Stapled to the Bone: Tommy John and His Amazing Elbow

I woke up the other day and felt a familiar achy twinge in my shoulder which I often sleep on the wrong way. I rotated it a bit to loosen it up and thought, "Maybe I need that Tommy John surgery."

Then I thought , "I don't even know who this Tommy John is! Why am I thinking of him in bed as The Boyfriend is sleeping soundly next to me?"

Tommy John turns out to be a real live person who was the one of the first to have an experimental surgery which turned out to be a procedure that has given many pitchers a second chance at the mound. He was a pitcher for the Los Angeles Dodgers and the surgery was first performed in 1974 by Dr. Frank Jobe, who just died this spring. The surgery was named after TJ but it's true name is ulnar collateral ligament (ULC) reconstruction.

Turns out that "Tommy John surgery" is not rotator cuff surgery as I had always believed, but elbow surgery and it's wild. It is "a surgical graft procedure in which the ulnar collateral ligament in the medial elbow is replaced with a tendon from elsewhere in the body." Basically, holes are drilled in the ulna and humerus bones (there's some crossword puzzle words for you) of the elbow and a tendon is woven in a figure eight pattern through those holes and anchored to the bone. That harvested tendon comes from the other arm or down by the knee or even from a cadaver. It takes at least a full year to recover for pitchers ,though they can be throwing after about 16 weeks.

At the time of the original surgery, Dr. Jobe put the chances of full recovery at 1 in 100. Today the chances of complete recovery is more like 85 to 92 percent. You can hardly name a team that doesn't have at least one pitcher who has had TJ surgery. Atlanta has 8 in the last four years. The exception is the Milwaukee Brewers who have an excellent record so far this year. Perhaps beer has restorative healing powers? But I digress.

They say the best way to avoid injury to pitchers is to just not to let anyone pitch. The human arm elbow and shoulder are amazing pieces of architecture and a baseball pitch from a major league player is a thing of amazing beauty. But it takes its toll. Pitchers are pitching faster than ever and more pitchers these days these day can pitch up to and even past 100 mph. Teams are more conscious of pitch counts and usually a pitcher, no matter how well he is doing pitches no more than 100 to 110 a game. Still, not only are pitchers throwing at a tremendous speed, they are throwing curves and sliders demanding subtle twist and turns in the body, arm and wrist. Torque, baby, lots of torque.

The Glue Gun Goddess of Ketchikan sent me a great video called "Why Chimps Don't Play Baseball"

though I will now refer to it as "Why Chimps Will Never Require Tommy John Surgery." Here is the link:

http://www.youtube.com/watch?v=Jq6dCFCMGq4&feature=youtube_gdata_player

At some point in our evolution, Grok threw a rock at his son Grunk and he caught it and threw it back and baseball was born. Then Grok threw a spear at a woolly mammoth and the barbecue was born and ever since we've been combining the two and meeting in the backyard for cookouts. And ever since we've been trying to throw the ball harder and more precisely and put a funky spin on it so it looks like it is going one place but really it is going another. And now we call it Major League Pitching.

So what causes the damage that requires Tommy John surgery? The UCL can be stretched or torn or frayed as the result of the tremendous repetitive stress of the throwing motion. A hard throw pushes the UCL to its maximum ability and repeating that motion and "balls to the wall" torque puts tremendous demand on the ligament.

There is a lot of demand on the modern pitching arm. High pitch counts, high velocity throws, sometimes

poor pitching form, earlier and earlier Little League pitching pressure on young pitchers. Like most things, it's probably a combination of all of these things. One article even suggests that there is a bit of an epidemic going on. You can't catch elbow injuries from another pitcher, but Tommy John surgery is seen as so successful that more and more pitchers are opting for the surgery earlier in their injuries. So far in 2014 alone according to basebzllheatmaps.com, there have already been 14 Major League pitchers that have undergone Tommy John surgery just this year. Some of them for a second time. Of course, not for the Brewers. Another IPA over here, please.

Some folks think that TJ surgery might even help them pitch better, like the Bionic Man back in the 70s. Before Tommy John had his surgery, he won 124 games. After his surgery, he won another 164 games. He retired in1989 at age 46 and ranks seventh all time among left handers. Not bad for a 1 out of 100 chance of recovery. There's such faith in the surgery now that some Little League parents have even approached surgeons about bringing their young sons in for the surgery to get an edge. Any surgery that opens up your arm, wraps ligaments around a joint, and puts screws in your elbow is not to be taken lightly. (I am thinking a screw needs to be tightened somewhere beside in that kid's arm.)

So next time you see your favorite pitcher throw a fast ball like a rocket down the middle of the plate, watch the torque he puts on it with his whole body, and appreciate the not so humble and amazing work of all those ligaments, bones and nerves. Then multiply that by 100 pitches in a game. And the other hundred or so pitches that leads up to that game and the thousand of pitches that shoulder and elbow has thrown over a lifetime. It makes you also appreciate the sports medicine professionals like Dr. Frank Jobe behind those elbows and arms and harvested ligaments wrapped in figure eights and stapled down to the bone.

It might make you want to go have another beer as well. Go Brewers.