Finally getting back to the blog space and it is once again spring, and baseball season is back. This year, greater attention has been brought to elbow injuries in some of the games best pitchers. Even though the season is only one month in, multiple pitchers have already been lost to elbow pain and injury. Not to mention the several still returning from injury last year including the Dodgers newest star Shohei Ohtani.
Many are calling it an epidemic and wondering what, if anything, has changed in the game that has lead to all of these injuries.
Ohtani, like many other pitchers sustained an injury to the ulnar collateral ligament, or UCL. This is the ligament that former Dodgers pitcher Tommy John injured decades ago. One of my mentors, Dr. Frank Jobe developed the surgery at the Kerlan-Jobe Clinic to reconstruct that ligament and allow Tommy John to return to pitching. Formally called ulnar collateral ligament reconstruction, most everyone now knows it as Tommy John surgery.
Many doctors, coaches and athletic trainers point to the increased velocity and spin rates that pitchers are using now to generate more strikeouts. That is likely a contributing factor, but the epidemic is likely multifactorial. Pitchers are also stronger now than in decades past with more attention to training and nutrition. This allows for the increased velocities and thereby more torque across the elbow. Baseball has become a year round sport for many athletes, putting more mileage on an already vulnerable ligament.
The Tommy John surgery recreates the ligament that holds the inner (medial) side of the elbow together by borrowing a small tendon from the forearm or hamstring. Ligaments are like ropes, they connect bone to bone. The crucial UCL connects the humerus to the ulna. During the throwing motion it is under super-physiologic loads. And eventually, over time, many of these ligaments fail under the stress.
A UCL tear will presents as medial sided elbow pain, typically occurring during the late cocking phase of throwing, which is just before the arm is starting to come forward.
Pitchers will usually feel immediate pain and will notice increased pain, decreased velocity with subsequent attempts at throwing.
Diagnosis requires an MRI to visualize the extent of the tear. Treatment depends on the tear pattern and ranges from non operative treatment including rest, rehab and platelet rich plasma injections to surgical treatment in the form of repair or reconstruction. One of the latest developments is the internal brace augmentation which uses a thick suture material to further enhance the stability of the repaired ligament.
Recovery time varies. A full reconstruction usually takes 12-15 months for return to pitching. Position players can get back to hitting and light throwing sooner than that. That’s why Ohtani is able to hit but hasn’t been cleared for pitching.
The Dodgers are predicting to have another 100+ win season even without Ohtani pitching. Should be a fun summer for Dodgers fans.