Issue 2

This is the second edition of the AZMSBL Newsletter with a variety of articles, quizzes, photos, and insights about the game we all love, baseball. In this edition you’ll find the following:

–An article by former major league and current AZMSBL pitcher Brian Kingman on his encounter with baseball luminary Sandy Koufax, & stories of his big league career
— Player and manager profiles on: AZMSBL President Lou McAnany, Executive Board members Ernie Barten and Joe O’Brien, Managers Mike Seaver (Phillies) and Larry Pickert (Cubs)
–A quiz and interpretation of controversial baseball rules by head umpire Mark Hratko
–A short piece on the heroism and humility of a medical doctor and shortstop who plays in the AZMSBL
–Baseball trivia by Board member Ernie Barten
–An article with photos, MRI and operative images, and an Angels major-league hopeful as an example of a current baseball medical epidemic–Tommy John Surgery, by Eric vanSonnenberg

We hope you enjoy the above articles. The authors obviously share our love of baseball. We actively welcome your input on these articles and those in Newsletter 1. In addition, we would love to hear from you about ideas you may have for upcoming articles or topics, and certainly would be pleased to have you actively participate in upcoming AZMSBL Newsletters. On behalf of the editorial board (Lou McAnany, John Silingo, Brian Kingman, Mark Hratko, Ernie Barten), give us your feedback and enjoy AZMSBL Newsletter 2.

Eric vanSonnenberg, Editor



Brian Kingman

For many of us, baseball was our first love. From Little League to MSBL, it has been a life-long relationship. Like every relationship there are ups and downs. I would like to share some of my baseball experiences with you.

I attended my first game at the age of 8 at the Los Angeles Memorial Coliseum. Dodger Stadium was not yet in existence. The Dodgers were playing the much hated Giants, and Don Drysdale was pitching. Attending that game made a tremendous impression on me. It wasn’t just the game itself, it was being in the middle of 30,000-40,000 cheering people, mostly adults, who were invested in the outcome of the game. It was then that I began to see baseball as more than just ‘a game’.

Sandy KoufaxMy parents made me attend church every Sunday. However, by the age of 9 or 10, I decided that baseball was more my religion. Koufax and Drysdale might as well have been gods, and Vin Scully, the Dodgers radio voice, was the High Priest. Each game was like a sermon. You learned about baseball, the players, and the history of the game from Vin.

One day in the 5th grade, my best friend found out that Sandy Koufax was going to be speaking at a $100 a plate luncheon at the Beverly Hilton Hotel. It was about a four mile bike ride from where we lived. Since it was in the middle of the week, we would have to figure out how to miss school, which we did.

When we arrived at the Hilton, we searched until we found the banquet room where Sandy was the guest of honor. We asked the doorman if we could just look in and actually see Koufax. When he opened the door, we saw Sandy sitting at a podium at the front of a large banquet room with at least 300 people having lunch and listening to various speakers. We both waved to Sandy; much to our surprise, he waved back. It made our day!

We thanked the doorman and asked if Koufax would be coming out through these doors because we wanted to get his autograph. The doorman told us that Sandy would, so we walked off looking for a good place to wait. As we were walking away, the doorman said, “Hey boys come back here.” He told us that Sandy wanted us to come in and join the luncheon. We couldn’t believe it, and we knew no one back at school would believe us either.

Don DrysdaleInside, the waiters actually set up another table for us in the very front of the room, right near the podium. We were surrounded by wealthy businessmen wearing suits, and there we were in our jeans and T-shirts. It’s not every day that you get to meet God, but on that day, 50 years ago, we thought we had reached the Divine. Needless to say, Sandy autographed our baseballs, but it was so much more than just an autograph that he gave us. It was a priceless memory and an act of kindness that showed us that Koufax was more than just a great pitcher.

Becoming a professional baseball player was a life-long goal for me. Signing a contract to play in the Oakland A’s minor league system was emotionally satisfying, validating years of hard work. However, as satisfying as it was, there was also a downside to professional baseball. Everyone who has ever played professional baseball learns very quickly, that although the competition is better and the game itself hasn’t changed, we weren’t just playing baseball anymore. We were in the business of playing baseball.

