It was one of those phone calls that, even before you pick it up, you know will bring bad news.
Arizona Diamondbacks starting pitcher Daniel Hudson woke up to that call from the team doctor in early June 2013.
Hudson was nearing the end of a yearlong rehabilitation process for a damaged elbow ligament, which required a fix commonly known as Tommy John surgery.
Earlier that week, he'd taken the mound in Jacksonville, Florida, as a member of the Mobile BayBears, the Diamondbacks' AA minor-league affiliate. In his first time in a real game situation in about a year, Hudson's fastballs were reaching his usual velocity, upwards of 95 miles per hour, and he retired the first three Jacksonville Suns batters in order.
Throwing warmup pitches to start the bottom of the second inning, Hudson felt some tightness around his elbow. On the second pitch that inning, he felt that something was seriously wrong. His fastball dipped to about 85 mph, and he became hittable. He stayed in the game and completed the inning by striking out opposing pitcher Nathan Eovaldi -- another big-leaguer in the minors for a rehab start -- but that called third strike would be Hudson's last pitch for another year.
Hudson flew back to Phoenix after the game so the team doctor could find out what went wrong.
"It felt different than it did the first time so I didn't know exactly what was wrong," Hudson says. "I didn't know [if it] was a strain or something."
Hudson anticipated seeing Diamondbacks physician Dr. Michael Lee the following afternoon at team facilities, but instead, Hudson woke up to the phone call.
He realized before answering that the call could only mean disaster.
"Sure enough, I answered the phone and he said to me, 'I've got no way to break this to you --- you tore it again,'" Hudson recalls.
That elbow ligament had ripped again, and he needed a second Tommy John surgery. He was in shock.
Hudson, statistically one of the top 20 pitchers in baseball in 2011, already had missed most of the 2012 season after undergoing Tommy John surgery in June of that year. The phone call meant he wouldn't come back in 2013, either, and in the best-case scenario, would miss a majority of the 2014 season, as well.
"I just remember dropping the phone as soon as I hung up, and I just laid on the bed and cried for like 10 minutes," Hudson says. "I thought about not doing it again and calling it quits."
The next day, Hudson made up his mind -- he'd undergo a second Tommy John surgery and again start down the lengthy path toward playing with the big-league club. "Five years down the road, I probably couldn't have looked at myself in the mirror if I didn't try again," he says.
Two weeks later, he was in the Birmingham, Alabama, office of Dr. James Andrews for his second Tommy John surgery in as many years.
There's a reason Dr. Andrews is almost a household name among sports fans, and particularly fans of baseball. Every year, the game is robbed of some of the biggest pitching stars because of injuries to the ulnar collateral ligament (UCL) in their elbow, requiring infamous Tommy John surgery.
Just in the past five years, the list of Tommy John patients includes more than 100 names, including Washington's Stephen Strasburg; St. Louis' Adam Wainwright; Brian Wilson, a free agent who pitched for the Dodgers and Giants; Josh Johnson, San Diego Padres; Matt Harvey, New York Mets; Jose Fernandez, Miami Marlins; and Kris Medlen, Kansas City Royals.
Even as the 2015 season begins, there are more names to be added to the list -- the Texas Rangers announced in early March that three-time All-Star Yu Darvish would miss the entire 2015 season to undergo Tommy John surgery. A couple of weeks later, the Mets announced 24-year-old right-hander Zack Wheeler would need the surgery, too.
The ligament repaired in this surgery, the UCL, is on the inside of the elbow, and connects the upper-arm bone to one of the forearm bones. Extreme stress on the ligament from certain actions, like throwing a baseball, can severely damage it.
Men have been putting such stress on this ligament since the top professional baseball leagues lifted bans on overhand pitching in the 1880s, but the number of pitchers needing Tommy John surgery is only now reaching an alarming level.
According to Major League Baseball, there have been 15 to 20 pitchers every year who have needed the surgery, but in each of thepast three years, that's increased to 25 to 30 pitchers. In a survey of players from 2012 to 2013, 25 percent of MLB and 15 percent of minor-league pitchers said they've undergone Tommy John surgery at some point.
