After Two Tommy John Operations, Daniel Hudson Hopes to Rejoin the D-backs' Starting Rotation

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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.

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Matthew Hendley
Contact: Matthew Hendley