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Original Issue

Arms and the Kid

Torn ligaments and Tommy John surgery--they're not just for big leaguers anymore

Like a lot of 13-year-olds, Daniel Hunker of Fairfield, Ohio, will soon attend tryouts for his town's rec baseball league. Fairfield's is a low-pressure circuit; no one gets cut at Saturday's tryout, and the season lasts only about 20 games. For now that suits Hunker fine since he's like an alarming number of kids his age in another way: In October he had an operation to replace the ulnar collateral ligament in his right elbow--the procedure known as Tommy John surgery. "I just started hitting a week ago," says Hunker. "I'm not going to be allowed to pitch this season. Maybe next year."

In recent years doctors have reported a spike in the number of ligament transfer procedures they perform on kids barely out of Little League. A decade ago Birmingham-based orthopedist James Andrews, who has operated on hundreds of pros, performed four Tommy John operations a year on patients high school age or younger. Last year he performed 53. "For throwers age 15 and below it's the most common surgical procedure I see in elbows," says Cincinnati Reds team doctor Timothy Kremchek. In 2004 Kremchek operated on 38 kids under 16, including Hunker.

The main culprits in what Andrews calls a "national epidemic" of juvenile elbow injuries are specialization and overuse. It's not unusual for kids--sometimes under pressure from parents dreaming of scholarships or signing bonuses--to play year-round for multiple teams. Pitchers are at the highest risk, but ligaments are shredding at every position. Hunker was primarily a second baseman and centerfielder when, after months of pain, he walked off the field in tears last August, his elbow mangled by the strain of too many throws and his sidearm motion.

Last year USA Baseball issued guidelines: Thirteen-year-olds, it said, should be held to 75 pitches a game and 3,000 per calendar year, and throwing breaking pitches should be avoided until age 14. The organization also suggests kids take at least three months off from the game each year. Unless players and parents show some restraint, surgeons will keep busy treating an injury that, says Kremchek, "is 100 percent preventable." --S.C.

For more on teens and Tommy John surgery, tune in to Real Sports with Bryant Gumbel this month on HBO.




Thanks to Kremchek (top), Hunker (above) will play, but not pitch, this season.



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