Could your young athlete be risking Tommy John surgery?

Date Published: 
June 13, 2014

In April, Major League pitchers set a new record. Since spring training, more than a dozen Major League baseball pitchers had undergone Tommy John surgery. For all of last season, the number was 19. Doctors say elbow injuries requiring Tommy John surgery have reached epidemic proportions in Major League baseball, and they’re worried about young athletes.

I’m betting you’ve heard about Tommy John surgery, but do you know what elbow injury leads to the surgery and what you can do to protect the athletes in your house? As I always tell you, getting the facts and understanding what you can do can make an important difference for the young athlete in your house.

Surgeons perform Tommy John surgery to repair an elbow ligament called the ulnar collateral ligament or the UCL. Think of a ligament as a kind of piece of rope that connects two bones in the body. The UCL connects the inside of your upper arm (humerus) to the inside of your forearm (ulna). Its main job is to control and support the arm’s movement and stability when performing any kind of motion.

Continued stress or trauma can cause the UCL to stretch or tear. When non-surgical treatment options fail, surgeons take a tendon from somewhere else in the body to replace the injured UCL. It’s mostly college and pro athletes who require this type of surgery, but it’s also been done on younger people.

The concern over young athletes skyrocketed following the release of a 2011 study that appeared in the February issue of the American Journal of Sports Medicine. The 10-year study followed healthy young male pitchers between the ages of 9 and 14. It found that kids playing more than 100 innings per year were 3.5 times more likely to suffer serious elbow or shoulder injuries than those who pitched fewer innings.

According to study lead researcher Glenn S. Fleisig of the American Sports Medicine Institute in Birmingham, Ala., “The study proved a direct link between innings pitched in youth and adolescent baseball and serious pitching injuries. It highlights the need for parents and coaches to monitor the amount of pitching for the long-term success and health of these young athletes.”

Further, Flesig said, “Based on this study, we recommend that pitchers in high school and younger pitch no more than 100 innings in competition in any calendar year. Some pitchers need to be limited even more, so no pitcher should continue to pitch when fatigued.”

Obviously, an important first step in protecting your young athlete is making sure that they are limiting the number of innings pitched. The best way to avoid a disagreement is to talk about it. Make sure that your youngster understands that it’s not only about their continuing to enjoy the sport, but life beyond sports. It’s about protecting their mobility and their quality of life in the future.

Be vigilant. Know the symptoms that are associated with a UCL injury. If your youngster is suddenly seeing a decline in ball-throwing ability, has pain or soreness on the inside of the elbow, or swelling along the inside of the arm, or if there’s pain when the arm is held in an overhead position, these are all warning signs.

Another sign is some instability in the elbow or irritation in what we call the funny bone, which is really the ulnar nerve. If your young pitcher is feeling numbness or tingling in either the ring finger or the small finger, that is a red flag.

Keep in mind that UCL injuries typically don’t interfere with normal daily activities and many other physical pursuits, such as exercising or running.

If there’s a problem, go to a doctor immediately. A doctor will look at your youngster’s history and conduct a physical exam. If the diagnosis isn’t clear, you can expect the doctor to order X-rays or an MRI. If that doesn’t clarify things, an MRI using a dye might be required.

Diagnosing UCL injuries is difficult, which is why experience and a thorough look at all the available information is the best approach.

If the diagnosis is a UCL injury, don’t jump to conclusions. Your doctor will likely tell you that UCL injuries are usually dealt with based on a conservative, non-surgical approach, first involving rest, icing and the use of anti-inflammatory drugs to deal with pain and swelling. Once the pain and swelling is under control, it is extremely likely that the athlete will be given a prescription for physical therapy.

Look for a physical therapist with experience in sports physical therapy. Don’t hesitate to ask about their experience. Expect that your physical therapist will focus on strengthening the muscles of the shoulder, upper back and shoulder blades, as well as in the forearm, and improving range of motion. The therapist will also work on stability, coordination and balance.

Your physical therapist will create a customized program to address your youngster’s specific needs, with a focus on returning to normal activities.

If surgery is required, seek an experienced surgeon and don’t hesitate to get a second opinion. Surgery will be followed by physical therapy, with the recovery process likely to take about year.

It’s a long season, but with attention from home and a good coach, you’ve covered all the bases. Let’s hope the only call your youngster hears is “Play ball.”

Bob Cairo is a licensed physical therapist at Tidewater Physical Therapy. He can be-reached by calling (302) 537-7260.