When Dr. Jobe taught me the intricacies of Tommy John Surgery in 2001, he was performing the surgery on professional pitchers. And indeed, when I started my surgical practice and my work with the New York Yankees, I was seeing primarily elite pro pitchers with UCL injuries. Then as time went on a new pattern of patients were filling my exam rooms. The office was filled with college athletes. College pitchers were suddenly tearing their UCLs.
During this time, I also observed a change in Yankee draft pick pre-contract MRI’s. The MRIs of asymptomatic college draft picks early in my career demonstrated mostly healthy UCLs. But then suddenly the MRI’s started showing that the UCL’s on college kids were looking more like weathered pro pitchers in the latter stages of their career.
However, the most concerning pattern emerged when high school kids began showing up in my office with elbow pain and torn UCLs. It became clear at that point that UCL injury was becoming an epidemic, and no pitcher, no matter what level or age, was immune to the injury. In fact, I published research in 2016 in the American Journal of Sports Medicine (Epidemiology of Medial Ulnar Collateral Ligament Reconstruction: A 10-Year Study in New York State — PubMed (nih.gov)), that demonstrated the age group undergoing Tommy John Surgery the most was 17 and 18 year old’s.
Last week however, made me worried of a completely new population. I started Tuesday morning at 7 am with a Tommy John Surgery on an 18 yo, then a 21 yo, then a 22 yo. Typical age and typical increase in elbow injuries in April. But I noticed something different. The 18 yo was a shortstop, the 21 yo was a catcher, and the 22 year old was a center fielder. Over a span of 16 days I performed 14 elbow operations on baseball players. And shockingly, only half of them were pitchers.
Is this coincidence or the signaling of a new trend? As I am thinking about it as I write, I take a look at the field at Yankee Stadium while I am covering a game. I take note of which players have had Tommy John Surgery — Kyle Higashioka behind the dish, Jordan Montgomery on the hill, Gleyber Torres in the infield, and Aaron Hicks in centerfield.
Like pitchers, position players injure their UCL’s because of numerous factors, but high on the list are velocity and volume. Position players are throwing harder and harder. How hard does an outfielder throw? In April of 2016, Aaron Hicks nailed the Oaklands A’s Danny Valencia at home with a throw that measured 105.5 mph — the fastest since the league began measuring. Infielders in MLB also have cannons reaching 95 mph on route to first base. And typically position players play every day except for those occasional days off.
Our younger players trying to get to the next level often do showcases. I had a catcher come in on a Monday with elbow pain after doing a showcase over the weekend where he fired a bucket of balls to second, first, and third as hard and as fast as he possible could. His UCL was torn. Do position players want to throw harder? They do. And many are engaged in velocity enhancement programs such as throwing weighted balls, which obviously risk UCL injury. Finally, many coaches, parents, and player’s themselves don’t suspect UCL injury and regularly play through elbow pain or discomfort. After all, position players are not known to have UCL tears. And let’s not forget how fragile the UCL is:
The spikes in position players needing Tommy John Surgery required my team and I to create dedicated rehab programs for position players following surgery. These programs also incorporate defensive drills and timelines for hitting. On a positive note, position players return to play faster than pitchers and many position players are candidates for UCL repair.
Each spring the start of baseball season revives enthusiasm for players and fans. Each year however, we seem to encounter a new crisis in the health of our baseball players. In our continued effort to prevent Tommy John Surgery, let’s make sure that we don’t ignore elbow pain in our position players and appreciate the fragility of this small ligament in position players.
Christopher Ahmad, MD is Head Team Physician for The New York Yankees, and author of the book Skill