Every minor league player has the same dream and shares a common goal– playing in the big leagues. But for 95% of them, the dream comes to an end in the minor leagues. To see one of your teammates released, and realizing it was the end of a life-long dream was painful. It was almost as if someone had died, and in a very real way part of them had. The joyful innocence of a neighborhood pick-up game was a distant memory, replaced by the harsh realities of professional baseball.

Most of the major league players I have known will tell you that their time in the minor leagues was more enjoyable than the time spent in the majors, if for no other reason than minor league players spend more time together. Major league players live with their families at home and have a room to themselves on the road. Minor league players are roommates at home and on the road. They endure 10 hour bus rides, worry about playing time, slumps, injuries, and the possibility of being released. Most of all, they share the dream of playing in the big leagues.

I got off to a great start in my second year playing for the 1976 Chattanooga Lookouts, the Double A affiliate for the Oakland A’s. I was 8-3 half way through the season, had a moving fastball in the mid 90’s, and good command of a sharp breaking slider. If it weren’t for the fact that the A’s were a team with several established veteran pitchers, I would likely have been called up to the big leagues at that time.

In 1976, baseball was in the early years of free agency. By mid season, A’s owner Charles Finley decided to trade and sell off his star players rather than lose them to free agency. Catfish Hunter had been traded to the Yankees and Reggie Jackson to the Orioles. When Finley attempted to sell Vida Blue, Rollie Fingers, and Sal Bando, Bowie Kuhn who was the Commissioner of baseball prohibited the sale, saying that, “It wasn’t in the best interests of baseball”. Well it sure would have been in my best interests!

There is a very good chance that if those transactions had been allowed, I would have been pitching for the A’s that summer. Unfortunately I tore a tendon in my elbow later that season, eventually underwent elbow surgery, and spent the next two years in rehabilitation, trying to get back on the path to the big leagues. I became a different pitcher by necessity. The velocity and movement on my fastball were diminished, and a curveball replaced my slider. The narrow and treacherous path to the big leagues became even more precarious.

In June of 1979, I finally made it to the Promised Land. I won my first game in Yankee Stadium in July. I felt privileged to have competed on the same field as Ruth, Gehrig, and DiMaggio, but even better having beaten the defending World Champions. I ended up with an 8-7 record on a team that lost 108 games.

Brian Kingman Sports IllustratedPrior to the 1980 season, the A’s hired Billy Martin to manage the team. He turned a horrible (54-108) team into a winning team (83-79) by maximizing the team’s strengths which were starting pitching and speed. Rickey Henderson stole 100 bases. We led the league in ERA, and set a modern day record with 94 complete games.

1980 was also the year I lost 20 games. Despite pitching well, I suffered from a lack of offensive support. 20 game losers are almost always found on 90-100 loss teams. However, I managed to lose 20 games on a winning team, something that hadn’t been done since 1922, and very likely will never happen again. The hardest part of losing 20 games for me was that I was the only one losing. The twenty game losers on those 100 loss teams had company. They say misery loves company, but I was all alone!

Billy Martin was a great manager. Few could match his knowledge of the game and none could match his willingness to take risks. He was a master of the element of surprise. Billy was a very intense individual. His intensity was both his greatest strength and his greatest weakness. The famous Lombardi quote, “Winning isn’t everything, it’s the only thing”, is the perfect description of what Billy was like. For Billy, losing was like a small piece of death.

As a player Billy was combative and frequently involved in fights. As a manager Billy could go from a great motivator to a bullying tyrant very quickly. He occasionally became involved in fights on and off the field, several of them with his own pitchers. One night at the hotel bar in Kansas City after a loss, Billy decided he wanted to fight me. I didn’t see it as a wise decision for either of us. Obviously it wouldn’t be a good career move for me, and Billy was sure to get at least a short beating before the coaches could intervene. We walked outside to get it on –me alone, and Billy with his entourage, the coaches as bodyguards. When Rickey Henderson noticed everyone headed outside he asked what was going on. He was told to not get involved. To his credit, he thought I looked outnumbered and disobeyed the coaches. Rickey was there for me if I needed help.

