19 May Large Number of Fastballs Contributes To Need For Tommy John Surgery
MedicalResearch.com Interview with:
Dr. Robert Keller
Robert Keller, M.D., Chief resident
Department of Orthopedic Surgery
Henry Ford Hospital Detroit
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Keller: Injuries to the medial ulnar collateral ligament (the ligament torn in pitchers requiring tommy john surgery) are common in overhead-throwing athletes. Recent data supports that the number of MLB pitchers requiring tommy john surgery continues to increase, with estimates near 25% of all MLB pitchers undergoing tommy john surgery. Recent investigations have attempted to analyze factors that contribute to UCL injuries with the aim to decrease the rate of injury. Studies have suggested that possible risk factors include pitching mechanics, pitch type (curve ball, fastball, etc), g, pitching fatigue, chronic overuse, and pitch velocity, among other factors.
Specifically, increased pitch velocity has been implicated as a risk factor for UCL injury. However, no study has exclusively attempted to assess whether MLB pitchers who required Tommy John surgery pitch at a higher velocity than those that do not. Pitch type (fastball, curveball, slider, etc) is another significant factor that has been investigated as a contributor to UCL injuries. Various biomechanical studies have attempted to correlate pitch types with torque across the throwing elbow, with contrasting results: some suggest fastballs create more torque, whereas others found off-speed pitches produce increased stresses. Beyond not evaluating MLB pitchers, these previous studies also failed to evaluate the volume or amount of a specific pitch type thrown by these pitchers that may contribute to UCL injuries.
MedicalResearch.com: What should readers take away from your report?
Dr. Keller:
1) Pitch velocity in MLB pitchers does not appear to be a direct risk factor for UCL injury.
2) The percentage of fastballs thrown, however, is a significant risk factor in pitchers requiring Tommy John Surgery. A 2% increase in risk for UCL injury was found with every 1% increase in the number of fastballs thrown, with 48% of fastballs thrown serving as a significant threshold for requiring reconstruction.
3) Stresses due to the amount of high velocity pitches thrown rather than the absolute maximum velocity obtained leads to an increased risk for UCL injury in MLB pitchers.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Keller: MLB pitchers requiring Tommy John Surgery do not pitch at higher velocities than matched controls, and pitch velocity does not appear to be a risk factor for Tommy John surgery. However, pitchers who pitch a high percentage of fastballs may be at increased risk for UCL injury because pitching a higher percent of fastballs appears to be a risk factor for UCL reconstruction.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Keller: A limitation is this study only looked at MLB pitchers, and caution should be used when extrapolating these findings for other levels of play (minor league, collegiate, and high school). Randomized, prospective trials would necessary to better assess these risks.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Robert A. Keller, Nathan E. Marshall, John-Michael Guest, Kelechi R. Okoroha, Edward K. Jung, Vasilios Moutzouros. Major League Baseball pitch velocity and pitch type associated with risk of ulnar collateral ligament injury.Journal of Shoulder and Elbow Surgery, 2016; 25 (4): 671 DOI:1016/j.jse.2015.12.027
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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Last Updated on May 19, 2016 by Marie Benz MD FAAD