The "epidemic" of ulnar collateral ligament (UCL) injuries leading to Tommy John surgeries has been the talk of the 2014 baseball season. The topic has been addressed constantly in the past few months. It has recently been a hot topic in New York as well as Yankee’s pitching ace, Masahiro Tanaka, who was coming from the lauded Japanese pitching system, has injured his UCL. My experience treating injuries in adolescent boys and young adults with sports injuries has led me to see this "epidemic" as a simple and straight forward orthopedic injury. The UCL is stressed when throwing breaking balls (curves, sliders, splitters...). A developing elbow with its muscles and ligaments has less ability to tolerate these forces, becoming weakened and injured.  The stress put on the elbow and the UCL only increases as the pitcher matures and throws with greater force and torque. This creates a perfect storm- a compromised UCL on a pitcher who only increases the stress on it as his fastball and breaking balls increase in speed movement. The fact that it happens to some of the best pitchers at a young age is more proof to this theory. A young pitcher with exceptional arm strength will continue to pitch long games several times a week and will be more inclined to develop and throw breaking balls at a young age. As he gets older and develops, he will become a star due to his “great breaking ball" which is accomplished by being able to create even greater torque and force on the elbow. The straight forward fastball pitcher or the pitcher who came to pitching late in his high school or college career will be less likely to develop a UCL injury while the youth star who continues to work and improve his breaking ball will be more likely to have Tommy John surgery. My advice: the kids with the best "arms" should not pitch in youth baseball. Those who choose to pitch should not throw any breaking balls. No one signs a pro contract from a great little league game, but a future pro career can be ruined from it.

Avi K, PT