Billy began by poking me in the chest with his finger. I grabbed his hand and wouldn’t let him retract it. He tried to swing his other arm at me and I grabbed it too. The coaches rushed in to break us up, no punches being landed by either of us.

Needless to say, 1980 was a very long year for me. Losing 20 games in a season is hard on any pitcher, but doing it for Billy Martin made it twice as hard.

Billy could play the nice guy too. One time on a flight after I had pitched well but lost, he told Art Fowler to bring me up to the front of the plane where Billy and the coaches sat. He told me I had thrown a great game that day and that he was proud of me. He said, “Next year will better. You’re going to win 20 games next year.” I returned to the back of the plane and about 10 minutes later I see Art coming down the aisle again looking straight at me. “Billy wants to see you again” Art said. This time Billy was on his second bottle of wine. He said, “With your stuff you’re going to win 23 games for us next season.” The guys in the back of the plane wanted to know what Billy had told me. I remarked, “The first time he said I was going to be a 20 game winner next year, and this time I had made it up to 23 wins. If this flight lasts long enough, who knows, I might have had a shot at winning 30!”

Oakland AsThe next two years saw us go from a playoff team in 1981 to a 4th place finish in 1982. Our pitching staff that had completed 154 out of 271 games during the 1980 & 1981 seasons began to show symptoms of overuse. Billy’s relationship with the owners deteriorated quickly, and he was fired after the season. I was sold to Boston and ended my career with the Giants.

Baseball comes to an end for everyone who has played the game. The end may come in high school, college, or perhaps in professional baseball. Very few leave the game on their own terms. The longer you play the game the more it becomes a part of your life, and consequently the harder it is to say goodbye.

Satchel Paige was right when he said, “Don’t look back, something might be gaining on you.” For a very long time, that “something” was my baseball career. It was several years before I could enjoy talking about it and revisiting the memories. The end of a career can be like a divorce–when someone you still love has decided to move on without you.

Despite not throwing a baseball for 25 years, teammates from college and high school convinced me to play baseball again in the MSBL World Series. What I discovered playing MSBL was beyond my greatest expectations. I rediscovered the joyful innocence of playing baseball as we all experienced it as kids, playing the game because we love it. It was almost a shock to see guys hustling and playing hard because they wanted to, and having a great time.

Baseball has always been more than just a game. Playing baseball for me is like going home again. New friends are made, and old friends are reunited. Vin Scully once said, “It’s a mere moment in a man’s life between the All-Star Game and an old timer’s game.” For some of us, it has been five of six decades since our first game as a kid, yet it too seems like a mere moment. Our time together is magical, but unfortunately comes to an end all too soon.

They say that professional athletes die twice in this life, and the first time is when you stop playing. Thanks to the Men’s Senior Baseball League, I am still trying to decide if I have been reincarnated or born again. Either way, I consider myself lucky–not everyone gets to die three times. No worries though, old ballplayers never die, they just fade away.


#1 (Billy Ball 1980-1982)

#2 (20 LOSSES)



#5 (Sports Illustrated Class of ’81)


Profile: Lou McAnany
President AZMSBL

Lou McAnany was born in Washington County, southwestern Pennsylvania outside of Pittsburgh, near the West Virginia border (& says, “I shoulda been born in West Virginia.”). He grew up in a small town in coal mining country, being raised by his grandfather, a coal miner.

Lou moved to Arizona in 1980, motivated climate-wise by the desire to escape rain & snow, & job-wise by the closing of the local mine. On arrival in Arizona, Lou repaired roofing equipment, then eventually settled on repairing janitorial equipment & propane buffers.

