Earlier this week, Jacob deGrom was put on the disabled list with rotator cuff tendinitis.
Later, it was announced that Jeremy Hefner re-injured his elbow and will need a second Tommy John surgery, which prompted Sandy Alderson to talk with Matt Harvey about slowing down his rehab program.
Greg Talbot is an injury analyst and physical therapy graduate student affiliated with NYU center for musculoskeletal care. He took time to answer the following questions from Matthew Cerrone about deGrom, Hefner and Harvey.
Matthew Cerrone: Should I be worried about deGrom’s rotator cuff tendonitis?
Greg Talbot: Fans should not be worried about deGrom’s rotator cuff tendonitis nor fear news about his shoulder. Rotator cuff tendonitis sounds much scarier than it actually is. … The rotator cuff tendonitis that deGrom is experiencing is nothing more than inflammation of his rotator cuff tendons due to the nature of throwing a baseball. If you are worried about this becoming a chronic ailment for deGrom, don’t be. While it certainly could become an issue again, deGrom should only become stronger with experience, and he will adapt to increased innings limits. With a little rest, deGrom will be back to electrifying Citi Field.
Matthew Cerrone: How common is it that a player needs to have a second Tommy John surgery?
Greg Talbot: Tearing the reconstructed ulnar collateral ligament (UCL) happens more often than you might think, just ask Jarrod Parker, Kris Medlen, Josh Johnson, Cory Luebke, Daniel Hudson, Brian Wilson and a handful of others that have had two Tommy John Surgeries. We have been conditioned to believe pitchers that have this surgery will definitely return without skipping a beat. Hefner’s injury is just a reminder that while the procedure generally allows athletes to return to pitching at a high level, Tommy John surgery is far from a slam dunk.
Matthew Cerrone: So, why would something like this happen to Hefner? What might cause a second surgery?
Greg Talbot: For starters, human beings are not built to repeatedly throw a baseball 90+ miles per hour.
That said, Hefner was diagnosed with an ulnar stress fracture and a sprained UCL. Stress fractures of the ulna, while somewhat rare, occur when the muscles surrounding the elbow become fatigued. When these muscles fatigue, they are unable to absorb the added forces on the elbow during the throwing motion. These forces are transferred to the bone and may cause a fracture.
The ulnar collateral ligament (UCL) stabilizes the arm during the throwing motion. As we have seen this year, any and every pitcher is at risk of insulting the UCL. When a pitcher reaches back to throw a pitch, the UCL is tasked with holding the Ulna, found in the medial forearm, and humerus, found in the upper arm, together. This repetitive movement places stress on the UCL. Experts believe that a pitcher’s mechanics can contribute to UCL tears, but pitchers with sound mechanics, like Matt Harvey, have also had the surgery. The bottom line is that pitching places a great deal of stress on the UCL, and there is not a good way to predict future injuries.
Matthew Cerrone: How do the Mets avoid something like this with Harvey?
Greg Talbot: There is no surefire way to avoid tearing the UCL, nor is there a secret formula for rehabbing a reconstructed UCL. Harvey needs to trust the process, and the Mets need to cautiously progress his workload. So many variables are present during the rehabilitation process: every pitcher heals differently, responds to the new UCL graft differently, has different pitching mechanics, and on and on. Harvey needs to stay the course and resist the competitive urge to push ahead of his doctor recommended pitching intensity.
Matthew Cerrone: So, basically, one has nothing to do with other?
Greg Talbot: Hefner’s injury should serve as a reminder to Harvey, the Mets, and every fan that nothing is guaranteed with the Tommy John procedure. Harvey is progressing well, and the surgery generally allows the majority (83%) of pitchers to return to pitching at a high level, but I’m sure Hefner will be the first to tell Harvey to respect the process.