Following a string of injuries, the Cincinnati Reds’ rotation has struggled to find a groove. Their most recent “you hate to see it” moment, in the words of manager David Bell, came last week when starting left-hander Brandon Williamson’s arm gave out during a back-and-forth battle with the Atlanta Braves. With his ulnar collateral ligament completely torn, the pitcher’s “out of nowhere” injury now has him destined for Tommy John surgery.
David McCabe, Owen Murphy, Ray Kerr — the Atlanta Braves roster (and its prospects) are more than a little familiar with the half-century-old surgery, too. It’s a fate befallen many in the sport these days.
It’s because there’s an “elbow epidemic” in baseball, and it’s made the procedure more common than ever. According to University of Florida professor of orthopedics and sports medicine Kevin W. Farmer and University of Florida professor of journalism Ted Spiker, young athletes are taking much of the toll.
On July 17, 1974, something began that would change baseball. The Expos’ Hal Breeden had just entered the batter’s box when Los Angeles left-hander Tommy John began experiencing debilitating elbow pain. He shook out the sensation, tossed out another pitch, realized it was only getting worse and left the field. A doctor told him his career was over; his elbow was shot. But the pitcher wasn’t truly out of options.
John went under the knife for a first-of-its-kind elbow reconstruction surgery, now named for him, and — according to MLB.com — possibly the “most important medical advancement in baseball history.” After recovering, the left-hander won more games than before surgery.
Johns Hopkins Medicine explained that the procedure repairs the elbow’s UCL by attaching a harvested tendon to compensate for the torn ligament.
“This ligament plays a critical role for athletes who throw, such as football quarterbacks and baseball pitchers, because it serves as an anatomical bridge,” Spiker and Farmer told The Conversation, a nonprofit news outlet of journalists that edits articles written by academic experts. “The UCL transmits the force of the throw from the shoulder to the hand as the ball is released.”
“But here’s the problem: The force on the elbow generated by pitching a baseball, especially from today’s high-velocity pitchers, exceeds the strength of the ligament,” they continued.
It can take more than a year for athletes to fully recover from the surgery, and it can lead to permanent weakness in the arm caused by nerve or blood vessel damage.
“Returning to play after Tommy John surgery is not without difficulties, and recovery takes a long time; John took close to two years before he could pitch again,” the University of Florida professors said. “Although today’s surgery is much less invasive, recovery takes about a year.
“About 80% of pitchers successfully return to playing after the surgery,” they continued. “But sometimes the repair doesn’t last forever, and about 30% of pitchers with repaired elbows undergo a second surgery.”
A 2018 survey of active players revealed that 26% of MLB and 19% of minor league pitchers have undergone Tommy John surgery. By 2023, 35.3% of MLB pitchers were receiving the increasingly in-demand procedure.
For players 15 to 19 years old, the number of procedures increases roughly 9% each year. In 2014, teenagers already accounted for 67.4% of all Tommy John operations.
The sweeper pitch, pitch clock and faster pitching all play roles in the procedure’s increasing necessity. But for the kids, the biggest influence is overuse.
“This is happening because youth sports have changed dramatically over the decades,” Spiker and Farmer said. “It is now a $15 billion business. Between school leagues, travel ball, all-star teams and showcases, young athletes play more often; in warmer parts of the country, they go year-round. Because many of them play for different teams and different coaches, nobody is monitoring overall pitch counts.
“That, along with the relentless focus on one sport at an early age, means excessive stress on the elbow,” they continued.
Orthopedics specialist and White Sox team physician Dr. Mark Cohen said the number of patients 15 to 19 in need of the procedure is growing rapidly.
“There’s just been an explosion of these injuries in these throwing athletes, and there’s a variety of factors but it’s almost at a point where it’s an epidemic,” he told Midwest Orthopaedics at Rush.
From an early age to the MLB, baseball has a problem with pitching: too many injuries.
“Nobody’s insulated from it, and everybody goes through it,” Braves manager Brian Snitker told The Atlanta Journal-Constitution’s Ken Sugiura in April.
“I hate it for everybody concerned,” he continued. “That’s the biggest thing we have in our game, is the pitching.”
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