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You've heard the phrase before: The pitcher 

It's a cringe-inducing phrase, and it's a serious injury. It happens when pitchers wear out their ulnar collateral ligament, which connects the upper and lower arm. Without it, a pitcher's career is over.

That was until a team doctor found a way to fix it.

 new book, "The Arm: Inside the Billion-Dollar Mystery of the Most Valuable Commodity in Sports," digs into the history of Tommy John Surgery. Passan joined MPR News host Tom Weber to talk about the procedure, and how it's become an epidemic among players, both in the major leagues — and in high school.

The surgery is named for Tommy John, who played for the Los Angeles Dodgers in the 1970s. In the middle of a game, Passan said, John pulled himself out and told the team doctor: "I can't throw anymore."

An X-ray showed his ulnar collateral ligament was gone. 

Dr. Frank Jobe, the team physician, gave John two choices: Go back to Terra Haute, Ind., and sell cars, or try a new surgery he'd dreamed up.

"Tommy John said, 'I'd rather play baseball than go sell cars,'" Passan said. "And 42 years later, and thousands of surgeries, here we are with things looking a lot different than Dr. Jobe ever anticipated."

The surgery involves replacing the ligament with a tendon from another part of the body. The ligament can come from the wrist, the hamstring or another location. Surgeons then drill holes in the elbow and wrap the ligament in place. 

"Over 18 months, the body will morph a tendon into a ligament, if it is put in a place where a ligament previously existed," Passan said. The first chapter of his book walks readers through a Tommy John surgery. "It's not for the faint of heart."

While major league baseball was behind the invention of the surgery, it has spread rapidly, in a way that concerns parents of young players.

"This started off with Tommy John in April of 1974," Passan said. "But between 2007 and 2011, 56.8 percent of Tommy John surgeries were on 15 to 19 year olds."

The culture of youth baseball has become so competitive that young arms are under enough stress to require this surgery. 

"If you play competitive baseball for eight or more months of the year, and you pitch, you are five times more likely to suffer an arm injury than kids who don't," Passan said. With a year-round schedule and college and major league scouts looking at younger and younger players, "the combination of these two things have wreaked havoc on developing arms."

For the full discussion with Jeff Passan on Tommy John surgery and his book, "The Arm," use the audio player above.

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Tommy John surgery was pioneered in the 1970s to repair pitchers' arms. But now it's being used on pitchers as young as 15. Jeff Passan's book, "The Arm," explores the issue.

Jeff Passan's book "The Arm," explores how one joint became the most valuable thing in the sport, and the dangerous consequences for young players.

The surgery that changed baseball

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