Dr. James Andrews talks Tommy John

Former MLB star John Smoltz is one of the numerous pitchers who've had Tommy John surgery performed by Dr. James Andrews. Gregory Smith/AP

When Dr. James Andrews talks about arm injuries in baseball, it would be crazy not to listen to him.

After all, he is arguably the world’s most famous and best orthopedic surgeon, and he has saved the pitching arms of some of the greatest professional baseball players on the planet.

So when he has a request for the sport he loves, maybe it should be wise and listen to his request -- especially at the youth and high school level.

“I think they should outlaw the radar gun,” he said. “Young pitchers, coaches, scouts and parents put so much emphasis now on throwing hard that these kids are hurting their elbows and their shoulders because they're trying to throw 90 mph.”

The radar gun, Andrews said, is one of many injury risks at the youth and high school level in an age of baseball that is seeing more and more teenage athletes on the operating table instead of the pitching mound.

And frankly, Andrews doesn’t like it.

“Every time I see a high school pitcher walk in my office it makes me sad,” Andrews said. “A lot of these injuries could be prevented, and it’s gotten to a point where I am seeing more and more young kids in my office.”

For decades the majority of his Tommy John patients could be found in the dugouts of major league, minor league and college dugouts. But during the past 10 years, Andrews said, a rapid rise of his patients could be found in your local high school yearbook.

Tommy John surgery is a procedure where the damaged ulnar collateral ligament in the elbow is replaced with another tendon on the body, such as from the forearm or hamstring. It’s also the most common surgery Andrews performs on young pitchers.

One of those pitchers is Bolles (Jacksonville, Fla.) right-hander Hayden Hurst, whom Andrews performed Tommy John surgery on in the eighth grade.

“I definitely can feel the difference,” said Hurst, now a senior. “Before the surgery it felt like I had a bum arm. Now it feels alive.”

Andrews used to do three or four Tommy John surgeries a year on high school athletes. Now he said it’s up to three to four times a week.

“It is surprising,” Andrews said. “Kids are growing up too fast. They are outgrowing the development of their ligaments. They are getting too big and too strong too quick. Their ligaments in the elbow aren’t ready.

“The first thing you need to do is basically have common sense,” he added. “If you step back and really understand the risk factors you can prevent these arm injuries.”

Here are the five main risk factors that Andrews believes contribute to the rash of elbow injuries among high school pitchers. By paying attention to these, it could lessen the chance of a major injury on the mound.

Year-round baseball

Like the radar gun, Andrews thinks they should get rid of year-round baseball.

“Young pitchers now are throwing hard all year and that is not a good thing,” he said. “There is no rest period. Baseball is a development sport and the ligaments in the elbow need rest to develop.”


Slow it down, Andrews said. Thanks to numerous years of experience and a multiple of studies, Andrews said there should be a line on how fast a pitcher should be throwing.

“We found that young pitchers who throw over 85 miles per hour have far greater potential of getting hurt,” he said. “When throwing more than 85, it creates a lot of stress on elbows that are still developing.”


This risk factor should be the easiest to understand, Andrews said. It’s also one of the biggest reasons for injury.

“There should be a pitch-limit rule at every high school in the country,” he said. “I have heard of kids who throw 160 pitches in a game and that’s just not safe.”

Andrews said pitchers should never pitch on back-to-back days and should never try and get through an inning when they feel any soreness or tiredness in their pitching arm.

Travel baseball (also called club baseball) also is a big cause for fatigue because coaches from separate teams do not communicate with each other.

“One coach will pitch a kid for five innings one night and then the next day the same kid will go throw five more innings for a different coach in a different game,” Andrews said. “These pitchers should not be playing in more than one league at once. You have to rest to prevent these injuries.”


Social pressure and scouts at showcase events also play a role in arm injuries.

Andrews said many arm injuries are associated with one-day showcase events where pitching prospects go throw for pro and college scouts. Most of the time, it’s not safe.

“A lot of the times they go to these events not in shape or tired because they maybe pitched the night before,” he said. “They throw them off the mound as hard as they can and damage their arm by doing so.”

The radar gun

“Just outlaw it,” Andrews said. “It’s time.”

Maybe it’s time baseball listens to him.