Throwing a ball overhead is one of the most stressful things you can do to your elbow. That’s why elbow injuries are so common in baseball players, specifically pitchers, from Little League to Major League.
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It’s the ulnar collateral ligament (UCL), the stabilizing band on the inside of your elbow, where your arm bends, that causes the most trouble.
The number of UCL sprains in youth and adolescent athletes has increased dramatically in the past five years. And currently one in four Major League pitchers has had UCL reconstructive surgery, says Mark Schickendantz, MD, orthopaedic surgeon and head team physician for the Cleveland Indians.
UCL reconstruction — also called Tommy John surgery, after the Los Angeles Dodgers pitcher who was first to have it in 1974 — is quite successful, says Dr. Schickendantz. But interest in the procedure has soared since ball players began claiming that Tommy John surgery improved their throwing.
It’s a misperception, however, says Dr. Schickendantz.
“The surgery may help you throw better than you did with a damaged UCL, but it isn’t a performance enhancement,” he says. “Tommy John surgery is not an elective surgery for ball players trying to improve their ability. It should be performed only when necessary.”
Here Dr. Schickendantz answers some common questions about elbow injuries in baseball and Tommy John surgery.
Q. Why are UCL injuries so common in youth baseball today?
A. There is no hard evidence, but there are several theories. We think there are more elbow injuries today because kids are starting to play baseball younger, throwing harder and throwing year-round, not giving their elbow time to rest and recover.
Q. What does a UCL injury feel like?
A. Usually there is pain on the inside of your elbow during throwing, specifically as you transition from late cocking to forward acceleration. Some players hear a pop from the inside of their elbow, but that’s not common. A pop can indicate a very bad UCL injury.
Most UCL injuries occur gradually from overuse. Due to the stress of repetitive throwing, your UCL wears down. It gets thinner, like the knees on an old pair of jeans, and becomes more painful over time.
Q. What should I do if I have elbow pain?
A. Many pitchers experience soreness after pitching. If you’re feeling elbow pain that is different than your typical post-pitch soreness, watch and wait for a few days. If the pain persists, take a week off from throwing. Apply ice to the inside of your elbow and take anti-inflammatory pain relievers. Return to throwing gradually. If there is still pain, see a sports medicine specialist.
Q. Should I have Tommy John surgery?
A. That’s up to you and your doctor. Many UCL injuries will heal on their own and not require surgery. Your doctor may recommend physical therapy or biologic injections.
Tommy John surgery usually is recommended only when a UCL has completely torn away from the bone and will not heal on its own. The procedure is a full reconstruction, taking a tendon from your forearm or elsewhere and attaching it as a whole new ligament.
Besides Tommy John surgery, techniques that repair rather than replace your UCL are becoming more popular.
Q. Will Tommy John surgery help me pitch better?
A. No. Surgery will not help you perform any better than you could before your injury.
Also, as with any surgery, there are risks. Only about 80 to 83 percent of professional baseball players return to the same level of performance after having Tommy John surgery. For high school players (age 18 and younger), it’s less — around 70 to 73 percent.
Q. How can I prevent elbow injury?
A. Youth and adolescent players as well as their parents and coaches should follow USA Baseball guidelines on limiting pitch counts and number of days on the mound.
Young athletes should not throw year-round. They should have at least two (ideally three) months off from pitching each year. I tell my patients, “If you have the talent, it will still be there eight weeks from now.”