John Smoltz, Pitcher for the Atlanta Braves

From the WebMD Archives

NAME: John Smoltz
TEAM: Atlanta Braves
POSITION: Pitcher
INJURY: Torn medial (ulnar) collateral ligament in his right (pitching) elbow

OTHER ATHLETES AFFECTED

Baseball: Kerry Wood, Chicago Cubs; Norm Charlton, Jose Canseco, Tampa Bay Devil Rays; Kerry Ligtenberg, Odalis Perez, Atlanta Braves

HOW IT HAPPENED

Smoltz has suffered through pain and discomfort in his right elbow for the majority of the last two seasons. He spent time on the disabled list twice in 1998 and twice again in 1999 due to trouble in the same elbow. He underwent arthroscopic elbow surgery prior to the 1998 season and again in September 1994 to remove a bone spur and chips. Last season, he modified his pitching style to relieve some of the stress on the elbow. In his last game of the year and in his early spring outings he also experimented with a knuckleball. He pitched poorly in his first spring outing and later said that the elbow was "pretty painful."

PLAYER BIO

John Smoltz is has been one of the most overpowering pitchers in baseball for most of the '90s. He won the national league Cy Young award in 1996 and has posted at least 10 wins in 10 of the last 11 seasons. The 32-year-old Smoltz, Greg Maddux, and Tom Glavine have been regarded as the best pitching threesome in the game for years. In '99, Smoltz ranked 5th in the NL with a 3.19 ERA. In 1996 -- his best season -- he set the Braves' club record for winning 14 straight games and also led the majors in wins (24) and strikeouts (276).

WHAT IS A TEAR OF THE MEDIAL COLLATERAL LIGAMENT (MCL)?

This ligament tendon in the elbow, the MCL, is also known as the ulnar collateral ligament, or UCL. It is most important for athletes involved in overhand sports such as baseball (especially pitchers), javelin, basketball, and volleyball. It stabilizes the inner aspect of the elbow (body side of the elbow "pit") as a pitcher accelerates through his pitching motion. Pitchers, sometimes throwing at velocities of more than 100 mph, put tremendous force on their arms and elbows. The tear can be caused by a dramatic event, if the pitcher is not warm, or if his mechanics are slightly off. The force on the elbow is so great that it tears the ligament. In Smoltz's case, it was more likely a gradual weakening of the ligament that led to the tear. These repetitive strains of the ligament stretch it out, and gradually the pitcher will feel looseness in the elbow. An athlete with the tear would describe a sharp searing pain in the elbow and may feel a pop or crack the moment that the ligament tears.

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DIAGNOSIS

Torn MCLs are diagnosed using physical examination -- testing for pain along the inside of the elbow and stressing or extending the elbow to see if the pain increases. Three radiographic studies are also used: an X-ray looking for bone spurs and calcifications; another X-ray looking for widening of the joint compared to the pitcher's non-throwing arm; and an MRI, which shows not only the bone, but also the ligaments, looking for imperfections, looseness, and tears in the MCL.

TREATMENT

For mild tears, which are just sprains, treatment entails not pitching for 10 days to 2 weeks, taking anti-inflammatory medications, icing the area, and doing a stretching and strengthening exercise. Then, the pitcher could start a throwing program, in which he begins throwing lightly from short distances and gradually progresses to throwing from a mound to the catcher. Smoltz, however, will undergo MCL reconstruction of the elbow, also known as "Tommy John" surgery, so-called after a famous pitcher who underwent the surgery. In this procedure, a piece of tendon is taken from somewhere in the body and inserted and fastened into the place where the real MCL had formerly connected.

PREVENTION

Stretching the ligament well before each pitching outing can help to prevent the injury. Also, It is far less likely to occur in athletes who do not play "overhand" sports -- especially those who do not pitch. However, stretching will not guarantee that a pitcher can maintain a strong, tight, healthy MCL.

RECOVERY

After the surgery, Smoltz will begin the long process of regaining strength and flexibility in his pitching elbow. Months after the surgery, he will begin the throwing program, which is far longer and slower-moving for pitchers who have surgery. This process will last almost a year. He should be fully recovered and ready to pitch up to his preinjury state by spring training 2001.

LONG-TERM OUTLOOK

Smoltz should be fine by next year's spring training. But, anytime a player undergoes elbow surgery, he risks losing either velocity or control. Before his diagnosis, he had experimented with the knuckleball, a pitch that puts very little pressure on the elbow. It is possible that, when Smoltz returns, he may change his style to include more light stress pitches and fewer power pitches.

WebMD Feature

Sources

Medical information was provided by Michael J. Ciccotti, MD, director of sports medicine at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia. He is also the team physician for the Philadelphia Phillies.

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