Tommy John Casualties

July 06, 2015

Elbow reconstruction operations are so common among major leaguers, and so often deemed successful, that pitchers who undergo the procedure (aka Tommy John surgery) don't often fear for their careers. But what about players whose arms are never the same?

THE TALL RIGHTHANDER draws his throwing arm back and then whips it forward, a motion honed over a lifetime on the pitcher's mound. A breeze cools his face as he works the angles and tries to entice his opponent to make a poor decision. But on this early-summer afternoon Adam Bernero isn't trying to get a hitter to chase a slider just off the plate. He's more than 300 miles from the nearest big league ballpark. Wearing waders instead of spikes, Bernero is standing thigh-deep in the Upper Deschutes River in Bend, Ore., reaching back to load his fly-fishing rod and making one cast after another. The rainbow trout aren't biting, so he keeps moving and switching between wet flies (which sink to deeper waters) and dry ones (which stay on the surface and look like insect wings).

After a few hours, Bernero shakes his right hand. "My last two fingers get numb when I've been doing anything active," he says. "That's when I have to switch to my left hand." It becomes clear why he quit professional baseball in 2008, suddenly ending a seven-year career as a journeyman reliever after feeling a pop in his right elbow.

Eight years after undergoing Tommy John surgery (shorthand for ulnar collateral ligament reconstruction), Bernero, 38, still feels discomfort in the joint, which puts him in a fraternity that fans rarely think about: the up to 22% of players who never make it back from an injury now widely perceived as no more career-threatening than a hamstring pull or a strained oblique.

WHEN PITCHERS first hear of the high success rate of Tommy John surgery, they are comforted. Scores of major leaguers—position players as well as pitchers—have had UCL reconstruction and come back as good as new. Just look at current aces Matt Harvey, Stephen Strasburg and Adam Wainwright. But there is no consensus on the best way to measure the success of the surgery. A 2014 study published in The American Journal of Sports Medicine concluded that only 67% of pitchers return to the same level of proficiency as they had before the operation. And according to Jon Roegele, a sabermetrician who runs the database Tommy John Surgery List, one out of every two major league pitchers who has UCL reconstruction will throw fewer than 100 innings the rest of his career.

But for the guys whose arms just don't work right again—as many as 70 major leaguers (Roegele's number) since 1974, when orthopedic surgeon Frank Jobe first performed the surgery on Dodgers lefty Tommy John—life is never the same. "You hear all these reports on TV about guys coming back," Bernero says, "but if it doesn't work, you're just kind of kicked off to the side. They never talk to you again."

Bernero has fly-fished since he was a kid in Sacramento. His father would lift him by the back of his waders and carry him to safety if the current became too strong. When Bernero left baseball, he worked first as a summer fishing guide in Alaska, trying to get as far as possible from the game and the doctors. Most frustrating, he says, was that he had followed every part of the rehab procedure given to him by his renowned surgeon, James Andrews.

Before spring training of 2007, Andrews operated on Bernero's elbow, which had calcified from the stress of pitching. A year later Bernero's arm was still locked at a 90-degree angle. A surgical cleanup by Andrews helped with the pitcher's range of motion, and he returned to the mound in May '08, with the Pirates' Triple A affiliate in Indianapolis. Four pitches into his fourth start, his arm seized up and he felt a pop in his elbow. He knew his career was over, so he gritted his teeth to make the moment last, finishing two no-hit innings as he took it all in. His only thought: I don't want to get off the mound. As he sat in the dugout afterward, a coach asked, "Hey, Bernie, you throwing all changeups today?"

In September, Bernero will begin pursuing a master's degree in sports and performance psychology at the University of Denver. His initial focus will be on performance, but he believes he can have a greater impact by helping athletes prepare for retirement. "If I can gain players' trust and help them with their performance," he says, "I can weasel my way in and say, 'Hey, man, it's gonna end.'"

Another Tommy John casualty, relief pitcher Tim Spooneybarger, is already working with athletes. He's a pitching coach in Pensacola, Fla., putting eight- to 25-year-olds through lower-body training regimens to reduce the stress on their arms. One of his most devoted protégés is Zane Gill, a righthanded senior at Pensacola Catholic High with an 88-mph fastball and a commitment to Duke. He had Tommy John surgery in May 2014, and, according to Spooneybarger, he's pitching well again.

Spooneybarger, a key contributor on the Marlins' march to the 2003 World Series, had his right UCL rebuilt toward the end of that season. It took him 23 months to get back to the mound—"I never really felt good," he says—and just four appearances into his rehab he felt something go wrong. Doctors told him he'd torn the tendon from the bone; then, during surgery, they discovered that the damage was worse than they had thought, and they had to reconstruct the elbow again. When Spooneybarger woke up, he couldn't move his leg: The surgeons had taken part of his hamstring to use in his elbow.

