Last October, I wrote about Major League Baseball’s growing epidemic of pitchers with ulnar collateral ligament (UCL) injuries of the elbow. The issue has even grown past pitchers as the Minnesota Twins’ Miguel Sano missed most of last season after having Tommy John surgery (named after the pitcher who was the first to have the surgery to replace this ligament performed on him in 1974) after injuring his elbow making a throw from third base. Add the New York Mets fans to the group that must be going crazy dealing with UCL injuries.

It was announced last week that Matt Harvey, the de-facto ace of the pitching staff, had a hard 180 inning limit in effect as he comes back from Tommy John surgery that caused him to miss all of 2014. After pitching into the sixth inning on Tuesday night, Harvey went over 171 innings for the year. The Mets have tried to limit Harvey’s innings this year by going to a six-man rotation (an available luxury for a team that may have three of the top young pitchers in the game and an ageless Bartolo Colon who last week became only the fifth pitcher 42 years or older to pitch a shutout since 1989) and skipping one of Harvey’s starts to give him extra rest and extend his season. Going into Wednesday’s games the Mets held a 6 game lead in the National League East. Scott Boras, Harvey’s agent, has said the 180 limit is non-negotiable. Harvey on the other hand has said he will pitch in the playoffs should the Mets make it.

The UCL is located on the medial (little finger) side of the elbow. The UCL attaches to the humerus (upper arm bone) on one side and the ulna (one of the forearm bones) on the other. The UCL is the arm’s primary restraint from stress to the elbow. Twisting and bending of the elbow, like the throwing of a baseball, puts extreme stress on the UCL. For throwing athletes (which I define as any athlete that performs repetitive overhead motion that includes swimming, tennis, javelin, baseball and softball among others) poor mechanics, inflexibility, and fatigue can lead to strain on the elbow. This increased strain can cause small ligament tears and stretching of the ligament so the ligament no longer supports the elbow during the throwing motion. The UCL can be injured acutely as well. Often an athlete will experience a “pop” in the elbow, along with sharp pain and numbness into the hand and fingers.

So what should the Mets do with Harvey for the remainder of 2015? If they should happen to win the World Series all will be forgotten as Mets fans celebrate their first title in nearly 30 years. If Harvey is shut down and they fail to win it all or even worse miss the playoffs they will be criticized for being too cautious. There is no guarantee that they will get to the playoffs again with Harvey on the roster. If the Mets continue to use Harvey and lose, they will be criticized for risking his health on a season that no one expected them to play as well as they have. Can you imagine the outrage in New York should Harvey turn into the next Mark Prior? Buckle up baseball fans, the real season is just beginning and it could be a wild ride.

Do you have a question regarding sports medicine that you would like to see addressed in this space in the future? Send your questions to SportsMed@lrhc.org and it may be featured in an upcoming article.

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