Increased velocity, too many competitive youth games are leading to elbow injuries in the majors

05/27/2014 7:34 PM

06/03/2014 10:17 AM

There was a collective exhale Tuesday from Royals fans.

When Yordano Ventura left the mound at Kauffman Stadium with a detachment of medical personnel on Monday night, the fear was that Ventura would join a star-studded list of major-league pitchers.

José Fernandez, Jarrod Parker, Matt Moore, Kris Medlen, Luke Hochevar and nearly 30 other pitchers have had ulnar collateral ligament reconstruction — better known as Tommy John surgery — this year.

It’s so bad that commissioner Bud Selig’s breakfast is routinely ruined.

“I’m almost afraid to pick up the paper because of the bad news,” Selig told ESPN earlier this month. “I’m very worried over the fact that it’s happening with so much regularity, over and over.”

Selig has made finding an answer a priority with the league’s medical advisory committee.

Glenn Fleisig said he should have seen this coming. He has been studying pitchers for years at the American Sports Medicine Institute, the nonprofit organization founded by renowned surgeon James Andrews.

“It caught us by surprise,” Fleisig said, “but now that it’s here and we think about it, we’re not surprised.”

In fact, Andrews told The Star in 2009 that he was alarmed by the rise of year-round competitive baseball among youth players. At that time, Andrews said he had seen more youth injuries that required Tommy John surgery, with some players as young as eighth graders.

A subsequent ASMI study of American-born players confirmed what Andrews knew.

“Pitchers who pitched too many competitive baseball games were the ones getting hurt,” Fleisig said. “It was the dominant factor. It didn’t matter who threw curveballs, who was tall, who was short, who had good mechanics, who had bad mechanics. Those mattered, but they were all secondary.

“The big primary issue was how much competitive pitching they did.”

A later study found no difference in prevalence of UCL reconstruction between U.S.-born pitchers and those from the Dominican Republic and Latin America. In each of these groups, 16 percent of active pro pitchers have a history of UCL reconstruction.

“This phenomenon or epidemic that we saw in the adolescent or even youth baseball players 10 to 15 years ago, these kids are now grown up (and in the major-leagues),” Fleisig said.

Another key factor in the rise of Tommy John surgeries: the rising speed of the average fastball.

The Pittsburgh Tribune-Review noted that in 2008 the average major-league fastball was 90.9 mph. Last year, it was 92. In 2003, Astros closer Billy Wagner was the only pitcher to throw at least 25 pitches at 100 mph. Eight pitchers did it a year ago.

“The 20- to 27-year-old major leaguers, they are pitching harder, with more ball velocity than the previous generation,” Fleisig said. “I’m not saying the top guy is faster than the top guy in the past, but it is a fact that there are more pitchers who pitch 95 mph and up.”

Even with proper mechanics, the elbow is not indestructable.

“The problem is the ligament and tendons can only increase their stress so much,” Fleisig said. “And we seem to have arrived at that limit for what the elbow ligament can take.”

To reach Pete Grathoff, call 816-234-4330 or send email to Follow him at


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