Tommy John (MCL) Elbow Reconstruction

These days, there seems to be a rash of medial collateral ligament (MCL) injuries in teenage pitchers. The problem is this: the really good pitchers are usually bigger, taller, heavier and can throw harder than the average pitchers. Everyone wants them to pitch for them. In Texas, the weather allows baseball essentially all year long. Some leagues pay strict attention to pitch counts. Others don’t. Good teenage pitchers can play in multiple leagues at once. They’re pitching way too much. And their elbows can’t handle it. When throwing hard, these stronger players can repetitively apply more force across their elbow than their elbows can stand.

Many teenage pitchers who would otherwise be able to play in college, or even the pros, burn-out their elbows and destroy their careers before they even graduate high school. Often, the best pitchers have careers that are over before they’ve even begun. And it’s often due to a MCL injury. Other issues, such as osteochondritis dissecans (death of part of the bone on the outside of the elbow) and posterior impingement (the point of the elbow gets bone spurs on it so that it doesn’t fit neatly into its slot) can also occur. But MCL injuries are the most notorious severe elbow injury.

MCL reconstruction (aka. the “Tommy John Procedure”) is pretty effective in adults. But it’s much less effective in teenagers. For whatever reason, many teenage pitchers that injure their MCL can never get back to pitching at a high level, even following a well-performed MCL reconstruction. There is no question that practicing prevention here is much better than needing treatment.

My message to parents is to protect your teenage pitchers. Don’t allow them to play in multiple leagues at the same time. If you do, familiarize yourself with recommended pitch counts and follow them strictly. It’s often difficult, as teenagers often think that they’re invincible, and want to keep on throwing. Many coaches are asking them to pitch for their teams. And what teenager doesn’t want that kind of attention? The problem is that teenagers are notoriously lacking in perspective, and don’t realize that the future does not end tomorrow. Getting necessary rest and not throwing too many pitches are important to preserve their elbows so that they can continue to pitch in college, and possibly beyond.

If elbow pain does occur, see a specialist, ie. an orthopaedic upper extremity, elbow or sports medicine trained surgeon. If he tells your teenager to rest his/her arm, then make sure they do it. It’s a lot easier to prevent problems in teenagers than to pick up the pieces once the elbow is badly injured. Remember: skeletally immature (ie. high school age or younger) athletes are more vulnerable to overuse injuries than adult athletes. And surgeries that work well in adults don’t always have the same success rate in teenagers. A little patience and rest in the short run can prevent the end of a promising career in the long run.

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