Lou has been married to the lovely Elaine (“Come here woman!”) for 23 years, having started their courtship in 1982. They have one son, Lou, previously a local high school baseball pitcher, who now is in law enforcement. Lou has a daughter Marion who lives in Pittsburgh, & has blessed him with two grandchildren.

Lou’s baseball career started in Little League, but had a long hiatus, as he started again at age 35. He’s been a lifelong lover of baseball & a Pirates’ fan, with some of his early baseball idols being Bill Mazeroski, Roberto Clemente, & Willie Stargell. He’s allowed himself to become a D’Backs fan as well.

Lou helped with the inception of the Arizona baseball league in 1995. The League’s now long-time success he attributes to good managers, good executive boards, & the “right concept”.

He describes himself as, “a baseball fan who attempts to catch a baseball”. He notes highlights of his adult baseball career as being on teams that won two NABA rings, & getting a game winning hit in an NABA semifinal game.

As a modest man, & master of one-liners, who presides over an extremely successful AZMSBL League of over 800 men, Lou proudly describes himself as a “hillbilly”, who more than any other aspect of baseball, “loves the camaraderie with the guys” (& editorially, with a few brews along the way!). AZMSBL owes an extraordinary gratitude to Lou for his vision & guidance all these years, helping to make the League such a huge success.


PROFILE: Mike Sever
Manager, Phillies

Mike is a native of Dayton, Ohio, with a high level of passion and ability in basketball. While Mike played baseball in high school, he achieved even more prowess as a star basketball player in both high school and college. Mike attended undergraduate college at Wright State University, and has Master’s degrees from both Wright State and Clark State Universities. Mike became head basketball coach at Clark State after his playing days, and has also coached high school basketball.

In basketball, Mike has scored as high as 46 point in a game, and had a tryout with the professional Dayton Wings. Were we to think Mike is a 7-footer with all this basketball background, all the more impressive is his modest height for basketball of 5 feet 10 inches.

Mike served in the military for seven years in the Air Force. Currently he is Assistant Director of Academic Services at Arizona State University, in which he is responsible for faculty advising and scheduling.

Mike moved to Arizona in 2005. He is married to Kathleen, and has two children, a nine-year-old girl and a six-year-old boy. Kathleen works in student services in the ASU College of Engineering.

Mike is an avid outdoorsman, and “any activity outdoors is fine”. Besides baseball, he still plays competitive basketball, and is also active in hiking, biking, and golf. Mike was involved in coaching in the ASU basketball camp under coach Herb Sendek.

With respect to his AZMSBL baseball career, Mike credits Ernie Barten with “breaking me in”. The camaraderie of being “around the guys” Mike describes as a baseball “highlight”. He is multitalented on the diamond, playing virtually any and every position. Despite 2 prior rotator cuff operations, he even pitches. Mike’s other baseball highlights include participation in the AZMSBL playoffs and managing, which he claims that, despite the stresses, is “great fun”.


Member, AZMSBL Executive Board
Manager, 45 Rangers

A truly nice guy and gentleman like Ernie Barten would never utter the famous Dutch saying, “If you ain’t Dutch, you ain’t much”, but in fact Ernie is a native of the largest seaport in the world, Rotterdam, the Netherlands, Holland (Remember Ernie’s brethren, famous Dutch pitcher, Bert Blyleven baseball fans?). Ernie, whose native language is Dutch, moved with his family to Salt Lake City in the mid-1950s. His Dad, one of 16 children, fled the Hitler regime early in his life, and eventually became a high-level optic and hearing aid specialist in Skaggs Drugs.
Ernie moved to Arizona in 1987 with his high school sweetheart and now wife of 40 years, Gerri. Ernie previously attended college trade school for two years, and had been on active duty in the Utah National Guard. Ernie’s initial job in Arizona was in sprinkler parts. However due to his work ethic and organizational skills, he was asked to join an insurance firm. One thing led to another, and Gerri too became an insurance agent. They now have a very successful independent insurance agency, and Ernie privately says that, “I work for my wife!” Ernie and Gerri have two sons in their 30s. Both are crackerjack golfers; one is a golf pro, the other works in the family insurance company.

