The first group is being studied, but it's that second group that has raised so much concern. Studies are underway, asking: Is it a result of pitchers who push a little too hard, too fast while rehabbing? Does the rehab program, or schedule, need to be re-examined?
Is this about pitchers with flawed mechanics who come back and go right back to the same flawed mechanics? Or is it possible Tommy John surgery itself isn't the surefire cure-all it's made out to be?
"There are a lot of urban myths out there," Ciccotti said. "There's [the theory that] we'll fix it and you'll be better than you were before. That's an urban myth. There's also [the belief that] everyone comes back in 12 months ? so, there's that pressure to get back -- and if it takes you 18 months, 'What's wrong?'"
But there's also one big-picture dose of reality to keep in mind: This is a surgery with an incredible success rate -- but it's not 100 percent.
"If 90 to 95 percent get back, that means 5 to 10 percent don't get back," Ciccotti said. "So the more of these you do, the 5-to-10 percent may stay the same, but there's a larger number [of total surgeries] because more are being done. And if we're talking about professional athletes, they're more discussed."
So, what are these repeat Tommy John surgeries telling us about the nature of that surgery itself? The sports-medicine community isn't prepared to say yet. But an incredible amount of research is being aimed at that very question as we speak.
The old baseball joke goes like this: How do you keep a pitcher from getting hurt? Easy. Don't let him pitch in the first place.
When the topic turns to how to prevent this stampede to the Tommy John surgery O.R., you hear that one a lot. But let's pose this question: Are we sure that's true?
"I know this is a bold statement, but I do not believe throwing is an unnatural act," Conte said. "The shoulder, I think, was designed to throw. ? When the cave men threw a rock [at whatever prey they were hunting], if they threw it underhand, they'd have starved to death. So they threw overhand. The shoulder is designed to do that. What it's not designed to do is throw repeatedly for two hours as hard as you can. It's just like the tires on your car. Tires are designed to run for 40,000 miles -- unless you drag-race. They're not designed for that. So they wear out a lot sooner."
In other words, the research on these injuries begins with the premise that all these sore arms are wearing out. The question is why. And everyone has a theory:
It's youth baseball: Studies conducted by Andrews and America's most prominent biomechanics expert, Glenn Fleisig, have focused increasingly on year-round youth baseball as a prime culprit in causing arm injuries later in life -- and sometimes not so much later. We reported on Fleisig's research in a 2012 piece on Stephen Strasburg's shutdown by the Nationals. It's pitching past the point of fatigue, Fleisig has found, that is the prime cause of injury. So, it's rest that alleviates that fatigue. But year-round pitching, at a young age, simply isn't allowing younger pitchers to rest and recover. And the results often don't show up until after they've turned pro. But is that something big league teams can prevent? "I'm not sure how you stop that," Conte said, "other than to stop it at the youth level."