Sports Specialists Discuss the Rise in Arm Injuries in Young Ball Players

All this week, WFUV News is looking at an alarming trend affecting baseball players of all ages, from Little League to Major League Baseball. 

Research shows that more Major League Baseball players are having arm injuries and needing Tommy John surgery, but it’s not just big leaguers going under the knife.

The American Sports Medicine Institute studied the number of baseball related elbow injuries that resulted in surgery from 1994 to 2011, however, rather than look at professional athletes, it focused on ball players in youth leagues and high school.

The study found a sharp increase in the number of elbow reconstruction surgeries performed in the 2000’s.

I reached out to three sports specialists by phone and peppered them with questions about the rise of arm injuries in teenage baseball players.

Dr. Frank Cordasco is a sports medicine orthopaedic surgeon at the Hospital for Special Surgery.

Dr. Joshua Dines is also a sports medicine orthopaedic surgeon at the Hospital for Special Surgery.

Dr. Anthony Scillia is an orthopaedic surgeon at the New Jersey Orthopaedic Institute.

What is Tommy John surgery, and what’s the injury that requires the procedure?

Dines: Tommy John surgery is the common name because the first pitcher who got it done was Tommy John, but it really talks about attaching the ligament to your arm bone. You put a lot of stress on your elbow when you’re throwing, and whether it’s one event where it tears, or overuse which is the more common cause, then you can need Tommy John [surgery]. The procedure is you take a graft, or another part of the body, and then reconstruct the ligament and attach that tendon so it starts to function as a new ligament.

Scillia: The injury is a tear to the ulnar collateral ligament which is the inside ligament of the elbow. It is stretched during overhead throwing, especially in pitchers. The ligament is reconstructed in surgery when a tendon is taken from another part of the body and is connected to the ligament through bone tunnels.

Cordasco: Tommy John surgery refers to a ligament injury that occurs at the elbow, the inner side of the elbow where the funny bone is located, and it’s very important in the throwing motion. The ulnar collateral ligament is what it’s referred to as, and it’s called Tommy John surgery because he was the first to get it. Simply sewing the ligament back is not generally enough, so we have to use a graft which is selected from the athletes body, and the surgery is designed to reconstruct this torn ligament with a graft.

How long does it take to recover from Tommy John surgery?

Dines: There are so many major league players that have had the surgery at this point that there is this perception that with this surgery you’ll come back a year later. The thing is, not everyone comes back. Only about 85 – 90 percent of the time do people come back to play, and this also isn’t a six week thing, this is about a year if everything goes okay.

A study from Dr. Christopher Ahmad, the Head Team Physician for the New York Yankees, found that some parents, coaches and teens think players throw harder after Tommy John surgery. Could you debunk this myth?

Dines: It’s hard with Tommy John surgery because to have parents think their kids will come back and play better is not good. There are cases when people do come back throwing harder, but it’s important to go back to why that happened. When they come back, they work on their leg strength and mechanics and things that get neglected. So when they do start throwing again, they might be throwing harder because they’ve strengthened so many other aspects of their game.

Scillia: I think there’s a lot of press related to the increase in potential of athletes after surgery. However, it’s not an advantage to have surgery, and what [doctors] are seeing now, is it does not increase the potential of the athlete. The surgery may not hold an athlete back, but it also isn't necessarily an advantage to the athlete.

Why are more teen ball players needing Tommy John surgery?

Dines: Ten years ago, people used to play all different sports, and just by doing different sports the arm gets rest. The kids now see baseball as a way to get a college scholarship, so now kids play year-round and have travel teams. I think throwing too much is definitely the reason for it. 

Scillia: I think it’s pretty clear that this is seen as an overuse surgery to the ligament, so stretching and then eventually tearing. The ligament can’t heal itself, [and] that’s why the surgery is required. We usually see this in higher level athletes in college and professional sports, but we are now seeing this at younger ages. I’ve seen kids at 10, 11 and 12 years-old getting the procedure. The procedure has absolutely increased in the [1990's], and [doctors] think it is from the increase in training and year-round participation in athletes. The three sport athletes are not as common and more kids are honing in on one sport.

Cordasco: I think one of the major factors associated with this injury is associated to fatigue. These are children growing into their bodies, so there’s a developmental component. As these children are developing into their bodies, they are playing more baseball. Children will play baseball year-round and fatigue is a big issue. The fatigue can come from a single game, a season or just year-round playing. 

What advice do you have for parents and teens who want to avoid serious arm problems?

Scillia: I would recommend that parents stick to the guidelines on a website [such as] stopsportsmedicine.org to prevent overuse injuries. [A young player should] stick to pitch counts, play for one team per year and stop pitching for four months out of the year because that really reduces your chance for injury. Try to ensure [players] do not overuse their elbow at the young age.

Cordasco: For parents of these young athletes, the most important factor is to focus on rest, and these young pitchers should not be throwing off a mound in practice. I think it needs to be looked at globally, and if professional athletes aren't throwing over 100 pitches, an adolescent should certainly not be doing it. I think the same could be said of knee ligament constructions. I see a lot of young athletes who have torn their ACLs, essentially blown out their knee, primarily because they’ve been playing sports year-round. There’s a whole host of factors and fatigue is probably one of the most significant ones.