No pitcher ever had his UCL ligament reconstructed until 1974, when Los Angeles Dodgers team physician Dr. Frank Jobe performed the first such operation on 31-year-old left-hander Tommy John. Before the operation on John, there's no telling how many pitchers' careers ended or languished from a damaged UCL ligament.
Jobe, who died in 2014, told the Los Angeles Times a few years ago that Sandy Koufax could have been the first patient of the surgery 10 years before John, if only the physician had figured it out by then. Koufax, one of the greatest pitchers in the history of baseball, retired at the age of 30 because of elbow pain.
Forty years after the first successful UCL reconstruction, that the injury is becoming more prevalent isn't news to Dr. Jeffrey Dugas, Dr. Andrews' business partner at Andrews Sports Medicine and Orthopaedic Center in Birmingham.
"I would say it's not surprising at all there's an uptick in these surgeries," Dugas says. Dugas and others attribute the increase to the much higher number of kids who no longer play a different sport in each season and instead concentrate on year-round baseball.
In fact, Dugas -- who estimates he's performed about 1,000 Tommy John surgeries -- says he thinks teams at the major-league level actually do a good job of managing pitchers to prevent injuries, as inning and pitch limits become more common, despite the dozens of MLB pitching stars requiring the surgery in each of the past few years.
"I believe, as most people in our profession do, that this is really a youth-development issue," Dugas says.
The world of youth baseball brings into play any number of factors that can combine to place early stress on the UCL in an underdeveloped arm -- not only are kids pitching year-round, they're sometimes doing so with high pitch counts and high velocity and perhaps even adding the wrist action to create a curve ball, which can add particular stress to the UCL. (See "Hardball," August 25, 2005.)
"This is really something that needs to be [better] controlled at the youth level," Dugas says.
The Diamondbacks have been especially affected by the recent rash of Tommy John surgeries.
According to what's perhaps the most complete list of Tommy John surgeries in professional baseball, compiled by Hardball Times baseball analyst Jon Roegele, there have been 27 Tommy John surgeries on pitching arms in the history of the Diamondbacks organization, which started in the 1998 season.
Almost half of these surgeries took place in the past five years.
Not surprisingly, the team has gotten worse over that time span. After winning the National League West title in 2011, the Diamondbacks posted a record of 82-82 in 2012, the year of Hudson's first Tommy John surgery.
In 2013, when Hudson got his second surgery, the Diamondbacks went 82-82 again.
Then, before the 2014 season, two prominent pieces of the D-backs' bullpen, Matt Reynolds and David Hernandez, required Tommy John surgery. The team's death blow came when lefty ace Patrick Corbin, an All-Star the previous season, also had to undergo Tommy John surgery before the season started.
As if this wasn't enough, right-handed starter Bronson Arroyo went down in June with a UCL injury that eventually required Tommy John surgery.
Corbin and Arroyo exemplify how these UCL injuries seem to come randomly. Despite what the doctors know about the causes of these injuries, they aren't perfect predictors.
Corbin, for example, didn't even play baseball for half of his high school years, engaging in other sports instead -- two factors that would seem to decrease the likelihood of a pitcher getting a UCL injury.
Then there's Arroyo, one of the softest-throwing pitchers in the game, who had gone 14 straight seasons in the big leagues without any sort of serious injury. (See "Rock 'n' Roll Pitching," May 27, 2014.)
With five pitchers missing all or part of last season after undergoing Tommy John surgery, the Diamondbacks imploded in 2014, finishing with the worst record in baseball, with 64 wins and 98 losses.
UCL problems were only the start of injuries for the 2014 squad, and the list of players who spent time on the disabled list became huge: power-hitting first baseman Paul Goldschmidt; outfielders A.J. Pollock, Mark Trumbo, Ender Inciarte, and Cody Ross; infielders Chris Owings, (now-retired) Eric Chavez, and Cliff Pennington; infielder/catcher Jordan Pacheco; and relief pitchers J.J. Putz (who moved to the D-backs' front office) and Brad Ziegler -- in addition to all the Tommy John patients.
