Few high school baseball players suffer severe injuries. Fewer have to get operated on and go through months of intense rehabilitation. Even fewer travel from the Outer Banks to St. Louis, Missouri. to have surgery performed. Sophomore Stephen Peters did all of the above.

Stephen was injured while pitching during the second inning of a fall ball game against Bertie his freshman year. He had a few symptoms leading up to Oct. 10, 2011, but did not know what they meant at the time.

“I started feeling pain in my upper bicep and in my elbow about two months before the injury in October. I was at a pitching lesson and my pinky and ring finger started tingling and I had extreme pain in my elbow. But I just kept going,” Stephen said. “It turned out that the tingling in these two fingers were a big symptom of it, that the ligament was separating or tearing.”

His father noticed something was wrong while Stephen pitched during the fall ball game.

“He pitched one inning and then there was a long inning when they were batting, and then he went back to pitch,” Bill Peters said. “He’s normally a pretty accurate pitcher, (but) then suddenly I noticed the balls weren’t very accurate. And then he just grabbed his elbow, and just said ‘Ah’ real loud.”

After an X-ray at the Outer Banks Hospital did not show an injury, the Peters were referred to Dr. Christopher Mann at Vidant Orthopedic and Sports Medicine-Outer Banks. An MRI revealed that Stephen had a ruptured Ulnar Collateral Ligament, or UCL. Dr. Mann confirmed that surgery was an option but not necessary.

“We agonized over it because it was really a surgery that, if he didn’t want to play baseball, he didn’t have to have it. But any motion that was similar to throwing a pitch, maybe even playing golf or something, probably he would have had trouble with. And since at that time he was a freshman, and he loved baseball, we couldn’t see telling someone in ninth grade he can’t be a pitcher anymore,” Stephen’s mother, Veda Peters said. “So, we really did agonize over whether we should even have the surgery.”

Stephen immediately started physical therapy with Amy Dougherty of Outer Banks Physical Therapy to strengthen the rest of his body. The Peters opted for the surgery, commonly known as Tommy John surgery.

“Before the surgery, she said probably the reason why it happened was because all my other muscles that went into pitching weren’t as sufficient, so I worked a lot on strengthening my back and my shoulders and legs,” Stephen said. “I was using my arm a little more than I was using (the rest of) my body.”

The Peters were subsequently referred to Dr. Kevin Bonner at the Jordan-Young Institute in Virginia Beach, Va. Dr. Bonner decided that it was best for them to meet with a more experienced orthopedic surgeon, Dr. George Paletta of the Orthopedic Center of St. Louis. Dr. Paletta serves as the St. Louis Cardinal’s head team physician and studied under James Andrews, the original teacher of Tommy John surgery. According to WebMD, a rare case of Tommy John surgery could also include a major complication of nerve damage.

“The Tommy John procedure requires that the UCL, which is the Ulnar Collateral Ligament, (is) ruptured during the throwing motion, and just like the ACL in the knee, they can’t repair the ligament that’s ruptured,” Dougherty said. “They have to take a graft and create a new ligament, just like they do at the knee. In his case, they took what’s called his Palmaris Longus. Since Stephen is left handed, it’s his left elbow that was operated on. So on his right wrist they harvested his Palmaris Longus tendon and then created a graft to recreate his Ulnar Collateral Ligament on the left.”

According to WebMD, Tommy John surgery is named after a former Los Angeles Dodgers pitcher who was the first to undergo this procedure to repair his ruptured elbow ligament. Tommy John operations are common among pitchers at the professional and collegiate level, but less common among high school players.

“His injury is not unusual in throwing athletes, but to have a 15-year-old suffer that type of injury is unusual,” Dougherty said. “Typically what happens is that ligament, instead of actually tearing the ligament, the bone will actually fracture at the insertion part of the ligament, where the ligament inserts onto the bone. So, we call it ‘Little Leaguer’s Elbow’ in the evolving anatomy of a young, typically male thrower. It’s not exclusive to males, but typically male throwers. If they’re still in puberty, typically they’ll fracture, as opposed to rupturing the ligament, and they require two different surgical interventions.”

Stephen had the two-hour surgery over spring break in 2012. He and his father arrived in St. Louis on a Tuesday. Stephen was evaluated on Wednesday and had surgery Thursday morning. His mother had to stay behind and run the family’s bed-and-breakfast.

“We actually got him a new phone right before he went, an iPhone, so that we could Facetime, so that I could see him,” Mrs. Peters said. “But it was hard. As a mom, I wanted to be there with him.”

Stephen left the hospital by Thursday afternoon, spent all of Friday resting, and flew home with his father on Saturday.

“The airport on Saturday, coming home (was difficult),” Mr. Peters said. “First of all, he had this big cast, and going through security they wanted him to raise his arm, and he couldn’t do that.”

After wearing a cast in a sling for a few weeks, Stephen transitioned to a brace that gradually increased his range of motion over the course of three months.

“He had like a Darth Vader arm, with a range of motion limiter,” Mr. Peters said. “He had to change the setting on it to get more range of motion.”

After nearly eight months of intense physical therapy, Stephen had officially recovered.

“He was perfectly on time. He was a classic, normal recovery. He was right on target with the protocol. He was able to progress. Sometimes the younger a thrower is, the more flexible the joints are. In older pitchers, for instance, sometimes they have a hard time getting their motion back. Stephen didn’t have that problem,” Dougherty said. “Stephen didn’t have any of the complications that can sometimes slow down the return to throwing. Thankfully, he’s a young, healthy kid. He healed beautifully.”

The Peters believe the process, while stressful, has strengthened their faith.

“It was definitely a faith builder, I think for Stephen, and I think for all of us, just feeling a little out-of-control with something that was kind of unknown and having to give up that control and believe that what we were doing was what God wanted us to be doing,” Mrs. Peters said. “We did have that affirmed a lot of different times along the way. It was definitely a maturing in our faith to go through the process. It’s still a maturing of our faith, you know, even now, as he’s playing again.”

Stephen missed four seasons of baseball total. He missed two seasons of fall ball, a spring season, and a season of Babe Ruth baseball. Fellow players on Stephen’s JV baseball team have encouraged him throughout his journey and recovery.

“(We have helped him) by building his confidence,” sophomore Brian Evers said. “We all kind of expected him to not be as strong, but he’s come a long way.”

More than a year after surgery, Stephen played first base and pitched for the JV baseball team. Stephen, his teammates, and his parents all agree that his pitching has improved since the Tommy John surgery. Stephen has an optimistic approach for the future.

“I’d definitely say that my placement and velocity (have) improved a lot,” Stephen said. “I want to show that just because I had this surgery, doesn’t mean that I can’t pitch anymore, and that I can’t be that person that you go to. I just hope we come out with a great winning season.”

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Graphic by Amelia Kasten