Tag Archives: Matt Cain

Brian Wilson – Tommy John

Its true.

Our beloved bearded wonder will not be closing this year. But long before the wonderful run in 2010 and the beard that became a San Francisco sensation, Brian Wilson’s elbow underwent significant stress to the point of a ligament rupture and the long rehabilitation of Tommy John Surgery.

I thought this would be an appropriate time to give ya’ll a run down of Tommy John surgery, what some of the main reasons for it are, why Brian Wilson may be looking at his second, and what that means for him trying to come back an All-Star closer.

First off a little about what Tommy John surgery is, and why it is used so much in baseball.  The Ulnar Collateral ligament (or medial collateral ligament) is made up of three different bundles of fibers that runs along the inner aspect of the elbow. The job of the the UCL is to provide stability at the elbow, especially when the shoulder is externally rotated like the cocking and acceleration  phases in pitching (below )

Because the UCL’s job is to protect the elbow during the throwing motion, overtime the UCL can weaken and eventually rupture, causing instability at the elbow and an inability to throw. Poor throwing mechanics and weakness in the muscles of the shoulder, trunk and even lower body, have been found to relate to a pitchers likelihood of injury at the elbow.  The number 1 factor in UCL tear is bad mechanics, and the number 2 is overuse. You put them together and you are an injury waiting to happen.

The details of poor mechanics are for another blog, but one thing that stands out and is something you can look for when watching for mechanical flaws is where the elbow and shoulder are when the lead foot makes contact. You want the arm up and in what we would call external roation, meaning it is just about ready to come forward and release the ball. When you see the arm below the shoulder it means the shoulder and elbow are behind the trunk and legs and puts a tremendous amount of stress on the shoulder and elbow. Looking at Strausburg (tore UCL in first season in the majors) and Cain ( hasn’t missed a start in his 7 years in majors) you can see a difference.

Tommy John surgery is used for a player that has significantly torn or even ruptured their UCL. The repair involves using an unimportant ligament from the  opposite forearm, threading it through the ulna and humerus of the dominant arm, and allowing the new ligament to scar down and add stability to the elbow. Many times the player may have increased velocity following the surgery secondary to the ability of the new ligament to withstand more force than the original. I learned personally in my time interning with the padres that many players view tommy john surgery as a positive, thinking that they will have the surgery and a year later will be throwing 3-5 mph harder.

Not necessarily the case.

AT BEST a player will throw off the mound for the first time a year after having TOmmy John, however it can be up to 18 months, and only 80% of pitchers that have the surgery make it back the level they were throwing at before. However over time that graft can deteriorate, and without changing the mechanics, one can find themselves right back where they started.

Brian Wilson was pitching on borrowed time. And if you look at how his release point has changed in the last three years, you can see this damage to his elbow started a while back.  The graph below represents his horizontal release point and you can see the release point continued to decrease dramatically and that puts tremendous stress on the elbow.

Now lucky for Wilson he stopped pitching before it ruptured and it sounds the the MRI is showing only grade II sprain. In a pitcher that hadn’t had the surgery yet Tommy John might be appropriate, however Brian Wilson may opt out of it and try and rehab it without surgery secondary to the much poorer outcomes of a second surgery.

Of course, all of baseball hopes he comes back.

Moral of the story though?

If it breaks and you fix it, make sure you address WHY it broke to begin with.