Hunter Greene’s Elbow Injury A Reminder Of All We Still Don’t Know

It was announced yesterday that Hunter Greene, the No. 2 pick in the 2017 draft, will have Tommy John surgery next week.

The news is a serious setback for both Greene and the Cincinnati Reds, who will see their top pitching prospect sit out all of 2019 and likely much of 2020. Understandably, whenever a top prospect or MLB pitcher goes down with Tommy John surgery, the immediate follow-up is to try to find someone or something to blame.

He was overworked. His mechanics were at fault. He didn’t train this way or that way. He simply threw too hard.

Here’s the reality that is hard to hear: We just don’t know. After years and years of study, the baseball industry does not know how to prevent Tommy John surgeries. And it likely won’t anytime soon.

While surely someone can find fault with Greene’s mechanics in one way or another, the knock on his blazing fastball throughout his development was that his delivery was too clean and he threw—if it was possible—too easily. With no funkiness in his delivery, hitters often got a very good look at his 100 mph fastball. Multiple scouts describe Greene as throwing the easiest 100 mph they have ever seen.


When it comes to workload, Greene was taken care of from a very early age. He threw less than 30 innings in his final season of high school, shutting down early to prevent wear and tear. He spent as much time hitting and playing shortstop as he did pitching on the showcase circuit. And he turned down the opportunity to pitch for USA Baseball’s 18U team when it won the COPABE Championship because he wanted to have a layoff from pitching, something USA Baseball’s Pitch Smart guidelines suggest.

 Tommy John surgeries by team since 2016
CIN 21
MIL 19
SF 18
NYM 17
NYY 17
CLE 16
LAA 16
SD 14
MIA 13
OAK 13
TEX 13
WAS 12
HOU 11
TB 11
CHW 10
LAD 10
MIN 10
STL 10
TOR 10
KC 6
Source: Jon Roegele’s TJ Database

It’s very true that Greene throws as hard as about anyone, but we’ve yet to figure out why Aroldis Chapman can throw 100 mph fastballs year after year with no arm injuries while others cannot.

We don’t know. As best can be determined, elbow ligament injuries occur for many, many reasons. Some aspects may be genetic. Some may be based on mechanics. Some may be based on workload. Some of it may just be bad luck.

ESPN’s Jeff Passan spent years reporting on this in the lead-up to writing the book “The Arm” in an effort to obtain answers regarding the Tommy John epidemic. In the end, he realized that when it comes to Tommy John surgery, there were no easy answers.

“I went into this project thinking I want to find what the absolute truth is and get it out there. And here we are six years after I started reporting it and I still don’t know,” Passan said on the Driveline Baseball Podcast. “I still don’t know, and I don’t know if I’ll ever know.”

I’ve talked to countless experts, trainers, coaches and pitchers about elbows and elbow injuries during my time at Baseball America. What I’ve learned is there are no easy answers, even if the temptation always exists to try to find one.

Thanks to Jon Roegele’s excellent Tommy John database, we know that every MLB organization has had at least four pitchers need Tommy John surgery over the past three years. The average organization has lost 11 pitchers to Tommy John during that span. The Reds (21 Tommy John surgeries) lead the way in most elbow injuries. But the Brewers (19), Giants (18), Mets (17) and Yankees (17) aren’t far behind, and several of those organizations have also been extremely productive in producing pitchers.

It’s possible that some organizations have found ways to limit the risk of TJs, and being quite secretive with trade secrets, they have kept those ideas to themselves. But the data makes it clear that no one has figured out how to avoid them overall.

The Red Sox lead the way with only four MLB or MiLB pitchers who have needed Tommy John surgery since 2016, but the Red Sox’s list of injured pitchers includes Jay Groome, the team’s No. 1 pick in 2017, and Roniel Raudes, who ranked as the team’s No. 6 prospect a couple of years ago.

The Astros run the most data-driven organization in baseball. They have had 11 pitchers succumb to elbow injuries over the past three seasons, which is right at the league average. The Dodgers, another organization that throws massive resources at every aspect of coaching and player development, have had 10.

Research will continue. With motion-capture technology and high-speed cameras, teams have the ability to break down deliveries in ways that were impossible a decade ago. It’s possible that improvements can continue to be made. But pitchers will continue to get hurt. Unfortunately, it’s a fact of life.

And anyone who says they have figured it all out is almost assuredly wrong.

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