Here we go again …
Miami Marlins ace Jose Fernandez has a torn ulnar collateral ligament in his right elbow that will require him to have surgery, according to a report. Fernandez will get a second opinion from the Marlins' team doctor after another physician discovered a tear in the UCL and recommended he have surgery.
Fernandez reportedly complained of soreness in his elbow after his latest start, last Friday night against the San Diego Padres. As it turns out, maybe there were telltale signs of a problem before he ever complained of discomfort. According to ESPN Stats & Information, Fernandez's velocity on his fastball dropped during Friday's outing from an average of 94.6 mph over his first four innings to just 90.7 mph over his last two. In fact, his average fastball velocity had progressively declined over each of his last four starts.
A dip in velocity has been thought to suggest a potential problem with a pitcher's arm. It's worth noting, however, that in Fernandez's case, not all his performance metrics dropped off at the same time. For example, on April 29 against the Atlanta Braves, one of those last four outings where his velocity was gradually declining, Fernandez still managed to strike out eight batters while throwing eight scoreless innings on his way to a victory. By his latest outing, however, all metrics were going in the wrong direction. On May 9, Fernandez gave up five runs, he had only five strikeouts (his fewest of the season) and, simply put, he lost.
The recent decline in Fernandez's performance may have only reflected the inevitable. Now that he will need to have surgery to reconstruct his ulnar collateral ligament, that ligament was probably in the process of failing for quite some time. Surgery translates to at least a year off of major league competition with an opportunity to not only allow the body to recover, but also to strengthen and condition it. The elbow and the new graft are going to be subjected to the stresses of pitching; physically preparing the rest of the frame -- the legs, the core, the shoulder -- may help mitigate those stresses to a degree.
The high success rate for Tommy John surgery (approximately 80 percent), as defined by return to play for at least one game at the same level or higher, has been well-documented. However, data presented at the 2014 American Academy of Orthopedic Surgeons meeting in New Orleans suggests that this number may be misleading. When return-to-play numbers are further stratified to evaluate whether pitchers are able to return to established competition (more than 10 games per season), the success rate drops to 67 percent. Consider that Cory Luebke (Padres) and Brandon Beachy (Braves) both failed to return for 10 games after their initial Tommy John surgery and have since undergone second (revision) procedures.
Even if pitchers are able to successfully return following this surgery, are they, in fact, throwing harder? A study presented at the 2014 American Sports Medicine Institute's Baseball Medicine conference showed that velocity actually decreased following surgery, despite pitchers' overwhelming perception to the contrary. Still, the confidence that comes with the perception of throwing harder, the year of rehabilitation and a lack of discomfort may ultimately contribute to a successful return.
The number of players continuing to fall victim to the injury, however, reminds us that fixing the broken wings does not correct the core problem. Seventeen Tommy John surgeries have been performed on major league pitchers thus far in 2014. If Fernandez undergoes the procedure sometime in the next week, the 2014 total through the second week of May will be just one shy of last year's number … for the entire season. If the pace keeps up, by the All-Star break the number could match the total of 2012, the record year, when 36 such surgeries were performed.
While there is reason to believe the pace could slow as the year progresses (more surgeries tend to take place early in the season), there's no denying that the number of season-ending elbow injuries since the start of spring training is alarming. Equally alarming is the increasingly young age at which some of these injuries appear to be happening. Fernandez is 21 years old; Tampa Bay Rays left-hander Matt Moore was not much older (24) when he had surgery in April; and Washington Nationals righty Stephen Strasburg was merely 22 when his ligament was reconstructed. Why is that the case? There are many theories, some of which I referenced when I wrote about the rash of Tommy John injuries in April, none of which explain this phenomenon in its entirety.
It may be, as the saying goes, the perfect storm, where numerous elements combine to yield one tragic consequence. In this case, the consequence is major elbow surgery that will sideline a pitcher for at least a year, likely longer. As the medical world gathers more data, hopefully our storm prediction tools will improve to the point where we get better at recognizing the early alarms and, more important, the clusters of contributing factors. Perhaps that will allow us to chart a better course for the athlete before the only choice becomes surgery, now … or later.