May 17, 2014

Epidemic or not, elbow injuries can’t be ignored

Young players are throwing too much and too hard, and their arms are failing too soon.

The youngest patient Dr. Keith Meister has treated with Tommy John surgery was 14 years, 11 months olds, around a decade ago when Meister was repairing arms at the University of Florida.

No one was charged with neglect of a minor for the events that led to surgery, though a coach or a parent should have been brought in for questioning.

Martin Perez will be 23 years, 1 month when Meister, the Texas Rangers’ team physician since 2004, performs Tommy John surgery Monday on the torn ulnar collateral ligament in the left-hander’s elbow.

No one will be charged for derailing Perez’s career, or those of too many other professional pitchers this season, though maybe now the voices that have been issuing warnings for years will be heard.

Perez will become the 19th major-leaguer since February to have the operation, a list that includes one of the game’s best pitchers and two of its top prospects.

The injuries have become so prevalent that commissioner Bud Selig admitted last week that he is concerned. Dr. James Andrews, the most famous sports orthopedist, has called the rash of wrecked elbows an epidemic.

Meister is tapping the brakes some before alerting the World Health Organization or declaring that pitchers’ elbows should be on the list of endangered species. But the growing list of arm injuries tells Meister that things are trending the wrong way.

The parents of young ballplayers can help stop the madness.

“There’s been a general trend and rise in shoulder and elbow problems in our young throwers,” Meister said Friday. “It’s something we’ve been talking about and yelling about for 10 to 15 years now. Maybe some of this is starting to manifest itself in younger age groups.

“A lot of this is preventable, and it’s preventable if you take care of your kids at a young age. The developmental program is screwed up. It’s misplaced priorities by coaches and by parents. Everybody is chasing the dream.”

The string of Tommy John surgeries this year among those who have caught the dream started in February with Padres lefty Cory Luebke, the second of his career, and has since collected 17 more pitchers and one infielder.

Jose Fernandez, the 2013 National League Rookie of the Year with Miami, beat Perez to the operating table Friday.

Pittsburgh pitching prospect Jameson Taillon had his Tommy John surgery in April. The elbow of Miguel Sano, one of Minnesota’s infield building blocks, was injured in March.

The 2014 list doesn’t include Matt Harvey, the New York Mets’ young star, or Dylan Bundy, the Baltimore Orioles’ top pitching prospect. They underwent Tommy John surgery last year.

Perez’s teammate Pedro Figueroa, 28, was on Meister’s surgical table last month for a Tommy John redo from an earlier procedure on his left elbow with another doctor.

The Rangers aren’t even the only team with multiple Tommy John surgeries. Oakland, Arizona and San Diego also have lost two pitchers, but Atlanta tops them all with three lost during spring training.

“We’re not alone,” Meister said.

Within the 19 Tommy John cases this season, Meister pointed to some interesting talking points.

• The average age of those with the elbow injuries is around 23, lending more support to the theory that players are throwing too much at young ages and breaking down sooner.
• Even more curious is that 16 of the 19 come from Texas, California, Florida or Latin America, a note that Meister credited to Rangers senior director of medical operations Jamie Reed.

Warm weather throughout the year allows players to play throughout the year, whereas players in cold-weather climates are forced to stop.

• Top prep pitchers from all climates aren’t resting enough after their summer seasons so that they can pitch in front of scouts and college coaches at showcase events. Pitchers try to light up the radar gun, then don’t rest enough before they resume throwing.

“No. 1, the whole concept of kids in their development years throwing as much as they’re throwing now and throwing year-round no doubt is a contributing factor,” Meister said.

“No. 2 is the velocity with which guys are throwing. There’s no question that if you look at fastball velocity the past 10 years, it’s going up, up and up. Ultimately, you can’t put a V-8 engine in a Volkswagen. Something’s going to blow.”

Not all hope is lost when a pitcher shows up at Meister’s TMI Sports Medicine office in Arlington. Most elbow injuries, he said, are treated with non-surgical options. Meister tries to be conservative before performing a Tommy John surgery, and he thinks that the procedure is done too often.

It’s been done to 18 big-leaguers this year, and Perez will be No. 19. Meister, though, isn’t quite yet ready to call the rash of Tommy John surgeries an epidemic.

But it is alarming, and should be even more eye-opening to parents and coaches of young ballplayers.

“We’ve got to be careful with taking snapshots,” he said. “Injuries can run in cycles. To some extent we’ve got to be careful to have too much of a doomsday feeling just because it’s been a particularly bad season for elbow injuries.

“We’ve got to look over the next five years, not just one year. Anybody that’s taking a look at this from an intellectual standpoint and trying to solve the issue has to have a broader view than just, ‘Hey, this has been a really bad year.’ ”

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