Taillon's Tommy John surgery: The only certainty is uncertainty

Long before Neal Huntington was the Pirates general manager, back in what he calls his “entry-level” days, he took a pitcher to see a doctor. The pitcher had thrown 94 mph fastballs in a game a night earlier, but the doctor diagnosed him with a three-quarters tear of his rotator cuff. As Huntington said, “You don’t always see it.”

Injuries to pitchers are baffling in frequency and unpredictability. Players keep themselves in better shape these days than before. Athletic trainers, doctors and pitching coaches are more informed about mechanics. Teams track innings and pitches thrown in an effort to keep their players, and by extension their multi-million-dollar investments, on the field.

But injuries still occur, and Jameson Taillon, 22, became the latest name on a long list. This right-hander, the top pitching prospect for the Pirates, will have Tommy John ligament-replacement surgery, meaning he will miss the remainder of 2014 and won’t be ready to pitch in a game until next April at the earliest.

Damage to the ulnar collateral ligament in the elbow, the injury that requires Tommy John surgery, continues to stymie pitchers, coaches and medical experts. They know some things that can cause it, but not all its causes. Knowledge of some causes has led to prevention plans, but even the best-prepared pitcher can get hurt.

“If we knew there was a sure-fire, 100-percent fix, every pitcher would do it,” Huntington said. “And every pitcher would do it the exact same way, and every surgeon would do the surgery the exact same way. The challenge is, these are completely gray areas. We’re learning more, but we still have a lot more to learn.”

PG graphic: Tommy John surgery
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Oakland’s Jarrod Parker, Arizona’s Patrick Corbin, Atlanta’s Kris Medlen and Brandon Beachy and Detroit’s Bruce Rondon are among the other pitchers who needed the surgery thus far this season or in spring training.

Huntington stood in the back of the PNC Park press box Sunday telling reporters that one-quarter of pitchers on active rosters at the start of the 2013 season had undergone Tommy John surgery. Shortly thereafter, on the field, the Pirates-St. Louis Cardinals game unfolded into a pitcher’s duel between Adam Wainwright and Edinson Volquez, both Tommy John surgery survivors. Pirates pitchers Mark Melancon, Jason Grilli, Charlie Morton, Francisco Liriano and Bryan Morris also have had the procedure.

“We’ve had, I think, less than 20 in our six years here,” Huntington said. “Our rate is significantly lower than the major league rate, but we’re still having them. And we’d like to have none.”

Though the Tommy John riddle is tough to solve, it isn’t for lack of attention. The procedure has existed since 1974, but it gained more notoriety in the past five years.

Washington Nationals starter Stephen Strasburg, the first overall pick in the 2009 draft, needed Tommy John surgery after 12 starts into his major league career and he became the center of heated debate when the Nationals decided to shut him down early in 2012, his first full season back. New York Mets starter Matt Harvey, who pitched well enough to start the All-Star Game in 2013 and gave Mets fans hope on an otherwise bleak roster, needed the surgery last fall.

As much as teams try to prevent UCL damage and preserve their new ones after surgery, uncertainty rules. Data generally supports the argument that overuse, especially at a young age, contributes to damaged UCLs. Bad mechanics, notably when a pitcher’s arm lags behind the rest of his body, don’t help. Compensating for an injury elsewhere can put more stress on the elbow.

Huntington said Taillon had participated in biomechanical evaluations, which take a close look at a pitcher’s delivery and the loads he puts on his body, but even that is inconclusive.

“They’re not the end-all,” Huntington said. “They provide you with some information, they provide you with some clarification on some mechanical strengths and mechanical weaknesses.”

The injury can strike the best, most durable pitchers, too. After 27 years in the majors, 324 wins and the most strikeouts in history, Nolan Ryan walked off the mound Sept. 22, 1993, after his UCL was torn. He was 46 and augmented his career by putting himself through grueling workouts to stay in shape.

“He had about as clean an arm action as you can have, especially later in his career,” Huntington said. “We talk about it all the time, it’s a matter of efficiency and a matter of when it’s going to happen and pushing that as far in the future as we can with everything that we do, with the selection process and the development process and the maintenance process.”

Bill Brink: bbrink@post-gazette.com and on Twitter @BrinkPG. First Published April 7, 2014 9:57 PM

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