MLB's elbow injury problem 'getting worse' as aces Shane Bieber, Spencer Strider fall victim

SCOTTSDALE, Ariz. — It was perhaps the most costly 24-hour span for pitchers in Major League Baseball history. 

It began Saturday with the Cleveland Guardians announcing that ace and former Cy Young winner Shane Bieber would undergo elbow reconstruction surgery, ending not only this season, but most of 2025. 

Next up was New York Yankees reliever Jonathan Loaisiga, who revealed that he has a torn UCL, will undergo surgery and be out for the season. 

Then it was Atlanta’s turn to reveal that ace Spencer Strider, who finished second in the Cy Young voting last season, has a damaged UCL and will undergo tests with Dr. Keith Meister in Texas, likely leading to season-ending elbow surgery. 

Oh, and if you go back just two days, the Miami Marlins announced that prized prospect Eury Pérez needs to undergo Tommy John surgery, too.

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“This is not an epidemic," veteran trainer Stan Conte, who spent 23 years with major-league teams, told USA TODAY Sports. 

“This is a pandemic. It’s been going on forever, and it’s getting worse."

The most alarming aspect to this rash of pitching injuries is that there’s no end in sight, with MLB commissioning a research study and interviewing medical experts. 

There were more than 260 major-league and minor-league pitchers in 2021 who had elbow surgeries, an increase of more than 400% from 10 years ago. 

Pitchers requiring a second Tommy John or elbow surgery have now doubled. 

While shoulder injuries have diminished, 35.7% of all pitchers on MLB rosters at the end of last season had undergone Tommy John surgery at one point in their lives, according to researcher Jon Roegele’s studies. Eleven more have had it since, bumping that percentage up to 37.0%.

Teams spent a major-league record $1.147 billion last season on salaries for injured players and their replacements, mostly pitchers. 

“People have been trying to come up with all kinds of solutions," said Conte, who works at the Conte Performance clinic in Scottsdale, Ariz., “but it ain’t working.’’ 

Conte, who has been a trainer or head of medical services for the San Francisco Giants, Los Angeles Dodgers and Miami Marlins, doesn’t have a magical answer either. The increase in velocity certainly is a leading cause of elbow stress. 

“Let me check my Insta feed," Arizona Diamondbacks special assistant Dan Haren sarcastically tweeted, “for guys throwing weighted balls at max effort against a wall, with a crow hop, with his bros cheering him on." 

Meister, director of the Texas Metroplex Institute for Sports Medicine, believes the increased spin rate is even more damaging. Tony Clark, director of the Major League Baseball Players Association, says the pitch clock is leading to injuries, although there were actually more injuries two years ago before the pitch clock was implemented.

“The league’s unwillingness thus far to acknowledge or study the effects of these profound changes," Clark said in a statement Saturday, “is an unprecedented threat to our game and its most valuable asset – the players.’’

MLB responded by saying: “This statement ignores the empirical evidence and much more significant long-term trend, over multiple decades, of velocity and spin increases that are highly correlated with arm injuries. Nobody wants to see pitchers get hurt in this game, which is why MLB is currently undergoing a significant comprehensive research study into the cause of this long-term increase."

Certainly, the wear and tear from kids pitching so frequently, Conte says, is playing a vital role in Tommy John surgeries.

“There’s such a sports specialization now," Conte says. “The fact that kids are throwing 85, going on travel teams and throwing all year-long, catches up to you. It’s like threads on a tire. You keep running them, and sooner or later, they go bald."

Conte’s clinic, which is run by his son, Nick, tries to identify pitchers who may be in danger of elbow injuries by analyzing an artificial intelligence program studying 37 different variables. Conte, who was director of medical services for the Marlins, informed the Marlins’ front office that ace Sandy Alcantara was going to require Tommy John surgery. 

“He threw 200 innings four years in a row, had great mechanics, but then had elbow problems," Conte said. “I said, 'This guy’s not going to make it.' You can let him throw, but it’s not going to happen. Just plan on him having Tommy John surgery in 2023. You could see it coming down the pike." 

