One of the most common surgeries that baseball pitchers undergo is Tommy John surgery. It’s named such because Tommy John was the first pitcher to undergo this repair in 1974. It is a surgery that helps to repair the ulnar collateral ligament [UCL] in the throwing arm and it takes a tendon from another part of the body to replace the damaged part. The first UCL surgery was performed by Dr. Frank Jobe and this injury is usually confined to the elbow in the throwing arm.
Statistics on Tommy John Surgery
1. The average amount of pitchers that underwent Tommy John surgery annually in the last decade: 16.
2. In 2012, a record of 36 procedures were performed on MLB pitchers.
3. It is believed that 33% of MLB pitchers have had this surgery as of the start of the 2014 baseball season.
4. There are currently 124 pitchers in Major League Baseball who are known to have had Tommy John surgery.
5. It is not uncommon for people to be able to throw harder after surgery than they were ever able to before the surgery.
6. Before the year 2000, only two years [1999 and 1996] had more than 10 operations completed. After the year 2000, there has never been fewer than 20 procedures completed.
7. Professional pitchers get back to the major leagues 87% of the time after they have the surgery completed.
8. Earned Run Averages of pitchers that come back after Tommy John surgery are 0.60 higher upon return to baseball.
9. In the year before Tommy John surgery, UCL pitchers’ performance declined significantly.
10. 60% of MLB pitchers require a UCL reconstruction within their first 5 years of playing professional baseball.
11. Dr. Jobe was a medical supply sergeant in World War II at the age of 18 and was the on-staff doctor for the Los Angeles Dodgers.
12. The amount of high school pitchers who believe that Tommy John surgery should be performed even though no injury is present: 1 in 2.
13. The average length of a Tommy John surgery: 60-90 minutes.
14. Kids have been shown to be more reckless with their pitches and pitching fundamentals because they figure they can just have Tommy John surgery later to fix a problem.
15. 15% of people actually lack the tendon that is most commonly used to fix the UCL tendon during Tommy John surgery.
16. The record amount of Tommy John surgeries on one player: 3 to Jose Rijo, who also had two additional arm operations.
17. Tommy John only missed 1 start after coming back from his surgery and it was because he got the flu, not because of a joint problem.
18. To help prevent kids from developing the need for Tommy John surgery, an iOS mobile app helps to teach pitching fundamentals.
19. 24% of players, 20% of coaches, and 44% of parents believed that a player who received Tommy John surgery would return in less than 9 months, even though recovery time averages 15 months.
20. 1 out of every 5 baseball coaches believes that a player’s performance is enhanced by Tommy John surgery.
21. Up to 10% of pitchers who receive Tommy John surgery are not able to return to the same level of performance that they had before the injury.
22. The number of Tommy John procedures that have complications afterward that must be medically addressed: 20%.
23. Only 4% of Tommy John surgeries result in serious complications that must be immediately addressed.
24. 67% of the pitchers who wind up needing Tommy John surgery were throwing breaking balls before the age of 14.
25. 85% of pitchers who required Tommy John surgery showed at least one overuse category out of the 3 primary risk factors for this injury.
26. 85% of the time, pain of a UCL injury is associated with the acceleration phase of throwing because of an inadequate warming up period.
27. There has been an approximately 50% increase in UCL reconstruction in high school players.
28. 60% of the recipients of Tommy John surgery annually are collegiate and high school athletes.
29. A lack of fundamentals could be to blame: a 20% reduction in leg and hip movement requires a 34% increase in rotational velocity to make up the speed difference of a throw.
30. If a Tommy John surgery needs to be completed again, the average time between surgeries is 3 years.
31. Once more than one Tommy John surgery is performed on an athlete, their chances of success drop to 33%.
32. The chances of complications rise to 40% when there is more than one Tommy John surgery performed over an athlete’s lifetime.
How is the UCL damaged in the throwing arm? It is believed that the damage occurs through repetitive high speed throwing motions. The incidents of injury are rising in pitchers and young baseball players and eventually the ligaments and tendons of the arm just can’t take it anymore. In the first surgery, the odds of Tommy John returning to play baseball were just 1%. He beat those odds and won 146 more games before eventually retiring, although he was out for 18 months. With modern surgery, it takes about 15 months for a pitcher to fully return and about 6 months for a position player.
Although baseball players take up much of the news about UCL injuries, the sad truth is that anyone can end up with this type of injury. Any time there is repetitive stress to the elbow, even if it is just from trauma, then the circumstances are present for this injury to occur. It is the throwing motion, however, that puts people most at risk because the ligament can stretch to the point through small tears and rips that it can’t hold the bones tightly enough together any more.
When pain is felt on the inside of the elbow, along with a feeling of the joint being loose or unstable, then there is a good chance that a UCL injury has occurred. This is especially true if there is the feeling of hitting your “funny bone” present on a consistent basis. There will be a decreased level of strength in the throwing or hitting motion present as well. Although a physical examination may sometimes be enough to diagnose this injury, an MRI is generally required to confirm a suspicion. The only way to repair the UCL injury is through the Tommy John surgery.
Effects of Tommy John Surgery
The fact that so many kids, parents, and coaches are looking at Tommy John surgery as a proactive measure is disturbing. It means that there is less of a focus on personal care because the surgery is seen as a guaranteed way to fix a problem that could develop.
Kids are looking at pitching as a major payday and with national television coverage of Little League games, they are under a lot of pressure to perform. It used to be that coaches would take pitchers out of a game if they threw a curveball as a kid. Now coaches are looking at speed and velocity more than mechanics in kids and that could be a big reason as to why there is such an increase to Tommy John surgeries being performed.
Because Tommy John surgery is seen as a fail-safe, pitching becomes based on situations instead of fundamentals. The only problem with this perspective is that there is no guarantee that a pitcher can return to the game or an athlete can come back to their preferred activity after the surgery. An 83% total success rate is impressive, but that means 17 out of every 100 kids that gets their UCL repaired is going to be unable to play again. Gambling on this surgery just to throw curveballs before a kid’s arm fully develops doesn’t make a lot of sense.
The steroid era in baseball might be to blame for part of this. Steroids don’t really help pitchers with the throwing mechanics, but it certainly helped hitters beef up and hit balls further. Pitchers felt the need to create results and so pitching mechanisms became more complex and breaking pitches with more torque were added, even if the pitch felt uncomfortable, because that was the only way seen to get an out.
Although anyone can damage their UCL, the fact remains that the baseball pitcher is at the greatest risk of suffering this injury. Making sure that proper warm-ups happen for kids, cool downs with ice occur on the joint, and that pitch counts are followed are just a few of the responsible ways that the prevalence of this injury can become reduced. A focus on total fundamentals should be emphasized on every level and maybe it’s time to go back to the day when coaches would pull a young pitcher if they threw a ball that could hurt their harm.
Expecting Tommy John surgery to work is a dangerous perspective to have.