How MLB's elbow epidemic is mowing through young pitchers and has no solution

·MLB columnist
How MLB's elbow epidemic is mowing through young pitchers and has no solution
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The big bosses do not want to hear the truth. Over the past two months, a handful of team presidents have called Major League Baseball's offices on Park Avenue and asked what the hell the sport is doing to fix the epidemic of pitchers' elbows blowing out. They want to hear that baseball is doing everything it can, that it recognizes this isn't some trend likely to pass by, that the league will be diligent in its pursuit of a solution. And so that's what they hear.

Down a level or two in management, inside the front offices bearing the brunt of ulnar collateral ligaments going off like landmines, they do want to hear the truth. It is ugly. It is troublesome. It is downright depressing. It is why when 21-year-old Marlins right-hander Jose Fernandez, the best young pitcher in baseball, reportedly tears his ulnar collateral ligament and likely heads to the 34th known Tommy John surgery in organized baseball this year – that's one every 2.5 days since the first on Feb. 18 – the GMs and assistant GMs cringe, fearful that their guy is next, that this isn't going away any time soon.

"Call me in 2022."

That's the truth from one person at the forefront of the war against elbow injuries, a sentiment echoed by others to Yahoo Sports as surgeries have piled up. It could be 2022 or 2023 or five or 10 or who knows how many years later. The point better represents where baseball stands today in its fight: the infant stages. Saving the arm isn't something that can be done overnight or even in a handful of years. Advances in medicine take studies, control groups, large samples and perhaps a complete overhaul of baseball all the way down to Little League.

Because another truth is just as horrifying: For all we believe we know about how the arm works and how to best protect it from the vagaries of throwing a ball overhand, catastrophic injuries are at an all-time high across the sport, throwing into question the efficacy of the changes in baseball ostensibly meant to keep pitchers healthy.

Just think about the list of pitchers Fernandez could join who have undergone Tommy John since the end of last season: Matt Harvey, Patrick Corbin, Jarrod Parker, Matt Moore, Kris Medlen, Brandon Beachy, A.J. Griffin, Ivan Nova and top prospect Jameson Taillon. Even amateurs aren't immune. Jeff Hoffman, a projected top-five pick in the June draft, and Erick Fedde, expected to go in the top 10, both need UCL reconstructions.

Their average age is 24.2 years old.

Of the 33 pitchers to undergo Tommy John this season, only three are not in their 20s: Luke Hochevar (30), Josh Johnson (30) and Peter Moylan (35). Almost all of the pitchers who have blown out grew up in an era when the importance of pitch counts was stressed (though often not enforced), and they ended up on a surgeon's table anyway. Which is why the presidents and GMs are asking the same questions being passed throughout the sport in email chains, bandied among gossiping scouts and debated inside clubhouses, with a dozen pitchers on every team hoping they're not next.

Cursory studies run by MLB have used rough numbers of surgeries from public data like newspaper reports and medical studies to try and understand the risk of a pitcher blowing out his UCL. In recent years, around 5 to 6 percent of major league pitchers a year have undergone the surgery. The minor league rate is a little lower, the college and high school rate smaller still, maybe around 1 percent.

Compounding the percentages, the league believes a rookie pitcher had somewhere in the neighborhood of a 15 to 20 percent chance of blowing out by the end of his first major league season. A pitcher with 10 years of major league service time: better than a 50 percent chance.

And while that's back-of-the-envelope math – and doesn't take into account usage or mechanics or genetics or the belief that pitchers who have stayed healthy long-term are far less likely to get hurt – it is a devastating indictment that a sport's single most valuable asset is also its most vulnerable.

MLB's medical research group, made up of physicians and trainers, is coordinating studies specifically targeting knowledge of Tommy John surgery, the elbow-ligament transplant pioneered by Dr. Frank Jobe in 1974. It has saved innumerable careers, the smile-shaped scar along the elbow ubiquitous in clubhouses these days, and provides a large enough sample that the league believes it can glean at least something from asking recipients questions about their surgeries.

This is where the research starts. There, and inside the league offices where its medical-records system stores more injury data than imaginable, and at other offices where experts try to intuit the data, to find connections, reasons, something, anything that might shed a little light on what baseball can do to stop this. Which, of course, presupposes there is a solution.

Part of the problem is a lack of classification. Those in the medical research group have yet to find a commonality among the patients. Nothing biomechanically significant. No strong correlations, not even with velocity, which does seem to go hand in hand – Fernandez and Harvey both reached 100 mph with their fastballs last season – but doesn't account for the great number of slower-throwing pitchers who needed Tommy John, including Charlie Haeger. He throws a knuckleball. Of the 77 pitchers whose fastballs have exceeded 100 mph since 2008, 19 have undergone Tommy John – about 25 percent, exactly in line with the rest of the major leagues.

Perhaps the greatest deterrent to fixing the elbow, counterintuitive though it may sound, is the teams themselves. Rather than treat elbow injuries as a public-health issue, worthy of broad-based studies and sport-wide scrutiny, teams consider injuries simply as another avenue toward an advantage. Healthy pitchers mean less reliance on minor league scrubs or kids who aren't ready for the big leagues, and it's no surprise the healthiest teams make the playoffs.

Tips and tricks to keeping players healthy, then, has fallen under the umbrella of proprietary information. At least two teams have started range-of-motion testing with minor league clubs this season and plan to pass along the data to MLB, and even if it doesn't spur a trend or encourage all of baseball to gather together and prioritize the arm, it's a start.

And that's what baseball needs, because this isn't going anywhere anytime soon. The fear that overuse in Little League or year-round play in teenage years or excessive expectations on the showcase circuit makes the fragile UCL all the more delicate turns an already-polarizing problem and adds to the difficulty in the hunt.

In the meantime, days like Monday will continue on. More kids like Jose Fernandez will blow out, more club presidents will scream and bellow, and more smart men and women will crowd into labs and in front of computers and into scout seats hoping they see something, anything that might help a problem that 130 years after the first baseball was thrown overhand still isn't close to being solved.

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