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Friday, September 21, 2012

FoxNews: Tommy John surgery: The next student steroid?

In lieu of this false belief, Ahmad said he’s seen a disturbing trend in which students believe if they blow out their elbow ligaments, they can qualify for Tommy John surgery and become better players.  Pitchers and coaches alike have become more reckless during practice and play, Ahmad said, because they wrongly believe that injuries can easily be fixed with surgery.  According to his research, 30 percent of coaches did not believe that throwing too much would lead to injury.

Because of these alarming patterns, Ahmad said it’s important for sports physicians to reach out to both students and coaches about the dangers of overthrowing.  It’s recommended that students take two to three months off a year in order for their tissue to recover and avoid rupture.  It’s important to remember that an athlete’s muscles and tissues are constantly growing – and need to be cared for.

 

Heinie Mantush (Krusty) Posted: September 21, 2012 at 11:25 AM | 32 comment(s) Login to Bookmark
  Tags: pitch counts, tommy john surgery

Reader Comments and Retorts

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   1. RoyalsRetro (AG#1F) Posted: September 21, 2012 at 11:39 AM (#4242055)
Stupid Obama.
   2. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 11:49 AM (#4242071)
Man, as someone who's had 5 surgeries in the past 4 years, and #6 coming up in two weeks, I can't imagine anyone wanting to have surgery.
   3. AROM Posted: September 21, 2012 at 12:02 PM (#4242090)
Someone who's never had surgery before might have a very unrealistic idea of what it's like. They see some pitcher who was throwing 92 come back from Tommy John surgery and 2 years later he's throwing 95 - They probably have no idea of the work that pitcher had to put in to get there.
   4. BDC Posted: September 21, 2012 at 12:36 PM (#4242126)
I might have missed it in TFA, but who pays for such surgeries? I would imagine that your ballclub pays for TJ surgery if you're Stephen Strasburg or Neftali Feliz. But it's gotta be expensive if you're Fred Nobody, and I can't imagine that Cal State Fullerton is going to cover it.

Maybe #1 is actually correct and TJ surgery for all is one of the socialist freeloader provisions of the ACA :)
   5. Jose Is The Most Absurd Thing on the Site Posted: September 21, 2012 at 12:51 PM (#4242132)
I might have missed it in TFA, but who pays for such surgeries? I would imagine that your ballclub pays for TJ surgery if you're Stephen Strasburg or Neftali Feliz. But it's gotta be expensive if you're Fred Nobody, and I can't imagine that Cal State Fullerton is going to cover it.

Maybe #1 is actually correct and TJ surgery for all is one of the socialist freeloader provisions of the ACA :)


If you've got insurance I would assume you pay some version of a co-pay or deductible and insurance picks up the rest. I know my company's insurance plan has a $1,000 co-pay for in-patient surgery (not sure how TJ works) so it's not cheap but I can't imagine people are going out of their own pocket for this.
   6. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 01:05 PM (#4242143)

If you've got insurance I would assume you pay some version of a co-pay or deductible and insurance picks up the rest. I know my company's insurance plan has a $1,000 co-pay for in-patient surgery (not sure how TJ works) so it's not cheap but I can't imagine people are going out of their own pocket for this.


Why would health insurance pay for TJ surgery? It's not medically necessary.
   7. I Am Not a Number Posted: September 21, 2012 at 01:21 PM (#4242166)
I might have missed it in TFA, but who pays for such surgeries?

Typical question from a 47%er.
   8. BDC Posted: September 21, 2012 at 01:22 PM (#4242169)
Why would health insurance pay for TJ surgery? It's not medically necessary

Exactly. Insurance companies require some sort of documented impairment, and then they'll cover treatment which returns you to the condition you were in. It's possible you'd get covered if the impairment was "used to throw 92-MPH fastball and has seen velocity dip to 89 lately," but I think there'd be heavy scrutiny of such a claim.
   9. Vailsoxfan Posted: September 21, 2012 at 01:36 PM (#4242183)
You only need functional impairment to get it covered. You can easily find a painful functional impairment on almost any person which produces meaurable symptoms. It would be easy. Elbow pain with throwing would be enough. Any sports medicine expert can find some functional issues that could contribute to it.
   10. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 01:45 PM (#4242192)
You only need functional impairment to get it covered. You can easily find a painful functional impairment on almost any person which produces meaurable symptoms. It would be easy. Elbow pain with throwing would be enough. Any sports medicine expert can find some functional issues that could contribute to it.

Really? Because, in a sane world, the answer from the Dr/insurance company should be "Stop throwing".
   11. RoyalsRetro (AG#1F) Posted: September 21, 2012 at 01:48 PM (#4242195)
We can all blame Henry Rowengartner for this.
   12. Danny Posted: September 21, 2012 at 01:50 PM (#4242201)
Pitchers and coaches alike have become more reckless during practice and play, Ahmad said, because they wrongly believe that injuries can easily be fixed with surgery. According to his research, 30 percent of coaches did not believe that throwing too much would lead to injury.

