Many experts attribute the increase UCL tears among teenagers to players and coaches not protecting their arms at a young age. Although there are often pitch counts limiting the amount of stress a young player can put on their arm, it has become increasingly common for young athletes to play for multiple teams. As athletes perform for multiple teams, there are no longer regulations preventing players from doubling or tripling the stress on their arms. It is the responsibility to the coaches, players, and parents to properly protect their athlete’s arm. Unfortunately, winning or the extra opportunity to perform in front of college or professional scouts prevents players from resting their arms, and instead, they increase the workload on their arm. Lastly, some experts contribute the rise in young athletes to radar guns becoming cheaper and more economical. No longer do only professional scouts or a few high level college programs have access to radar guns, but every scout or high school coach can have access to radar guns. According to Jeff Passan in his book The Arm: inside the Billion Dollar Industry of the Most Valuable Commodity in Sports, “the wide availability of radar guns has caused young athletes to no longer focus on mechanics, location, or off-speed pitches, but rather do anything possible to increase the number on the gun.” This increased emphasis on high-velocity pitching and the lack of proper mechanics, compounded by the increased workload young athletes are putting on their bodies, is leading to the Tommy John Epidemic. As future physicians, it is important to be aware of an issue that is plaguing both professional and young athletes while being aware of the methods of prevention to limit such injuries from occurring.

Jason Comeau is a second year medical student at The American University of the Caribbean School of Medicine


Sources:
https://www.chicagotribune.com/entertainment/books/ct-prj-the-arm-jeff-passan-20160426-column.html
https://www.washingtonpost.com/sports/2019/05/21/velocity-is-strangling-baseball-its-grip-keeps-tightening/?arc404=true
https://www.chicagotribune.com/entertainment/books/ct-prj-the-arm-jeff-passan-20160426-column.html



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