Ernie played baseball as a youngster in Salt Lake City in a Mexican Little League. His high school sports life largely revolved around skiing. Before moving to Arizona, Ernie played in both fast and slow pitch softball leagues. His baseball career really began at age 37 in the Tempe City League. He played in NABA for several years, but credits Executive Board member Chuck Brockman with recruiting him to AZMSBL.

Ernie lists as his baseball highlights hitting a home run at Scottsdale Community College in a tournament, and having won five rings in MSBL and NABA tournaments. Ernie was elected to the Executive Board of AZMSBL in 2010. He has managed the Liners, Pilots, Aztecs, Rattlers, and currently the Rangers.


Manager, Cubs

Larry Pickert - AZMSBLThe longtime successful manager of the Cubs (10 years) in the AZMSBL is Larry Pickert. Larry is a native of Kansas, still proud of his roots and a Jayhawk fan. He is a graduate of the University of Kansas with a degree in chemical engineering.

Larry’s family ties were strong and molded him value-wise. His father was an insurance agent for Met Life; his Mom, initially a homemaker for four kids, eventually had a successful career as a realtor, winning trips to Hawaii, Aruba, and Brazil. Larry has two brothers and a sister. One brother was an AAA baseball player. Larry himself, started baseball in the third grade. He was predominantly a catcher and a pitcher. As a catcher, he proudly claims to have “harassed batters”. Larry played baseball from Little League through American Legion ball. As a pitcher, he laments that the, “best game I ever pitched, we lost 1-0.”

Larry went to Catholic School growing up in Kansas, where, along with further values that molded him, he played baseball and basketball..
Larry moved from Kansas to Indiana after college. He became general manager of a Delcro Electronics store in Kokomo, Indiana. His baseball managerial career began with softball in Indiana, where his team, “Pick’s Peak”, consistently were winners despite, “not being the better team” (managerial expertise?). In addition to managing, Larry played shortstop on these teams. In his transition to baseball, Larry took up fast pitch softball as a third baseman and an outfielder.

Larry was instrumental in starting MSBL in Indianapolis in 1990-91 shortly after becoming eligible (30+ years old). He predominately was a catcher in baseball that time. He then moved to Colorado Springs, Colorado where he played in the local MSBL.

Larry moved to Arizona in 1999. His Initial sports participation was in basketball and volleyball. He played NABA for one year, before transitioning to AZMSBL in 2001. In this era of both professional and amateur instability and movement in team personnel, Larry has been a model of fidelity–a Cub throughout his entire AZMSBL career. Larry has managed the Cubs for 10 years (Editors note–as a Cub my entire AZMSBL career, Larry is a model manager–good to his word, fair, straight-forward, fun, clear in expectations and priorities, reasonable, and non-egotistical.).

Larry credits Lou McAnany and John Silingo for the success of AZMSBL, and feels the League is doing very well. His personal AZMSBL highlights are winning the championship one year and batting .500. Under Larry’s managerial leadership, the Cubs are a perennial playoff team.

Currently, Larry is credentialed and does both high school basketball refereeing and baseball umpiring. As a “cat person”, he tolerates his lady friend Marcia’s dog. Otherwise, they have a great relationship, as long as Larry can pursue his other hobbies–skiing, gardening, and visiting with family and friends in his (and Marcia’s) native Kansas City. And of course, pursuing Larry’s true love– baseball!


Manager, AZ Heat
Member, Executive Board, AZMSBL

Joe O'Brien AZ Heat AZMSBLLoving Yankee Pinstripes? Wearing number 23? Idolizing Don Mattingly? Yes, it’s AZMSBL Executive Board member, Joe O’Brien. A native of New Jersey, Joe describes himself as a “Jersey Shore Boy” (Snookie connection?). A true family man from his childhood to today, Joe grew up in a close family with his Mom, Dad, and brother upstairs, and his grandparents downstairs. Fond memories for Joe include watching Yankee baseball with his grandfather, and listening to former Yankee All Star shortstop Phil Rizzuto, who became a Yankee announcer.