More reckless than when? The good old days when young hurlers were on strict pitch counts?
   13. cercopithecus aethiops Posted: September 21, 2012 at 01:53 PM (#4242208)
Really? Because, in a sane world, the answer from the Dr/insurance company should be "Stop throwing".


So you can't imagine that a torn ulnar collateral ligament would impair any function other than throwing a baseball overhand? Insurance companies pay for non-athletes to have shoulder, knee, and hip surgeries all the time. I don't think elbows would be held to either a higher or lower standard for proving impairment.
   14. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 02:02 PM (#4242215)
So you can't imagine that a torn ulnar collateral ligament would impair any function other than throwing a baseball overhand? Insurance companies pay for non-athletes to have shoulder, knee, and hip surgeries all the time. I don't think elbows would be held to either a higher or lower standard for proving impairment.

If it impairs daily life, it should be covered. If it just means you can't throw a ball very fast, or have pain when throwing, it shouldn't be.
   15. BDC Posted: September 21, 2012 at 02:12 PM (#4242224)
you can't imagine that a torn ulnar collateral ligament would impair any function

Well, sure, but that's not the scenario in TFA. What's discussed there is this situation:

50 percent of student athletes believed the surgery should be performed in absence of injury in order to improve performance


And I'll bet it's been done, but almost certainly at the cost of the pitcher's family: the ultimate suburban surgery. Now it's quite possible, as vailsoxfan describes, that an MD could finesse the insurance issue by writing up a treatment plan that emphasizes the grave risks to young Tanner if he can't throw the hard slider, but ethically and politically (and medically, for that matter), snapper has the high ground here.
   16. The Clarence Thomas of BBTF (scott) Posted: September 21, 2012 at 02:38 PM (#4242279)
Well, it won't matter because all these young pitchers will get derailed by their jenkum addictions before they blow out their elbows.
   17. Vailsoxfan Posted: September 21, 2012 at 03:01 PM (#4242310)
A UCL tear can impair other function. And having one torn means other function (the shoulder) is already impaired, whether the pitcher realizes it yet or not. I dont advocate anyone getting it fixed unless they clearly need it. But all kinds of orthopedic surgery is done and paid for by insurance (including Medicare) when the main complaint is I can't golf, ski, bike etc...Where do you draw the line in these cases? If they stop doing those activities maybe their medical expenses go up because they lose an enjoyable healthy activity and then their health begins to fail generally.
   18. Zach Posted: September 21, 2012 at 03:08 PM (#4242321)
Assuming there actually are any kids who believe this (rather than just assuming they're immortal like all teenagers), someone should point out that blowing out your arm $%^#$%^ hurts. To paraphrase Jack Nicholson, I like my arm. I like holding things with it. I really hated blowing out my shoulder, because it always hurt when I used it. Surgery was a huge blessing, because it meant I could do things without my arm pulling out of my shoulder.

Regarding whether insurance covers arm surgery -- of course it does, and of course it should. A major arm injury is a life changing impairment of a major body part. Think of all the things you use your arm for in a day. Having a major arm injury hurts your ability to do any of that, and if it happens to you as a teenager, it will keep on hurting you for the next sixty years. Ten thousand bucks for a functioning arm is the biggest bargain around.
   19. SuperGrover Posted: September 21, 2012 at 03:36 PM (#4242371)
If they stop doing those activities maybe their medical expenses go up because they lose an enjoyable healthy activity and then their health begins to fail generally.


When did the medical industry in this country start believing in preventive care?
   20. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 03:38 PM (#4242377)

Regarding whether insurance covers arm surgery -- of course it does, and of course it should. A major arm injury is a life changing impairment of a major body part. Think of all the things you use your arm for in a day. Having a major arm injury hurts your ability to do any of that, and if it happens to you as a teenager, it will keep on hurting you for the next sixty years. Ten thousand bucks for a functioning arm is the biggest bargain around.


Just like I said. They should cover it if it impairs everyday life, not if it just affects your ability to plan sports.
   21. Zach Posted: September 21, 2012 at 03:51 PM (#4242400)
Just like I said. They should cover it if it impairs everyday life, not if it just affects your ability to plan sports.

A fair point. But it's easy to underrate quality of life and functional impairment issues. One day I was talking to my dad (a doctor) about a book on hand medicine I found on his desk. He pointed out that some of the most common workplace injuries are to the hand, and they have some of the largest impacts on people's quality of life and ability to earn a living. Just because it's not life threatening doesn't mean it's not a big deal.