In fact, catcher Miguel Montero (since traded to the Chicago Cubs) and second baseman Aaron Hill were the only hitters on the team to get more than 500 plate appearances. By comparison, World Series runners-up the Kansas City Royals got at least 500 plate appearances from each of the nine starters.
However, none of the non-UCL injuries require the time away from the game and the rehab work that comes as a result of Tommy John surgery.
Paul Goldschmidt surely will return as one of the game's best at his position after breaking his hand last year. For the team's Tommy John patients, it's not that easy.
A small percentage of pitchers never pitch at the level they did before the surgery and fade away from the majors. Although it's generally accepted that a pitcher can come back after a year, he won't be back to where he was for a full 18 months, Dr. Dugas says.
This leaves a lot of uncertainty for the five Diamondbacks pitchers looking to come back this year from Tommy John.
The Diamondbacks aren't alone in this situation, as every team in baseball has had to figure out how to replace a pitcher on the big-league squad while keeping the injured player on the team's payroll.
In the Diamondbacks' case, the team's decline over the past few years has elevated Josh Collmenter from a prized long-reliever to a starter, and despite not being an ace by any stretch of the imagination, he's scheduled to be the team's Opening Day starter this year.
The team presumably will have to make space in the rotation for Corbin later in the season when he returns from Tommy John surgery. Corbin, who turns 26 in July, missed the entire 2014 season, after posting a 14-8 record and 3.41 ERA during his All-Star season in 2013.
In a world without UCL injuries, the Diamondbacks would have a pretty good pitching rotation, and the same can be said about several other teams that have been hit just as hard by these injuries.
Instead, not only do teams have to deal with problems that arise with more Tommy John surgeries, Arizona now is one of a few that contend with another variable -- a pitcher's needing a second Tommy John surgery, as in the case of Daniel Hudson.
The odds of a big league pitcher coming back to the majors from Tommy John surgery are about 85 percent.
The odds of a major league pitcher coming back from a second Tommy John surgery are unknown, but it's certainly not 85 percent.
"[A second surgery is] never a good thing," Dr. Dugas says. "The success rate of revision Tommy John surgery is nowhere near the first one."
Dugas says revision Tommy John surgeries are a relative unknown, because there aren't that many pitchers who've had them done. Even the best-known surgery centers for Tommy John, such as Andrews Sports Medicine, haven't done more than 20.
Though there are several well-known relief pitchers who have successfully made comebacks from a second surgery, there's a very short list of starting pitchers who have enjoyed similar success.
Perhaps the only active starting pitcher who has undergone two Tommy John surgeries and maintained a relatively high level of success is Chris Capuano, a 36-year-old left-hander with the New York Yankees who's known mostly as a soft-tosser -- his primary pitch is a sinking fastball that averages about 89 mph.
The current state of affairs doesn't look good for the list of starters looking to come back from a second surgery, which, in addition to Hudson, includes Jarrod Parker of the Oakland A's, Cory Luebke and Josh Johnson of the Padres, Kris Medlen of the Royals, and Brandon Beachy of the Dodgers.
Halfway through spring training, the Arizona coaching staff was unsure of how Hudson would be used this season.
Hudson, who hasn't started a game since 2012, entered spring training going through a starting pitcher's routine. Early in spring training, he said this was to provide more structured work and to throw out some of the variables involved with relief pitching.
However, Hudson will start the season in the bullpen. Although the D-backs' rotation -- headlined by front-end starters Collmenter and Jeremy Hellickson -- generally is projected to be subpar, Hudson hasn't been given a starting role just yet.
Hudson's comeback as a starter would arrive with a lot of variables. He'd undoubtedly have inning and pitch caps. After the first surgery, he says he made some "minor tweaks" to his mechanics, but after the second surgery, he says he's changed his mechanics "big-time."
There's no way to predict how he will fare against the best hitters in baseball, though it's easy for fans to have forgotten just how good Hudson was.
