A counterintuitive thing can happen when people feel overly safe and supported: they tend to take more risks. This phenomenon was detailed wonderfully in Tom Vanderbilt’s excellent book Traffic, among other places. It isn’t hard to understand why: when there’s a big net waiting below, you are far more likely to jump a little farther.

So it is with Tommy John surgery, the wildly popular orthopedic elbow surgery procedure which major league pitchers have been opting for in record numbers. The procedure’s staggering success rate has pushed many pitchers to throw harder at an earlier age, secure in the knowledge that they can hit the “reset” button anytime with a visit to their orthopedic surgeon:

If Tampa Bay Rays left-hander Matt Moore opts for Tommy John elbow surgery as expected, he will be the 13th major league pitcher to have the ligament-replacement operation since spring training. That’s only six fewer than all of last season, and three under the annual average from 2000-2011, according to an industry-commissioned study.

And it’s starting earlier than ever before:

“We mathematically, statistically, scientifically have proven that the kids who play baseball year-round are three times more likely to end up on a surgery table by their 20th birthday that those who don’t,” says Fleisig, citing a 10-year study targeting teenagers who pitch more than 100 innings in a calendar year.

Tommy John surgery is a great advance, and there is no question that it extends careers. But ligaments do not age and strengthen like muscles, and the long-term effects of such optional procedures may yet be unknown in such large numbers. If you have questions about elbow surgery in San Diego, please contact my offices today.


Although I’ve spent a good amount of time working with professional and NCAA athletes, the majority of my patients nowadays come to me with more conventional injuries. Case in point: most wrist surgeries I perform these days are more likely to be for repetitive stress symptoms from activities such as golf and tennis than for gridiron trauma.

Still, it is helpful sometimes to highlight what professional athletes go through, and why their outsized physical injuries can benefit from the same orthopedic surgical procedures as the rest of us. Star Yankees first baseman Mark Teixeira is a perfect example: After straining a wrist tendon at the World Baseball Classic last year, Teixeira eventually was forced to take a seat for more than 100 games.

And how is he feeling now after his wrist surgery?

“I’m close to 100 percent. I feel like I’m healed. I wish I was a little bit looser; my wrist is going to be tight for a while because of the way the surgery was performed. They had to kind of tighten everything up to make it secure. It’s still a little bit tight, but that’s why I’m doing rehab every day and doing exercises every day. I’ll start swinging a bat in January and that will also help loosen it up.”

Just a little snapshot into how fast and seamless recovery can be in the hands of an experienced orthopedic surgeon. If you suffer from elbow, wrist or hand pain and want to speak with a wrist surgery expert here in San Diego, please contact my offices today.


Many patients come to my San Diego orthopedic surgery practice with injuries they have recently read or heard about. One question that often follows is why particular sports are more likely to give rise to certain injuries. Baseball, for instance, seems to spawn a high number of shoulder and elbow injuries; basketball produces many back injuries; and of course the NFL is the home of the concussion.

The immediate answer is self-apparent, of course: Different sports require different movements. Of the three big American sports, however, baseball is unique in that there are few direct collisions with other bodies. (This squeaker of a World Series ending notwithstanding.) As a result, baseball remains an excellent source of study on the ways we can injure ourselves through repetition alone.

Injuries endemic to baseball tend to involve the muscles of the arm, neck and shoulder. This is because of the simple reason that much of the sport involves swinging, throwing and extending. Recently I came across this ESPN page which provides an outstanding overview of why these injuries arise so often. My favorite quote covers the preponderance of elbow injuries among pitchers:

The injury label can be as generic as elbow tendinitis, which simply means inflammation of some tendon around the elbow. For throwers, the most commonly affected tendons are those located on the medial or inner aspect of the elbow. It is here that the tendons of the wrist flexors (which bend the wrist down toward the ground) and the forearm pronators (which rotate the forearm from a palm-up to a palm-down position) attach, hence the term flexor-pronator group. The flexor-pronator muscles provide protection to the elbow joint by countering the torque produced during pitching, so lingering problems here can put the elbow at risk.

Of course you don’t have to be a pitcher to acquire an elbow injury such as lateral or medial epicondylitis, or even cubital tunnel syndrome. The wisest course of action for any stress injury is rest and recovery. But when the body is unable to heal itself adequately from an injury, sometimes the body needs a little extra help in the form of medication, bracing, or soft tissue manipulation techniques. On occasion elbow surgery performed by an expert orthopedic surgeon is necessary to achieve maximal recovery and return to your activity of interest.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow