Oh, snap!: Tommy John Surgery

Named “Best Sports News Article: 2014-2015” by Manhattan College’s “The Quadrangle”

The need for a pitcher to undergo Tommy John surgery (TJS) — repairment of the ulnar collateral ligament — is an epidemic.

Between ’05 and ’11, the average number of TJS cases in Major League Baseball per year was 16. That number skyrocketed from ’12 to ’14, increasing to 28 per year. In ’14 alone, there were more TJS conducted than in the entire ’90s: 80, according to ESPN’s Sport Science.

TJS has an 80-percent success rate, which is high but still leaves pitchers with a one in five chance of failure, according to USA TODAY Sports.

“It’s not so much the MLB organizations but the pitchers, even going back to youth baseball, which is problematic,” Andy Martino, “New York Daily News” baseball insider, said. “A lot of times pitchers are drafted already well along the way in having this kind of damage because of overuse. … There are all kinds of debate. Nobody knows the answer. Teams are trying all sorts of different things and there’s no evidence that anything is really helping or hurting. It’s just hard to figure out.”

From ’94 to ’97, of those who had TJS done at the American Sports Medicine Institute, 100-percent were adults. Skip to ’10, the procedure has spiked to 40-percent for teenagers.

The overuse Martino mentions is seen in one-sport athletes, specifically baseball players, more so than in a multi-sport athlete, according to, Montefiore sports medicine specialist Dr. Tony Wanich said, who sees about five TJS cases each year.

“You do see it in other sports it’s just most of time those players don’t need surgery,” Wanich said. “It’s really just the baseball players that end up needing surgeries because of the unique stresses that get put on by throwing a baseball.”

Stephen Strasburg talking about his torn elbow ligament that will require Tommy John surgery and keep him inactive until 2012. (Photo Credit: David)

This stress Wanich is referring to is called a valgus stress. The arm is able to rotate further back more than the average person can, according to Wanich. As pitchers throw too much and too long on high school and travel baseball teams year round, their age, weight and bone development aren’t being monitored because of how many places they are pitching.

“It’s the younger years, where we’re just throwing and throwing and throwing,” Manhattan College pitcher Mike Scarinci said, who first injured himself in April ’13. “That needs to be limited. As a kid, we’re not doing the same things as we’re older. We’re not long tossing every day to develop arm strength. And obviously we’re not doing what’s called ‘pre-hab’ — shoulder exercises — to strengthen everything up to avoid rehab.”

He rested for two weeks after his injury and rehabbed but couldn’t get himself to 75-percent.

“I felt a tightness and then I was pitching in a game, and it just got worse and worse,” Scarinci said. “And then eventually it was at the point where I was throwing the ball 55 feet, I couldn’t get it to the plate. My velocity dipped eventually. Every pitch was just screaming pain as if someone was stabbing me in the elbow.”

The first doctor’s opinion he received said it was a partial tear of his ulnar collateral ligament, and the second and third opinions said it was full blown.

He underwent TJS in June of that year and returned to the mound this season.

Partial tears are developed throughout a career without a pitcher realizing it, but breaks between pitching heal the UCL and helps their longevity, Wanich said. That’s why he says he encourages them to play other sports between seasons.

“Every pitch that anybody’s ever thrown, from the time they started throwing, is where it counts,” Wanich said. “This injury is not this one time throw that just pops it. It’s this chronic, every little by little insult that it experiences to build upon the previous one. … When you focus on one sport so exclusively, overtime it just takes that toll.”

This article also appeared on “USA Today College.”

  • Robert Monteagudo

    Great article! MLB is currently focused on power pitching, both starting and relieving. As a result any current player, position or pitcher, will get promoted faster because they can throw the ball in the 90’s, Jason Motte is a good example and also a good example of a worst case scenario for position players being converted to pitchers. These type of pitchers arms aren’t prepared to handle the conversion and inevitably break down. MLB has many such players in the pipeline so unless they come up with a true solution, this will keep happening. The MLB position translates all the way down to Little League where teams focus on power pitching which explains the 40% spike in youth TJ surgeries. Hate to sound old but I look back to the 70’s & 80’s and the examples of Don Sutton and Tom Seaver, for argument’s sake. While pitchers of that era also suffered from “blown out arms”, today recognized as ulnar collateral ligament tears, there was more concentration on developing sound, repeatable, pitching mechanics. Sutton and Seaver threw on regular pitching regiments, Sutton pointed out in an interview that in that era they threw practically every day whether it be long toss, batting practice, catch, bullpen or game. You point out in your article the key point of taking time off in the winter to rest by simply resting or playing another sport. Sadly, many baseball programs continue year round to the detriment of players that will ultimately undergo future Tommy John surgeries. The lure of making an MLB salary (what’s the minimum now, 2 million?) is too great.