Incidentally, I live in Germany right now, and Europe arguably has way too little in the way of sports medicine. You see a lot of otherwise healthy young adults limping around with fixable impairments. Some of that excessive American care gets spent on things that affect people's lives but not life expectancy.
   22. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 04:01 PM (#4242426)
Just because it's not life threatening doesn't mean it's not a big deal.

Agree. I'm just saying the ability to play recreational sports isn't a big deal.

If a guy can't dress himself, or work because his arm hurts so bad, obviously insurance should pay to fix it.
   23. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 04:02 PM (#4242429)
Incidentally, I live in Germany right now, and Europe arguably has way too little in the way of sports medicine. You see a lot of otherwise healthy young adults limping around with fixable impairments. Some of that excessive American care gets spent on things that affect people's lives but not life expectancy.

You'd think people would pay for that themselves. People have no problem going out-of-pocket for boob-jobs, liposuction, and Lasik.
   24. Bourbon Samurai Posted: September 21, 2012 at 05:02 PM (#4242530)
If it impairs daily life, it should be covered. If it just means you can't throw a ball very fast, or have pain when throwing, it shouldn't be.


It impedes jerking off. A human right!
   25. I Am Not a Number Posted: September 21, 2012 at 05:22 PM (#4242544)
Isn't R.A. Dickey missing a UCL entirely?
   26. Jose Is The Most Absurd Thing on the Site Posted: September 21, 2012 at 05:25 PM (#4242549)
Agree. I'm just saying the ability to play recreational sports isn't a big deal.


That's true but the physical tools used to play recreational sports are also going to come in handy doing things like mowing the lawn, picking up your child and shoveling the driveway. I'm not disputing that a purely elective surgery should be on the patient's nickel but the reality is that an injury that limits someone in sports is likely to limit them in their day to day lives as well. Just as an example my 67 year old mother doesn't pitch but she had rotator cuff surgery a couple of years ago.
   27. Walt Davis Posted: September 21, 2012 at 06:31 PM (#4242606)
Incidentally, I live in Germany right now, and Europe arguably has way too little in the way of sports medicine. You see a lot of otherwise healthy young adults limping around with fixable impairments.

I can't speak for Germany but I can for NZ. This isn't really a problem there but you will see a reasonable number of folks limping around. That's not because it's not covered but because, being lower priority and due to a under-supply of surgeons, you might have to wait a while to get this sort of work done.

But NZ has a fairly unique system of no/very limited liability as the government covers (almost all) the medical costs of any accident even if it's from you farting around on the weekend -- the government-owned Accident Compensation Corporation (ACC). They also cover 80% of salary for missed work beyond 1 week. They charge levies to employers (to cover work-related) and other levies/taxes to cover the rest. They can be kinda stingy -- they're committed to getting you well enough to work but not necessarily at the same job you used to do which is why they aren't completely bankrupted by the 80% salary compensation rule.

The waiting in NZ has little/nothing to do with healthcare being a government operation -- I'm pretty amazed how efficiently it's worked for me. It has to do with NZ wages generally being low compared to other Western countries so doctors and nurses can make tons more elsewhere and so they do.

EDIT: I will add that kiwis who can afford generally carry a private major medical policy (fairly cheap) so they can access private hospitals with shorter waiting lists for this type of stuff.
   28. Greg Pope thinks the Cubs are reeking havoc Posted: September 21, 2012 at 07:07 PM (#4242626)
Isn't R.A. Dickey missing a UCL entirely?
"
Wait a sec... Dickey is the guy from Cleveland who threw the pitch hr called "the thing"?
   29. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 07:22 PM (#4242632)
The waiting in NZ has little/nothing to do with healthcare being a government operation -- I'm pretty amazed how efficiently it's worked for me. It has to do with NZ wages generally being low compared to other Western countries so doctors and nurses can make tons more elsewhere and so they do.

Wait, but if it wasn't a gov't operation, wouldn't wages rise enough to bring the Drs. and nurses back?
   30. Weekly Journalist_ Posted: September 21, 2012 at 07:54 PM (#4242648)
Isn't a little bit of waiting and rationing a small price to pay for universal access? If the alernative is our ####### of a system, then sign me up.
   31. snapper (history's 42nd greatest monster) Posted: September 21, 2012 at 07:58 PM (#4242651)
Isn't a little bit of waiting and rationing a small price to pay for universal access? If the alernative is our ####### of a system, then sign me up.

No, because there's no reason for it. We could easily provide free/subsidized health care for those too poor/sick to afford insurance without subjecting the other 80% of the population to an unresponsive gov't monopoly.
   32. Good cripple hitter Posted: September 21, 2012 at 08:08 PM (#4242658)
Wait a sec... Dickey is the guy from Cleveland who threw the pitch hr called "the thing"?


Texas, but yeah. The thing was a forkball, IIRC.

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