High incidence of pitchers having Tommy John surgery concerns MLB

Miami Marlins starting pitcher Jose Fernandez wipes his Miami Marlins starting pitcher Jose Fernandez wipes his face after surrendering a grand slam home run to the San Diego Padres' Jedd Gyorko during the sixth inning of a game on Friday, May 9, 2014, in San Diego. Photo Credit: AP / Lenny Ignelzi

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Major League Baseball has been discussing the high incidence of pitchers undergoing Tommy John surgery, a person familiar with the issue said Wednesday, and it has become Topic A for Dr. Gary Green, baseball's medical director.

Miami Marlins ace Jose Fernandez could become the 18th player this season -- 17 are pitchers -- requiring reconstruction of his elbow because of a tear in the ulnar collateral ligament. The Yankees' Ivan Nova recently had the procedure and Mets righthander Matt Harvey is recovering from the surgery performed last November.

"It's certainly something that is happening with increasing frequency and [has] much more focus on it by clubs, media, fans," said a participant at the quarterly meetings at MLB headquarters in Manhattan. "How this impacts drafts, signings, use of pitchers in player development and major leagues are issues every club now looks at differently than in the past."

Green, an internist at Ronald Reagan UCLA Medical Center, said, "This has been a research priority for us. We certainly recognize that something is happening to a quarter of our pitchers. It's something that we've had our attention on for several years. And we're actively researching this and we're going to continue doing that regardless of whether or not this is a spike this year.

"It's clearly a problem. This is a research priority and the commissioner has talked to me and conveyed his concern. And they said whatever resources you need to bring for people to bring in to look at this, you have whatever you need."

There is a theory that the damage is the result of over-usage and that it largely affects hard throwers. "It's a little premature, but overall I would probably agree with that," Green said. "That's why we are researching this because we don't have a good answer. The thing that I would caution against is that while everybody maybe has a torn ligament, how they get there may differ. We may be saying the ulnar collateral tear is [the] end point -- it could be from multiple problems."

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Joe Torre, MLB's executive vice president of baseball operations, believes the problem lies beyond merely saying it is endemic to power pitchers. "Tommy John didn't throw hard," he said of the first pitcher to have the surgery in 1974.

Green said, "Even though we know that there are now more pitchers throwing at a higher velocity that they used to, that could be an association, not a causation. That's why we're doing research to find the causation rather than just things that could be associated with it. Everyone can speculate. Until we get some better answers, everybody has different opinions."

Green could not put a time frame on finding a solution, saying, "I've been asked that a lot. That's not how research works. You can have a breakthrough and then you find something and sometimes that raises three more questions. I really couldn't put a timetable on it. I would love to be able to, but you have complex problems that have complex answers."

Notes & quotes: Mets COO Jeff Wilpon attended the meetings. Hal Steinbrenner, the Yankees managing general partner, was not in attendance Wednesday.

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