It was no different, he said, forecasting that Bieber would need elbow surgery this year. Conte’s opinion never wavered even after Bieber opened the season striking out a major-league leading 20 batters in 12 shutout innings, increasing his velocity to its highest level in two years (93.7 mph) after training this winter at Driveline Baseball. 

“You knew something was off with that ligament," Conte said. “What we’re doing is seeing if we can get ahead of curve. We’re seeing if someone’s heading towards the cliff, and maybe we can stop something.’’ 

The real concern, Conte says, is the repeat Tommy John surgeries. The first Tommy John surgery has an 85-90% success rate, but it drops down to 50-55% in repeat surgeries. 

Bieber, who’s a free agent after the season, has dealt with arm and shoulder injuries the past few years. Who knows now when he’ll be back.

“He’s devastated by it," said Chris Antonetti, Guardians president of baseball operations. “He feels as though he is letting a lot of people down. I tried to reassure Shane that couldn’t be further from the truth." 

Strider, who struck out a major-league leading 281 batters this season, likely will be out the remainder of the season, too. The only real question is whether Strider will need Tommy John surgery or an internal brace procedure, which may permit him to be back early in 2025. He’s in the second year of a six-year, $75 million contract. 

Look around, and there are more star pitchers on the injured list these days than are active. 

Cy Young winners Justin Verlander, Max Scherzer, Jacob deGrom, Gerrit Cole and Alcantara are all on the injured list. Lucas Giolito and Brandon Woodruff are out for the year. Walker Buehler, Shane McClanahan and German Marquez are recovering from Tommy John surgeries. Cubs ace Justin Steele and Mets ace Kodai Senga are out. And, Dodgers $700 million star Shohei Ohtani won’t pitch until 2025 after undergoing elbow surgery last September. 

There were 166 players who opened this season on the injured list this season, including 132 pitchers. 

“There are lot of different theories on why,’’ Conte says, “but we can all agree that something needs to be done.’’ 

Around the basepaths

– The Miami Marlins, who could be the first team to conduct a fire sale this summer after their 0-9 start, may also find themselves needing a new manager in 2025. 

Skip Schumaker, the NL manager of the Year last season, is a free agent after the year. 

The Marlins originally had a club option on Schumaker in 2025, but the Marlins agreed to void the option during contract talks this past winter. 

Alex Cora of the Boston Red Sox and Schumaker certainly would be the hottest names on the managerial free-agent market. 

– If the Marlins decide to start trading, Jazz Chisholm, Josh Bell, Jesús Luzardo, Luis Arráez and Braxton Garrett would be their top commodities to start a rebuild.  

– The Chicago White Sox privately believe that prized center fielder Luis Robert Jr. could be out for 3-4 months with his Grade 2 hip flexor strain, another blow to an offense already without DH Eloy Jimenez. 

The White Sox will explore the market for reinforcements with free-agent outfielder Tommy Pham still available and perhaps an ideal fit. 

– The hysteria in New York over Juan Soto in the Yankees’ opening series in New York cooled down when Soto went 1-for-16 in the next four games against Arizona and Toronto. Still, he’s hitting .333 with a .873 OPS with the Yankees getting off to a 7-2 start. 

Soto, who should be seeking a $500 million contract, is expected to create a free-agent bidding war between the Yankees and Mets. Yet, with that high of a price tag, it’s unknown if there will be a surprise team who’ll get involved in the bidding. 

– While it’s far too early to know, or even speculate, who will be commissioner Rob Manfred’s successor, Theo Epstein reiterates to friends and associates that he has absolutely no interest in the job. 

– A’s first baseman Ryan Noda expressed that he wants the Athletics’ temporary home to be up to MLB standards playing at West Sacramento’s Sutter Health Park for the next three seasons. 

“Concerns?" he told the Oakland Tribune. “The field, the locker rooms, the dugouts, the surface, making sure all the safety protocols and everything is up to par. That field needs a lot of work, a lot of money put into it in order for it to be a big league place."

The biggest concern may be the playing field at Sutter Health Park. If the Giants’ Triple-A Sacramento River Cats plays there as well, the playing surface will take an absolute beating. 

– The A’s and the city of Oakland were $80 million apart in their negotiations to remain at the Coliseum. 