Spooneybarger made it six games into his next rehab stint, in 2008, before seeing a doctor because of pain in his arm. He got a call back from the doctor while he was at the ballpark. "He told me I had torn my ligament for a third time," says Spooneybarger, now 35. "I dropped the phone, walked inside, got my stuff and drove home."

Brian Anderson reacted almost the same way to his second UCL tear, in 2008. Three years earlier, in spring training before his 13th big league season, he was diagnosed with severe tendinitis in his left elbow. He rested and rehabbed, but by early May the pain was unbearable. He was sitting on the bench grimacing after the second inning of a start in Baltimore when a Royals teammate alerted manager Tony Peña. Doctors later told Anderson he'd probably been pitching with a partially torn UCL since midway through the '04 season. By the time he had Tommy John, in June 2005, the elbow was shredded.

Disappointed by how quickly his season had ended, Anderson rushed back after the surgery, ignoring occasional tightness and soreness. Ten months after the anesthesia wore off, he was in a game for the Rangers in extended spring training. After only a dozen pitches he heard a sound like paper tearing, felt a sharp pain in his arm and walked off the mound. He didn't need anyone to tell him what was wrong. The second UCL surgery was scheduled for a year to the day after the first one; he got it pushed up a week for good luck.

Anderson was more careful in his second rehab stint, deciding early on that he'd take off the entire 2007 season no matter how good he felt. Going into spring training in '08, on a minor league contract with the Rays, he was confident he'd recovered, but in an appearance against the Yankees he tried to sneak a down-and-in fastball past Bobby Abreu and felt a burning sensation in his arm. Three pitches later he heard the familiar tear. He finished the inning but knew he wouldn't go back under the knife.

Now 43 and the Rays' color man on Sun Sports, Anderson has found in broadcasting much of what he missed about playing. There's constant work and a repeatable schedule, and when the producer counts down to a live shot Anderson gets almost the same rush of adrenaline that he felt before delivering the first pitch of a game. Like many other Tommy John casualties, he lacks full feeling in the last two fingers of his throwing arm; he could be a position player in beer-league softball, he guesses, but he couldn't pitch even there.

Looking back, Anderson laughs at his naive reaction when he got the results of the MRI that led to his first surgery. It's sad, but at least there's a plan of action, he remembers thinking. Doesn't everybody come back from Tommy John?

SOMETIMES THE failure of Tommy John surgery is more roundabout: The procedure succeeds, but patients favor the reconstructed elbow and suffer career-ending shoulder injuries. Righthander Dan Giese, 38, spent nine years in the minors with four organizations before he was called up by the Giants. ("We don't have room for you here," his Triple A manager said, pausing to let Giese believe he was being released, "but we do have room up in San Francisco!") In May 2009 he was mostly a long reliever with his third team, the A's, when he noticed during a rain delay that his right arm was numb.

The season-ending surgery seemed to go well, but after a year of rehab Giese felt a sharp pain in his right shoulder. An MRI showed he had torn his labrum; the doctors stopped talking about getting him back to the big leagues and started talking to him about quality of life.

Mike Witt had a similar experience. A heralded Angels righthander who, at 24, threw a perfect game on the final day of the 1984 season, he started to wear down later in his career. He was traded to the Yankees in '90, and one wet night in Baltimore his landing foot slipped on the mound. "[That] made my throwing arm lag, and I felt my elbow pop," Witt says. After Tommy John surgery he too got through most of the rehab process before the shoulder pain took hold. He made nine excruciating starts in '93 and finally called it a career.

Witt is 54 and coaches baseball at Santa Margarita (Calif.) Catholic High. Even though he believes his heavy workload played a role in his injuries—"I look back and go, Maybe those 14 complete games in one year was not the smartest thing," he says—he tries not to coddle his young pitchers. In 20 years of coaching, he's never had a kid with an arm injury.

"We do have pitch counts," he says, "but at the same time I want them to go out there and have fun and enjoy competing and get a chance to get out of jams, and I don't want to baby kids. You learn how to pitch by pitching."

Larry Christenson was the Phillies' first-round pick in 1972 and spent his 11-year career in Philadelphia. He was born with a back defect, and he had four elbow surgeries and 27 bone spurs and chips removed before a variation on Tommy John surgery spelled the end for him. But he still finds a silver lining in his reputation for being injury-prone: He believes it lowered his trade value and kept him in the city he'd grown to love.

