Torn UCL? Now What?
Why the most common pitching injury rarely has a clear path forward
5 minute read
“He needs Tommy John surgery for his UCL, right?”
Dan wants to know the prognosis for Felix Bautista’s elbow injury. It’s been a resurgent year for his hometown team, the Baltimore Orioles, and small talk between us inevitably settles around baseball when he heats his lunch in the kitchenette adjacent to my office. Bautista has anchored the Orioles bullpen the entire year, cutting down hitters late in pressure-packed games with a fastball which routinely hits 100 miles-per-hour and nose-diving, demonic, splitters. The kind of silly stuff you find in an MLB bullpen these days.
It’s a notable role reversal. I’m often the one asking Dan, my thesis advisor with a PhD in clinical psychology, the questions. But, when it comes to the ambiguous, frustrating, world of elbow pain and organizational politics within baseball, I’m the lab’s resident expert.
Well, it’s not quite that simple, I begin, as he leans against my office door. Prior to my own ulnar collateral ligament (UCL) injury while pitching in the Pittsburgh Pirates organization, I assumed the definitive answer to sharp elbow pain was elbow reconstruction, Tommy John, surgery. “TJ” is akin to a hard thrower’s oil change; In 2018, more than 25% of pitchers in Major League Baseball sported Tommy John scars from their past.
Throwing a baseball in the upper-90s is like playing with a loaded gun. Mine went off during my third year as a professional. Like most UCL injuries, it wasn’t a clean 100% tear. The first doctor I consulted likened the ligament to a rubber band which can lose its elasticity. The status of mine? Frayed and slightly torn.
I entered the nebulous protocol for dealing with a pitcher’s elbow pain, while my agents and I lobbied the Pirates for weeks to receive imaging on my elbow. They were reluctant to do so. Many organizations operate the same way, discouraging players from receiving MRIs in the first few weeks after an injury. Their logic is simple: most pitchers will show some degree of damage to the ligament, even if it isn’t causing any pain. MRI results are often inconclusive and only muddle treatment options; there’s no way to truly know if the UCL is the symptomatic element for fringe cases like mine. So, what do teams do? They wait and see.
They rest players after an elbow injury, often with a designated period of “no-throw” and physical therapy to loosen and strengthen forearm muscles which may be inflamed. Some, like me, are told they’re a prime candidate for a platelet-rich-plasma (PRP) injection in lieu of surgery. A PRP injection starts by drawing blood from the arm of the patient. Its then spun through a centrifuge to separate red blood cells from plasma which is then re-injected into the site of the tear. The idea? Jam all your blood’s natural healing into the site of the tear to make the UCL thicken.
Distrust is the most common sentiment among pitchers waiting for a clear path forward. Agents push teams to get more extensive imaging or meet with specialists who give confounding second opinions. Few players see the long wait, the testing and re-testing of the elbow after less invasive treatments, as a good-natured attempt by the organization to get back to the field quickly and healthy. They’re mostly viewed as cost-cutting, flimsy efforts to fix something that should have been operated on in the first place. In most players’ opinions, PRP injections are simply delaying the inevitable.
Most days, I wish I’d cleanly snapped my UCL. While rehabbing my sprain I spent my days in the Pittsburgh Pirates training facility in Bradenton Florida, with five different players, Big Leaguers included, working through the grueling Tommy John rehab process.
I envied them. I harbored a secret fantasy of pocketing the heaviest weighted ball I could find, sneaking out after dark, and firing it at a brick wall over and over and over again. Let’s blow it all the way out this time. Leave no room for doubt. Anything was better than waiting, waiting, waiting, to test out a balky elbow after undergoing a testy procedure which seemed like it had a coin flip chance of working. There’s something appealing about leveling your elbow to ground zero when you’re stuck in the endless “wait and see” cycle; no matter how long it took to rehab, at least I could move forward assured that I had a solid foundation in place.
Eventually, I decided to step away from baseball. After a PRP injection and multiple periods of extended rest, my elbow continued to hurt when I pushed my body to the edges of my velocity. Something wasn’t quite right. My arm felt like a limp pool noodle when I tried to dial up my best fastball while my command splintered, and my velocity sagged. My tingly elbow and ambiguous rehab weren’t the main reasons behind my retirement, but they certainly made the decision easier.
So, what did I tell Dan about the availability of his team’s lockdown closer? I told him you could spend a lot of effort reading the tea leaves: follow along with the team’s press releases, raise and lower your optimism with every update. Or, you could resign to the news no pitcher likes to hear upon entering rehab.
“We’ll have to wait and see.”