Matt Harvey and the Ulnar Collateral Ligament

Major league pitchers are remarkable athletes who have the ability to throw a baseball at high velocity, often spinning it so it bends in its flight, with such accuracy that they could “drive a nail” with the pitch from a distance of 60’6″. In doing this, they are able to earn huge salaries for mutlitple years. Teams depend on the stars to provide stability by providing consistent performance. However, each pitcher has a constant fear that he will injure his arm. Where this can be an injury to almost any part of the arm, it is the ulnar collateral ligament here that causes the most trouble.

Yesterday, the New York Mets announced that its All-Star, Matt Harvey, has torn this ligament. Harvey, 9 wins and 5 losses, is leading the National League in strikeouts with 191 in 1781/3 innings pitched and is second with an earned run average of 2.27. He is a remarkable pitcher, who, at 24, could perform at this level for ten years or more. That is, if he over comes this injury.

The ulnar collateral ligament (UCL) is located on the medial or inside of the elbow. I has three parts that serve to keep the elbow, involing the Ulna and Radius of the upper arm and the Humerus of the lower arm, together. The UCL connects the Ulna to the Humerus and tries to keep the connection firm and tight. Where there is injury to the UCL, a valgus force occurs and that means the connection is not tight and the elbow bows slightly.

What this means for a pitcher is that the last two actions of the pitching motion, elbow flex and then wrist flex in a curve ball, is disrupted and control and velocity is impaired. That is why Mets’ Manage, Terry Collins, mentioned that Harvey’s pitches were “not as crisp” as they had been. Some pitchers can pitch with this problem, but normally a power pitcher like Harvey (see: strikeouts, above) can not do so. I have seen power pitchers try to become breaking ball, change-up pitches, but rarely with success.

The cure for UCL injury is what is called Tommy John surgery, named for the Dodger lefthander who first underwent the procedure. A video of the precedure is here. As you can see, this is involved surgery with holes drilled into bones and tendons harvested from other parts of the body. However, there is a high degree of success for those pitchers who have undergone this procedure. Tommy John, Chris Carpenter and John Smoltz come to mind, and some have suggested that this may become mandatory surgery for young pitchers because the reconstructed elbow may be more stable than a normal elbow. However there is a better way and that is by compelling pitchers to pursue a rigorous training program that strengthens the ligaments.
Briefly, they should follow the UCL surgery, post-op proceedures, as religiously as someone who is recovering from the surgery does. Benefits are well worth the effort.

Matt Harvey is the latest of the power pitchers to damage his UCL. This may cost him a year of rehabilitation, but he will be back. Tommy John procedures are refined now and are more effective. The only question I have is why this sudden rash of such injuries. I was told once that a pitchers arm should be “loosey goosey,” that is, it should look like a “woman’s” arm (sorry, that is an old reference, ladies). Now, players are ripped and maybe the muscles are stronger than the ligaments and that power causes the tears. Once, I heard a pitcher’s (Ralph Lumenti) arm break while throwing a fastball. Clearly, the forces are there to do the damage, so strength in the elbow should me emphasized. But this is not a death sentence for Matt Harvey, he will be back, and, I might add, will be well paid during his rehab.

2 thoughts on “Matt Harvey and the Ulnar Collateral Ligament

  1. Well written and very accurate Clark. Two small corrections. It is a “valgus” force and tendons, not ligaments are harvested to reconstruct the ligament. Some say, especially in ACL reconstruction, that using a tendon for reconstruction prevents a full return to normal. This probably has to do with the fact that the structural anatomy of the two is different and that uninjured ligaments are innervated (have nerve endings), most importantly with proprioceptive receptors that help the individual know where the limb is in space.

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