A Virginia native, Hudson grew up pitching. He played in Little League baseball with Justin Upton, the Padres outfielder recently traded by the Atlanta Braves who spent six seasons with the Diamondbacks. At Virginia Beach's Princess Anne High School, Hudson pitched to an 11-2 record with a 1.12 earned-run average as the team won the state championship in 2005. His hitting was impressive, too; he batted .412 with nine home runs his senior year as a part-time first baseman. (Hudson won a Silver Slugger award in 2011 as the best-hitting pitcher in the National League.)
Hudson stayed in Virginia to go to college at Old Dominion University, where he wasn't dominant on the mound but was well above average. He posted a career 20-14 record with a 3.70 ERA. The ODU record book lists Hudson as the third-leading career strikeout leader in school history, a couple of spots behind some guy named Justin Verlander, the Detroit Tigers ace.
In 2008, the White Sox took Hudson in the fifth round, 150th overall, in the MLB draft. He wasn't a can't-miss prospect out of college -- though major baseball publications pegged him as a top-100 prospect -- but Hudson flew through the minor leagues. He went from a rookie league in 2008 to starting the 2009 season in low-A ball. During the 2009 season, Hudson went from low-A to high-A to AA to AAA to the major leagues with the White Sox organization, never playing more than nine games at any stop. Fans voted him the best starting pitcher in the minor leagues in the 2009 Minor League Baseball Awards.
Though Hudson started the 2010 season with the White Sox's AAA affiliate, he made only three starts in the majors before getting dealt to the Diamondbacks at the trade deadline along with Sox prospect David Holmberg in exchange for D-backs starter Edwin Jackson.
Hudson stayed in the majors with the D-backs, posting a 7-1 record with a 1.69 ERA for the remainder of 2010, a season in which Arizona narrowly escaped a 100-loss season. In 2011, Hudson's first full season with the Diamondbacks, the team won the NL West crown, though Hudson's great year was overshadowed by that of Diamondbacks starter Ian Kennedy, who was a Cy Young candidate after finishing the regular season with a 21-4 record and a 2.88 ERA.
Hudson's stats may not have looked stellar with a 16-12 record with a 3.49 ERA, but the stats website FanGraphs ranks Hudson as baseball's 12th-best pitcher by wins above replacement (WAR) -- a measure of a player's total value -- which put him just ahead of the formidable trio of Seattle's Felix Hernandez, San Francisco's Matt Cain, and Philadelphia's Cole Hamels.
Despite Hudson's role getting reduced to what he describes as a team cheerleader for much of the past two years, he's developed into a fan favorite in large part because of his presence on Twitter, where "Huddy" gives his genuine thoughts on the game and also cracks a lot of jokes, like, "I can't wait to tell all my daughter's friends how much she farted as a baby." (Hudson and wife Sara had their first child, Baylor, last year.)
Despite all the missed time on the field, it's Hudson's potential as a top-tier pitcher that's kept him on the team -- which required the Diamondbacks to sign him to a new contract after the 2013 season.
But Hudson, now 28 years old, acknowledges that this is his last chance.
"I can't do it again," Hudson says. "I can't do the rehab three times."
He says the possibility of injuring his UCL a third time always will be in the back of his mind while he's pitching.
Even if he goes down again with damage to the ligament, thus ending his career, he says he can live with it.
That's because of 799 days of tedious work that finally paid off.
On June 26, 2012, Hudson walked off the mound because of pain in his forearm in the second inning of a game in Atlanta against the Braves.
From the surgery to the rehab to the second surgery and more rehab, it was 799 days until he got back on the mound in a big league game, on September 3, 2014, a contest that otherwise was meaningless as the Diamondbacks again flirted with a 100-loss season.
His taking the ball in the bottom of the eighth inning in that game in San Diego may have been the high point of last season.
In 13 pitches, Hudson -- with his family watching in the crowd -- retired three Padres batters in order, preserving a 5-1 lead.
"It was unbelievable," he says. "I still haven't been able to find words for it other than that. Two and a half years between pitches is a long time."
Hudson says what he told reporters after that game still is true.
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