Pitchers: Fastballs May Increase Risk for Tommy John

For Major League Baseball (MLB) pitchers, speed matters, says a new study from Henry Ford Hospital in Detroit. In a retrospective, case-controlled study, researchers collected data on 83 MLB pitchers from two years before and after they had surgery and matched it against a group of pitchers with no prior surgery over the same time period. And according to the May 18, 2016 news release, MLB “pitchers who throw a high percentage of fastballs may be at increased risk for Tommy John surgery…”

“Data included pitching statistics like pitch velocity, pitch types and innings pitched as well as pitching demographics like age, experience and whether they are left-handed or right-handed.”

As news release, “Researchers suggest that throwing fastballs nearly half of the time puts pitchers at risk of injury to their elbow. MLB pitchers who have undergone Tommy John surgery threw on average 7 percent more fastballs than pitchers who had no surgery. Researchers found no statistical differences in other pitch types like curveballs, sliders and change-ups. They also found no correlation between pitch velocity and risk of injury.”

“Our findings suggest that throwing a high percentage of fastballs rather than off-speed pitches puts more stress on the elbow, ” said Robert Keller, M.D., chief resident in Henry Ford’s Department of Orthopedic Surgery and the study’s lead author. “This leads to elbow fatigue, overuse and, subsequently, injury.”

Vasilios (Bill) Moutzouros, M.D., a Henry Ford orthopedic surgeon and the study’s senior author, said, “Our research should not be interpreted by pitchers who may now think they can go out and throw 80 percent of curveballs and not be at risk of injury. With overuse and continued stress on the elbow, the potential for injury over time is very real and at any playing level.”

Dr. Keller told OTW, “With the increasing number of pitchers requiring Tommy John surgery, this study’s senior author Dr. Bill Moutzouros and I have been dedicating a significant amount of time and resources into finding ways to limit the need for reconstructive surgery in players. It appears that the public-at-large has implicated the curve ball as a cause for elbow injury, but recent biomechanical studies have suggested that the elbow experiences more torque and force when throwing a fastball compared to off speed pitches. We set [out] to evaluate this by comparing those pitchers that required Tommy John surgery to those that did not.”

‘It appears that throwing at a high velocity for a greater percentage of time (i.e., throwing a higher percentage of fastballs compared with off-speed pitches) seems to place more stress to the elbow, therefore leading to more elbow fatigue and overuse and subsequent UCL [ulnar collateral ligament] injury.”

“We do caution physicians that they should be aware that this study only evaluated a group of Major League pitchers, pitchers with great mechanics who pitch at very high velocities. Caution should be used when extrapolating these findings for other levels of play (minor league, collegiate, and high school) as poor mechanics and conditioning may alter risk to the throwing elbow.”