A friend in Christenson's home state of Washington introduced him to financial services, and Christenson, a high school graduate, dedicated himself to earning his Series 7 certificate. He opened Christenson Investment Partners in the Philly suburb of Conshohocken, Pa., in 2004. "I love this second career," says Christenson, 61. "It was better for me to get hurt early on. I was young enough to get involved in another field."

Meanwhile, about a dozen people in Southern California feel blessed that Giese was forced to quit baseball a few years earlier than he'd planned. Two years into his job as a policeman on the San Diego Harbor Patrol, in September 2012, Giese was returning from a graveyard shift when he and three other officers noticed smoke rising from a housing complex. They evacuated the sleeping residents and kept the flames under control until the fire department arrived.

Giese is now a pro scout for the Yankees, covering the Dodgers' and Astros' organizations from top to bottom, as well as various levels of five other teams. Despite his own injury history, he tries not to be gun-shy about arms. "If a pitcher has a high-maintenance delivery, I'll make note of it," he says, "but some guys with the best-looking deliveries have had Tommy John, and some guys with the craziest deliveries have not had Tommy John. There's just no way to know."

THE UPTICK in Tommy John surgeries (chart) has become something of an epidemic, peaking at 104 major and minor league players in 2014. (Ninety-five of them were pitchers.) Baseball is on pace for 128 this year. Nearly a third of pitchers on active rosters have had to have their elbows reconstructed. Theories as to why abound—one is that players specialize earlier, and young pitchers throw more innings than they should—and countless studies have been commissioned, including one by MLB that will follow all first-year pitchers who joined the Dodgers', Mets', Phillies', Rockies' and White Sox' systems in '14. Researchers will track the pitchers' biomechanics, the range of motion in their arms and the number of innings they pitch in hopes of finding whether certain players are predisposed to UCL injuries. The study is being supervised by Glenn Feisig, research director of the American Sports Medicine Institute, which is run by Dr. Andrews. The hope is to expand the program from the current five to all 30 MLB teams.

No one knows why some athletes respond better to UCL reconstruction. Maybe surgical techniques vary fractionally. Maybe some bones can handle stress that others can't. Maybe for some pitchers the rehab process is simply too long—or too short. For guys like Adam Bernero, there's only a second career and a lot of second-guessing. "I always wonder if I didn't have surgery, if I could have pitched through it," Bernero says. "I think about it all the time."

He loads and releases his rod, keeping his casting arc between 10 and 2 o'clock. Suddenly the line pulls tight. He catches a trout, inspects it and pulls out the hook. Then he gently tosses it back.

Bernero knew his career was over, so he gritted his teeth to make the moment last, finishing two no-hit innings as he took it all in. His only thought: I don't want to get off the mound.

SI.COM

To learn how Angels pitcher Garrett Richards recovered from his knee injury, including video of the special equipment he used, go to SI.com/thecomeback

A Snap of the Elbow

The rise in reports of UCL surgeries among pitchers in the last 20 years indicates that more and more are having the operation before they reach the majors

[The following text appears within a chart. Please see hardcopy or PDF for actual chart.]

Major and Minor Leaguers

Major Leaguers

DATA FROM TOMMY JOHN SURGERY LIST

130

120

110

100

90

80

70

60

50

40

30

20

10

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015*

*PROJECTED

PHOTOPhotograph by Jonathan Ferrey For Sports IllustratedCAPTAIN HOOK Despite UCL surgery, Bernero's arm is no longer good for pitching, but it works fine for one of his favorite pastimes, fly-fishing in the Pacific Northwest. PHOTOROBERT BECK FOR SPORTS ILLUSTRATEDBROKEN WINGS Elbow reconstruction couldn't save the careers of Bernero (opposite) and (above, from left) Spooneybarger, Witt, Anderson, Christenson and Giese, who either reinjured their arms or hurt their shoulders after Tommy John surgery. PHOTOGARY ROTHSTEIN/ICON SPORTSWIRE (SPOONEYBARGER)[See caption above] PHOTOJONATHAN DANIEL/GETTY IMAGES (WITT)[See caption above] PHOTOBILL KOSTROUN/AP (ANDERSON)[See caption above] PHOTOMARK GOLDMAN/ICON SPORTSWIRE (CHRISTENSON)[See caption above] PHOTOJIM MCISAAC/GETTY IMAGES (GIESE)[See caption above] PHOTOPETER READ MILLER FOR SPORTS ILLUSTRATEDPATIENT ZERO John (left, with Jobe) got the desired results from the surgery that would bear his name, earning more than half of his 288 career wins after the operation in 1974. CHART

HOLE YARDS PAR R1 R2 R3 R4
OUT
HOLE YARDS PAR R1 R2 R3 R4
IN
Eagle (-2)
Birdie (-1)
Bogey (+1)
Double Bogey (+2)