– Congratulations to assistant GM Fred Uhlman, who quietly retired from the San Diego Padres this past week after spending 29 years in the organization. 

Uhlman is one of the most respected, admired and loyal executives in the game. 

He says that he was not forced out, and has a strong relationship with G.M. A.J. Preller, but simply wanted a change. 

“A.J. and I have talked about this since my Dad passed in 2020," Uhlman said in a text message to USA TODAY Sports. “Talked again in December, but wanted to wait and help get to opening day. I’ve wanted to wait and help get to opening day. I’ve wanted to jump into something new and challenging, most likely scouting…. 

“A.J.’s been awesome. Could have stayed in my current role or moved into a scouting role here, but wanted a fresh start if one is out there. Would love to scout again if the right opportunity is out there… They say being uncomfortable is a good thing and I’m about to get uncomfortable for the first time since 1995." 

– Angels GM Perry Minasian finally persuaded fan favorite Torii Hunter to join the organization as a special assistant. Hunter was offered the Angels’ first base coach job in November, but he passed. 

– Boston Red Sox shortstop Trevor Story’s nightmare continues with the latest injury: a dislocated left shoulder.

Story has missed 187 games the past two seasons since signing a six-year, $140 million contract, and now will be out for an indefinite period. 

– The Washington Nationals’ ownership, who finally signed off on Stephen Strasburg’s retirement, are the ones to blame for even signing Strasburg to the ill-fated, seven-year, $245 million contract. The Nats front office recommended only a two-or three-year deal, but the ownership let Strasburg’s fabulous 2019 postseason that led to a World Series title sway them. 

– There was a loud cheer was of sarcasm from the Angels’ crowd celebrating third baseman Anthony Rendon’s infield single, snapping his 278-day hitless streak, even giving him a standing ovation. 

– The Kansas City Royals rotation has been ridiculous in the early going, yielding a 1.26 ERA, with their starters giving up one or no runs in seven of the nine starts. 

– Larry Lucchino, who died last week at the age of 78 after being a top executive for the Baltimore Orioles, San Diego Padres and Boston Red Sox, deserves to be in the Hall of Fame one day. 

He’s the one responsible for the construction of Camden Yards, Petco Park and the vast enhancements at Fenway Park. 

“One of the most accomplished executives that our industry has ever had," Manfred said.

– Colorado Rockies fans didn’t try to hide their disgust toward Kris Bryant and his struggles by heavily booing him at their home opener. 

“I’ve been through it all,” Bryant told reporters. “The death threats, the ‘kill yourself.’ All the craziness that this game will dish out. … 

“It takes courage to show up every day in this game. This game dishes you a lot. A lot of up, well, not a lot of up, but a lot of downs.” 

Bryant, who has hit just 16 homers and driven in 48 runs with a .727 OPS, since joining the Rockies, is in the third year of a seven-year, $182 million contract. 

– This is the first time in the Arizona Diamondbacks’ franchise history they opened the season without Greg Schulte in the radio booth, and the first time in 40 years the Minnesota Twins were without TV announcer Dick Bremer, each of whom retired. 

– Who wouldn’t love to see the Pittsburgh Pirates return to prominence after their 7-2 start, but remember, they did the same thing a year ago. They opened up with a 20-8 record, proceeded to lose 11 of their next 12 games, and finished 76-86. 

It’s a long season. 

– The Yankees have had a policy in place since George Steinbrenner bought the franchise in 1973 with no beards or hair below the collar, but apparently there is a rule on the number of necklaces a player can wear, too. 

New Yankees left fielder Alex Verdugo said that he was told by manager Aaron Boone that he can wear only one chain per game. 

“It’s kind of been hard, man,” Verdugo told the Associated Press, “because usually I’m used to wearing like three of four.” 

– The only team to open the season with an 0-9 record and finish with a winning record is the 1983 Houston Astros, who finished 85-77, according to Codify Baseball. 

Yes, the Marlins could be in trouble. 

– Washington Nationals pitcher Josiah Gray is scheduled to graduate in June with a degree in business management from Le Moyne College in N.Y. 

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