Joe’s family vacationed in Arizona for many years, then moved to Phoenix. His Dad became an administrator at St. Joseph’s Hospital in Phoenix. Joe’s brother, Chris, his best friend, is an ASU graduate. Joe himself attended Daemon College in Buffalo, New York, in the physical therapy program. He graduated with a Master’s Degree in physical therapy.

Joe moved to Phoenix in 2000. He married his school “friend” of eight years (a great friend obviously!). Joe and Kathleen have two daughters, ages five and three. Joe previously worked in the Scottsdale Health Care System specializing in home care follow-up for trauma patients.
Joe’s baseball career was aided early on by his Dad constructing a home plate for his two boys to play baseball in their yard. Stickball and wiffle ball were the early forays into the baseball world. Joe played Little League, high school, and club ball in college. He has also played “some softball, and the little golf”. However, Joe is so baseball oriented that he describes his main hobby as “baseball”, and, “doesn’t even watch football”. He proudly owns “every Don Mattingly baseball card”, plays first base like his idol, and wears Mattingly’s number 23. He lives the dream every day of playing baseball with his brother Chris and 17 friends.

Joe fortunately has recovered from a severe injury in a blue baseball collision 2009. He suffered fractures to his orbital bone (around the eye) and his jaw. From that baseball low light, Joe is excited about his new highlight, ie–becoming a member of the Executive Board of AZMSBL. Joe manages the AZ Heat in the 25 Division, appreciating the “camaraderie of baseball with the guys”. We are delighted to have this baseball aficionado as the newest member of the Executive Board of AZMSBL.


John Silingo/Eric vanSonnenberg

When the starting pitcher ends an inning unscathed, he and his teammates ought to feel good. But not quite real good when both the catcher and the second baseman ask the pitcher, “Are you ok?” Even worse is when the first baseman also notices something odd about the pitcher and asks the same question. And when the pitcher gets woozy, feels his legs buckling, & collapses, something truly is real wrong. Such is what happened to AZMSBL’s very own Vice President, John Silingo, in a game last summer.

In a routine summer AZMSBL summer league game between the first place Diamondbacks and the tied for last Indians, the D’Backs were lacking a few players. President Lou McAnany made a few calls, & came through with several players, including Kenny Fleisch, specifically Dr. Kenny Fleisch as a replacement player. Replacement player shortstop Fleisch became the game’s MVP–but not as a player.

John had collapsed on his way to the dugout after the inning due to ventricular fibrillation, a lethal heart condition if not acted on and treated virtually immediately. And Kenny did act immediately! Recognizing the severe condition and acting expeditiously, Dr. Fleisch performed CPR and brought John back from the extremely dangerous arrhythmia.

John was subsequently taken to the hospital, and eventually underwent quadruple coronary artery bypass surgery, very significant stuff. We are all happy to report that John is recuperating well, is out of the hospital, and is back playing the game he loves.

A few more words about Kenny. He is an Emergency Room Physician, schooled at the prestigious University of California, San Francisco School of Medicine, and experienced in precisely the calamity that afflicted John. There could not have been a more appropriate physician on the spot than Kenny. And recall the fortunate irony—that President Lou was able to secure replacement player Kenny Fleisch.

Presidential intervention by Lou—or true Divine intervention? Either way, thank God for Kenny, and welcome back John!


Mark Hratko, Chief Umpire

1. Is a runner out if hit by a batted ball if it is beyond infielders who have no play on the ball?

ANSWER: RULE 7.08 Professional Interpretation: Unless the ball has gone between the legs of the infielder, passed within arm’s reach of the infielder, or has been deflected by a fielder, the runner can be called out if struck by a legally batted fair ball that is within the infield. Ex: R3 (Runner on 3rd Base) is struck by fair batted ball that is hit past the 3rd baseman. Ex: R2 on 2nd baseball is hit with a fly ball. Runner is not protected by the bag.

