Spring is finally here, and Little League baseball players throughout the Granite State are oiling up their baseball gloves, taking swings in the batting cages and finally running around the infield.  Pitchers are staring intently at the catcher’s mitt, ready to strike out another Casey at the plate.  But a cautionary tale came our way from Major League Baseball last week from Miami via Tampa via Santa Clara, Cuba, about the limits of even the greatest young prospects.

Jose Fernandez grew up in Cuba and tried three times to defect to the United States before the age of 16, each time failing and having to go to prison.  PRISON!!  Finally, in 2008, he was able to relocate to Tampa, Fla., with his family and was a pitcher for his local high school team, which won the state championship twice in three years.  He was selected by the Miami Marlins in the first round of the 2011 Major League Draft.  In 2013, he was named to the All-Star game and won the National League Rookie of the Year award.

The future looked bright for the 21-year-old Fernandez.  A Major-League leading 70 strikeouts.  An ERA of 2.44.  And then, just like that, pain in the right elbow last week, “only” throwing 90 miles per hour, placement on the disabled list, and possible “Tommy John surgery” to repair a “sprain” in his right elbow.  Sixteen pitchers in the Majors have had the surgery this season, as well as a few college pitchers who were predicted to go high in the draft.  Read the MLB.com story here.

So how prevalent is Tommy John surgery, in this day and age of pitch counts for Little Leaguers and AAU players, year-round training, higher velocities and supposed better awareness?  James Andrews, the noted orthopedic surgeon in Birmingham, Ala., feels the incidence of the surgery is now at “epidemic” proportions.  Read the USA Today story here.

The surgery, which is a reconstruction of the ulnar collateral ligament using forearm or hamstring tendon, was first performed in 1974 by Dr. Frank Jobe on Los Angeles Dodgers pitcher Tommy John.  The replacement tendon is weaved through holes drilled through the humerus and ulna bones.

The post-operative rehabilitation can take a year or more, but a majority of professional pitchers who have undergone the surgery have returned to pitch at the Major League level.  Tommy John was able to pitch 14 more seasons after his surgery at age 31.  However, even those with a “Million Dollar Arm” are not immune from this injury.

So what to tell those young pitchers hoping to make it to Williamsport this summer?  Watch the pitch count, warm up and stretch out before any game or practice, focus on fastballs instead of breaking balls, rest the arm if pain develops, and use cold application for any swelling.  Watching out for fatigue in young pitchers is key.  Read the OrthoInfo article here and the Tampa Bay Times article here.

Play ball!



Stuart J. Glassman, MD

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