In September 1986, the late Dr. Frank Jobe performed a manual test on Nolan Ryan’s painful right elbow and determined that the pitcher needed Tommy John surgery, a procedure Jobe had pioneered more than a decade earlier.
Ryan said no—he was turning 40 that January and knew the expected recovery from an elbow-ligament replacement at that time was as long as 18 months. When the season ended Ryan simply went home, hoping his elbow would heal. On Dec. 15—Ryan still remembers the date—it suddenly stopped aching. During the following year, as he earned the second of his two National League ERA titles, he recalls Jobe telling him, “I think [the ligament] calcified over enough that it stabilized your elbow.’”
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The self-healing that Ryan described in a recent interview is similar to what ailing Red Sox left-hander David Price, who spent the first two months of the 2017 season on the disabled list and returned to the DL on July 28, says he is experiencing. According to Dr. James Andrews, one of two physicians who examined Price in March, that self-healing is not entirely uncommon.
The worst-case scenario for Price—Tommy John surgery—is unlikely based upon what the pitcher said he heard from Andrews after he first felt discomfort in spring training.
Price is not assured of returning this year; he might run out of time in his rehabilitation to return to form. He resumed throwing on Monday by playing light catch at 60 feet and increased that to 90 feet on Tuesday. If all goes well, a bigger test will come this weekend, when he plans to start spinning breaking balls.
The official description of his injury is “left elbow inflammation,” but Price told me earlier this month that his issue is more with his lower triceps than his elbow. He had a similar ailment with the Rays in 2013 and missed nearly seven weeks.
“It’s kind of the lower triceps—that’s where I felt it,” Price said. “It wasn’t pain. And it was only on an off-speed pitch. The days that I played catch in Seattle [before his second trip to the DL], I could throw as hard as I wanted with the fastball, and it was fine. But when I spun a breaking ball or threw a changeup, that’s when I felt it.
“It felt like [it did] in ’13. It was just dull. I felt it in ’13 doing little stuff like opening the refrigerator, clapping, stuff like that. That’s what it felt like this time.”
No pitcher is assured of future health, particularly one who has thrown more than 1,800 big league innings. But Price, who turns 32 on Saturday, learned he had a unique elbow after visiting Andrews and Dr. Neal ElAttrache, another of the sports’ most prominent orthopedic surgeons, in March. Initially, Price thought he would need Tommy John surgery. What Andrews and ElAttrache told him was quite the opposite.
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“It heals itself,” Price said of his elbow. “It lays down bone on my ligament. It calcifies and turns into bone.”
According to Price, Andrews said the formation of bone on his ulnar collateral ligament was comparable to Ryan’s situation. Ryan, who said he never saw Andrews, was not surprised to hear the famed surgeon knew about the uniqueness of his elbow, reasoning that baseball doctors exchange information. Andrews declined to discuss specific cases but spoke generally about what he called the bony ossification of the UCL.
“Repeated stress to the ligament over its attachment below the joint causes a gradual pulling reaction that over time forms what we call a traction spur,” Andrews said. “It pulls on it and instead of pulling off, it has a healing response with calcification and eventually bone formation. The bone that forms protrudes up into the ligament. You can say that the actual ligament turns into bone as it progresses.”
Andrews said pitchers who heal in such fashion sometimes go their entire career without suffering major elbow injuries. Some, however, still require Tommy John surgery.
“We do see this more commonly in certain genetics, especially in Latinos,” Andrews said. “It’s a healing response. It doesn’t always create the necessity to do a reconstruction. In some cases, the ligament finally gives way above the bone and fails. Then you have to take that bony portion out and do a ligament reconstruction with a graft.”
Andrews estimated that such cases account for two-to-three percent of all Tommy John surgeries. The difficulty, he said, is deciding when to operate on pitchers who form bone around the ligament. Even doctors are puzzled by the condition, and many rarely see it.
A doctor in Boston, not affiliated with the Red Sox, examined Price in July and thought the pitcher needed Tommy John surgery when that was not the case. Said Andrews: “It’s hard to explain even between baseball physicians. [We’re] still trying to figure out why this happens. Some people have the potential to form calcium deposits that turn into bone as a result of injury.
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“The bony invasion of the ligament happens very gradually. Players usually are able to manage it. They don’t even know what is going on until late; they are desensitized relative to elbow pain. A lot of good baseball players are able to manage pain without paying attention to it—the good ones, the mature ones, the major leaguers who last a while.”
After his elbow healed Ryan produced four straight seasons of 200 or more innings and 200 or more strikeouts. His career did not end until Sept. 22, 1993, seven years after Jobe recommended he undergo Tommy John surgery. Ryan, playing for the Rangers, finally tore his UCL on a pitch to the Mariners’ Dave Magadan.
By then, Ryan was 46. He retired rather than undergo a ligament transplant. But once again, his elbow healed itself, anyway.
“I could have pitched the next year,” Ryan said. “I was a volunteer pitching coach for TCU where my oldest son Reid was going at the time. I threw batting practice to those kids all the time. And my elbow was never an issue.”
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(Top photo: Getty Images)