2. Once a balk occurs, is the play is automatically dead?

ANSWER: RULE 8.05 The ball is dead, and each runner shall advance one base without liability to be put out, unless the batter runner reaches first on a hit, error, base on balls, hit batter, or otherwise, and all other runners advance at least one base, in which case the play proceeds without reference to the balk. A balk is called when the batter-runner and all runner(s) DO NOT ADVANCE 1 base each. If “BOTH” batter-Runner & runner (s) advance at least 1 base, the balk is ignored and the play stands. “REMEMBER” both batter-runner and runner(s) must all advance at least one base by any type of playing action.

3. Runners on first and second, no outs. The batter bunts the ball 25 feet into the air between first and second base. By the time the second baseman reaches the ball and throws to first base, both runners have advanced one base, and the batter beats the throw to first base. The umpires convene and call the batter out by the Infield Fly Rule. The runners are ordered back to their original bases. Correct or Incorrect?

ANSWER: RULES 2.00 (Definition) & 6.05 (A Batter is out when) Definition of an infield fly is a fair ball (not including a line drive or bunt) which can be caught by a fielder with ordinary effort. The infield fly is not to be considered an appeal play. The umpire’s judgment governs and must be immediate. “IN JEOPARDY” Since the ball is alive and in play and a bunt is not an infield fly, runner(s) are liable to be put out.



(Answers at End of Newsletter)
Ernie Barten

1) Which pitcher has the most wins in Dodgers’ history?

A) Sandy Koufax
B) Don Drysdale
C) Don Sutton
D) Clayton Kershaw

2) Who was the only major league player to play at least 500 games in each of four teams (Astros, Expos, Mets, Tigers)?

3) Which major-leaguer holds the record for the fewest errors by a shortstop (accomplished in 1990)?

4) How many times did Hank Aaron hit 50 or more home runs?


Eric vanSonnenberg, MD

Tommy John in his New York Yankees baseball playing days

Tommy John in his New York Yankees baseball playing days

Ready for this? As of June, 2014, 144 pitchers in Major League Baseball have undergone Tommy John surgery. That is approximately 1/3 of all MLB pitchers. Rarely if ever has there been such an ‘epidemic’ of any type in medicine, much less in surgery, that so influences baseball. Currently, the pitching aces of the Atlanta Braves, Arizona Diamondbacks, Miami Marlins, and New York Mets are all recovering from Tommy John Surgery, obviously a huge impact on each team. Let’s now see what this epidemic is all about…

Tommy John was an effective, albeit below the radar, left hander who pitched from 1963 to 1990 for the Dodgers, Yankees, White Sox, and Cleveland Indians. Tommy pitched for 26 major league seasons, compiling 288 wins and a 3.34 earned run average. Despite these impressive statistics, to date he has not been voted into the Hall of Fame. Growing up in basketball-happy Indiana, Tommy was an outstanding basketball player who held many records, but ultimately decided to pursue baseball.

In 1973-1974, John ruptured the ulnar collateral ligament (UCL) of his left elbow. He subsequently underwent the then experimental and pioneering UCL operation by Dr. Frank Jobe. Tommy says he was given less than a 2% chance of recovery that would enable him to pitch in the major leagues again. After the initial surgery by Dr. Jobe, and after over a year of rehabilitation, Tommy went on to win another 164 games. Now, some 40+ years later, Tommy Surgery has revolutionized UCL injury therapy, thereby resurrecting the careers of innumerable professional and amateur athletes, especially MLB pitchers (the Braves John Smoltz for example).

Diagnostic MRI of severe UCL injury--the white appearance reflects edema and swelling from the damage. The upper arm is at the top of the image; the forearm is at the lower part of the image.

Diagnostic MRI of severe UCL injury–the white appearance reflects edema and swelling from the damage. The upper arm is at the top of the image;
the forearm is at the lower part of the image.

The UCL connects the upper arm bone (humerus) to the lower forearm bone (ulna) on the inner aspect of the elbow. Repeated stress or trauma can cause micro-tears in the ligament, while larger injuries can result in rupture of the ligament itself. Although some athletes who play tennis, discus or javelin throwing, football, softball, and wrestling have developed UCL tears, baseball pitchers predominate in the frequency and severity of the injury.

The classic symptoms of UCL injury are pain on the inner elbow, tingling in the pinky and ring fingers (supplied by the ulnar nerve), a sensation of “looseness” in the elbow, and a feeling of “funnybone” irritation. Pitchers typically have increased pain on throwing, thereby limiting the speed of their pitches, the rotation necessary for breaking pitches such as sliders and curveballs, and the number of pitches that can be thrown.

The diagnosis of UCL damage is made by analysis of characteristic symptoms, physical diagnosis of tenderness over the ligament, and radiologic tests including plain x-rays and, most importantly, magnetic resonance imaging (MRI). The latter most definitively establishes the diagnosis of UCL damage.

The initial therapy for UCL injury is so-called conservative and non-operative. This includes rest, anti-inflammatory medications, and ice over the elbow after throwing. Another strategy for athletes who can tolerate it, is strengthening of the surrounding muscles to compensate for the UCL damage.

Should the pitcher (or other athlete) not respond to conservative therapy and still wish to pursue pitching, Tommy John Surgery then becomes the treatment of choice. The surgery is performed by an orthopedic MD surgeon who transplants a tendon from somewhere else in the body (arm, hand, leg) to replace the damaged UCL. Holes are drilled in the humerus and in the ulna for insertion of screws to secure the transplanted tendon to the two aforementioned bones. Characteristically, the postoperative recovery and rehabilitation time is at least a year.

During the operation itself with the injured UCL being repaired.

During the operation itself with the injured UCL being repaired.

Classic Tommy John Surgery in athletes is successful in approximately 90% of patients. Nonetheless, a recent medical study from Henry Ford Hospital in Detroit on 168 major-league pitchers who had undergone Tommy John Surgery between 1982 and 20 was not as encouraging as prior data. Although the 168 pitchers did make it back to the major leagues after the surgery, objective data demonstrated decline in their performances. ERA increased from 4.152 4.74, WHIP increased from 1.40 1.48, and the overall number of innings pitched declined.

A related, but clearly different, injury that is being seen more commonly by physicians is “Little League Elbow”. Rather than intrinsic damage to the UCL, Little League Elbow is the ligament being pulled off the child’s growth plate before adolescent bone fusion and total bone growth have been achieved. Rest and limitation on pitching (or whatever the activity is) are the preferred strategies for treatment. This might consist of, for example, no more than 50 pitches per day for Little Leaguers.

California Angels prospect Austin Wood optimistic after Tommy John surgery

California Angels prospect Austin Wood optimistic after Tommy John surgery

Two myths that are considered to be debunked by published medical studies are: A) breaking pitches are more injurious to young elbows than fastballs, and B) Tommy John Surgery actually makes a pitcher stronger than he (or she) ever was previously. Both statements are unproven by published medical studies and experience. So yes, specialist physicians tell us to let the Little Leaguers throw all sorts of breaking pitches, but limit the number, and again note that too many fastballs are the main cause of Little League arm injuries.

Truly, one of the great advances in sports medicine in the last 25+ years has been Tommy John Surgery. Perhaps the greatest attestation to Dr. Jobe’s pioneering advanced was the recurrent lament by one of baseball’s all-time greatest pitchers, Sandy Koufax, was career ended years prematurely because of UCL damage. Sandy frequently asked Dr. Jobe why he hadn’t invented the procedure years earlier to salvage and further Sandy’s illustrative, but short-lived career. While Dr. Jobe (who died in March 2014 at age 88) was honored in 2013 in Cooperstown, perhaps the baseball Hall of Fame should reserve a spot for the doctor who has made such a monumental impact on baseball!

Answers to the Quiz:
1) c
2) Rusty Staub
3) Cal Ripkin
4) 0