Tommy John Surgery and Baseball Pitchers

Learn about Tommy John surgery and the various options baseball pitchers have after suffering a UCL injury.

R.A. Dickey

No one would've blamed Tommy John if he'd quit. By the 1974 season, the Los Angeles Dodgers pitcher had already played more than 10 years in the major leagues, including an All-Star season in 1968. The sinkerballer was in the middle of perhaps his best season to date, with a 13-3 record, when he wrecked the ulnar collateral ligament (UCL) in his pitching arm. (Discover the causes of UCL injuries.)

The prognosis at the time? Not good, until Dr. Frank Jobe came forward with an idea for a revolutionary surgical operation. The procedure would remove a tendon from John's right forearm and use it to replace the destroyed elbow ligament. John underwent surgery in late September of that year, then sat out the entire 1975 season. Many questioned whether he'd ever return to the mound. But in 1976, John did just that, and he continued to pitch for 13 more seasons, winning 288 career games and earning three more All-Star awards.

Clearly, "Tommy John surgery" worked for Tommy John himself; and today the once-radical procedure is almost routine, with a growing number of major leaguers, college ballplayers and even high-school pitchers placing their wounded elbows under the knife. While some, like Washington Nationals pitcher Stephen Strasburg, are able to return to throwing at a high level, many are not so fortunate.

So what are the factors that determine whether or not UCL reconstruction will be a career ender or extender?

First, take a closer look at the circumstances surrounding Tommy John at the time of his surgery. He was already a proven big league pitcher. He did not have to develop into a good thrower after the surgery; he already was one. As long as he could return to full strength, he'd have a spot in the rotation. He also had access to top-notch athletic trainers and physical therapists to guide him during a prolonged rehab.

Unfortunately, many pitchers who suffer UCL injuries are young, still improving their strength and pitching skills when they get hurt. A high school junior or senior who undergoes Tommy John surgery loses 12 to 18 months to recovery while his uninjured peers continue to work on their strength and skill development. By the time a 19-year-old pitcher is ready to return from UCL reconstruction to the mound, he's being outperformed by younger pitchers who've been continually pitching. So Tommy John surgery isn't a sure bet for younger players.

But what other options does an aspiring big leaguer have? New York Mets pitcher R.A. Dickey offers one example. When the Texas Rangers drafted him 18th in the 1996 Draft, they offered him a signing bonus of $810,000. Then, team physicians discovered that Dickey had no UCL in his right throwing elbow joint. The Rangers cut their bonus offer to $75,000.

Dickey opted not to have surgery, and his first few MLB seasons were unspectacular. He was demoted to Triple-A, and he may never have returned to the Bigs if he hadn't figured out how to reinvent himself as a knuckleballer. Today, Dickey is arguably the toughest pitcher to hit on the Mets roster. During the 2012 season, he pitched 44 consecutive innings without allowing an earned run—a league record. Call this the Dickey option: try to pitch without a UCL.

Another alternative is to switch positions. A torn UCL might take away a 90-mph fastball, but it still leaves you enough throwing juice to play elsewhere on the field. Not everyone can be a pitcher, and there is no shame in changing positions.

But the best option is prevention. By mastering your pitching mechanics and developing total-body strength, you can better protect your UCL from injury. Pitchers should also know the warning signs of UCL stress, and take proper steps to address small injuries before they turn into big ones. If your elbow feels sore, hurt, or just plain off, be sure to communicate what you're experiencing to your family, coach, physician and team therapist before your next start.

Learn more about Tommy John surgery and other common athlete procedures through STACK's Sports Injury Guide.

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