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Stretched too far, younger pitchers need Tommy John

By Daniel Paulling dpaulling@paducahsun.com

Despite his injured right elbow, Rhett Sutton was shocked with his diagnosis last August.

For the previous seven months, the St. Mary freshman alternated between pitching until the joint hurt and resting it in hopes of a full recovery. After Sutton underwent an MRI in July, his orthopedic physician consulted then-St. Louis Cardinals team doctor George Paletta on an hour-long conference call.

The physician asked how soon the family could schedule an appointment with Paletta. Tired with how long Sutton's injury had lasted, they visited the next day. Paletta then broke the news that Sutton required the same surgery as Cardinals pitchers Adam Wainwright and Jason Motte.

"At the time, I didn't know what he was telling me," Sutton said.

But then he realized what Paletta was saying. Sutton needed Tommy John surgery. At age 13.

"It's never a perfect day when you operate on a kid who's a freshman or a sophomore in high school," Paletta said. "That's a kid who's suffered an injury you'd rather not see at that age."

Dr. Frank Jobe performed the first Tommy John surgery, which came on major league pitcher Tommy John in 1974. The procedure, which involves replacing a torn ulnar collateral ligament in an elbow, was considered a radical experiment to save John's career. 

When Sutton underwent his surgery on Aug. 27, just seven days before his 14th birthday, he became the youngest such patient for Paletta, who has done more than 500 Tommy John surgeries. 

Sutton also joined a growing number of youth pitchers who have undergone Tommy John surgery and became a mentor to another of Paletta's patients, a 14-year-old from Iowa who underwent Tommy John surgery and wanted Sutton's advice.

Many sports medicine professionals, including Paletta, believe overuse of youth pitchers is leading to the increase of injuries and has impacted the major leagues. If a professional player avoids injury as a youth, the thinking goes, the wear and tear eventually catches up with him.

Fifty-five professional players have had Tommy John surgery this year, including eight for a second time, according to a database compiled by baseball writer Jon Roegele.

Pitchers who have had it this year include former first overall draft pick Luke Hochevar of the Kansas City Royals, Atlanta Braves starting pitchers Brandon Beachy and Kris Medlen, and 2013 National League Rookie of the Year Jose Fernandez of the Miami Marlins.

"I don't completely agree with the word, but there's been a relative 'epidemic' of elbow surgeries," Paletta said.

There are many theories on why youth pitchers are becoming injured more often.

Youth pitching instructor Kent Wallace of the Baseball Barn tells clients to avoid throwing a curveball, which is believed to be dangerous for younger players because of the amount of torque placed on the elbow. Another idea is to limit pitch counts and innings thrown.

Paletta believes two major factors are responsible: the year-round focus resulting from specialization and a desire among younger pitchers to throw as hard as possible. A position paper released in May by American Sports Medicine Institute research director Glenn Fleisig presented similar conclusions. 

Wallace, who played at Murray State before spending seven seasons in the New York Yankees' and Houston Astros' minor league organizations, recalls participating in Little League seasons of just 14 to 16 games in the early 1980s.

But now youth players are participating in scholastic baseball in the spring, on multiple teams during the summer and fall and, in Sutton's case, in pitching lessons in the winter.

"Kids that are 9 and 10 don't need to play 90 games," Wallace said. "I hear this all the time, but it's nonsense: 'They're kids. They bounce back quicker. Their arms are like rubber.' That's so far from the truth."

Paletta believes pitchers in middle school or early in their high school career need between two and three months off each year from throwing. He suggested they could use that time off to do conditioning or build strength in other parts of their body, such as the core or legs.

When they do pitch, Paletta says, they shouldn't be trying to throw as hard as possible - though that may be difficult with the prevalence of radar guns at showcase events in the hands of college coaches and major league baseball scouts.

"Velocity is what college coaches and pro scouts want to see," Wallace said, "so that's something we want to work on."

Many people in the sports medicine profession, though, compare the ulnar collateral ligament to a rubber band. If you stretch it to 50 percent of its capacity many times, it'll hold. If you stretch it to 100 percent capacity, you'll need a new rubber band. 

"There's nothing good that comes from (the increase in Tommy John surgeries) except the fact that it has raised awareness of this injury," Paletta said. "Hopefully that raised awareness gives us in sports medicine an opportunity to further educate young players as to the risks and what can be done."

But he added he has "guarded optimism" that conditions will improve for youth pitchers.

"I don't think it's likely," Paletta said, "but I think that there's a chance."

Sutton's chance of needing Tommy John surgery again is low. He doesn't plan on pitching again and has improved his throwing motion as a middle infielder for his travel baseball team.

The 2 1/2-inch scar on the inside of his right elbow is healing, as is the smaller one on the inside of his left wrist. Paletta took a tendon from Sutton's left wrist to form the new ligament. 

"I'm not giving up a chance at being a college baseball pitcher," Sutton said. "I'm keeping my chance of being a college baseball hitter alive. I'm a lot stronger now. I can throw farther, harder, longer. I'm happy I had it."

Call Daniel Paulling, a Sun sports writer, at 270-575-8662, or follow on Twitter @DanielPaulling.

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