Baseball ’90 PREVIEW : It Can Be One Pitch From Over : Injuries: Despite medical advancements, pitchers live with pain and knowledge that the next pitch could be the last.

Since your arms are what used to be your front legs, it isn’t surprising that several million years of evolution still haven’t produced a limb capable of pitching in the major leagues without distress.

If adaptation produced a human being capable of heaving the occasional rock at a passing wildebeest, that is still different than trying to throw 120 pitches at 90 m.p.h. within 2 1/2 hours, let alone with sliders mixed in.

The slider, the pitcher’s ace in the hole, is relatively easy to control, hard to pick up and hell on the practitioner’s elbow. Thus he is afforded the classic dilemma, as enunciated by Ken Brett, the Angel announcer who became a good pitcher when he began throwing sliders, but felt it every time he threw one:

“If I wanted to keep from working 9 to 5, I had to keep throwing it.”

He hung in 14 seasons despite constant discomfort.

He says he’d do it over again, too.

Not that there weren’t worse things one could do to one’s one and only pitching arm. “King” Carl Hubbell made a noble name for himself throwing the screwball, which called for him to snap his elbow down in an even more unnatural way--facing outward. In retirement, Hubbell’s elbow faces outward and remains bent, permanently.

For a pitcher, the strain on his elbow is rivaled only by that placed on his shoulder. Legions of pitchers had what was for decades vaguely called “a sore arm.” It was akin to bearing the mark of Cain. With few exceptions, sore-armed pitchers didn’t come back.

To pitch was to be outwardly stoic, to worry inwardly about the frailty of this limb which one would so over-exercise, to hide one’s distress lest management begin to look him over and write him off, to go out there regardless of how it feels. If a pitcher waited until he felt fine, the credo went and still goes, he might never pitch.

Brett, struggling with his chronically sore elbow in the mid-’70s, at the zenith of his career at age 25 in Pittsburgh, was called aside by Willie Stargell who recommended a local acupuncturist.

Brett went and got great relief.

He says he told the Pirate trainer, who told him to keep going but not to let him know anything about it.

Thus did the conspiracy endure. Pitchers gritted their teeth, found comfort where they could and hung on for dear life.

Medical science was just getting interested.

If Alejandro Pena had reported the same problem in his right shoulder in 1980 that he did in the middle of the decade, he’d have likely undergone major surgery on his right rotator cuff.

Instead, he underwent arthroscopic surgery. If Pena never regained his pre-surgery form, at least he went back to throwing hard.

If Fernando Valenzuela had reported the same problem in his left shoulder--actually Valenzuela had to be dragooned into admitting that it hurt--in 1986 rather than 1988, he might have undergone arthroscopic surgery.

Instead, he was put on a strengthening program. In his first season back, 1989, the one in which pitchers often struggle, he started slowly but finished well: 10-9 in his last 23 starts, with a 2.96 ERA. The Dodger orthopedist, Frank Jobe, expects the curve to keep going up this season.

It was Jobe who became famous by taking a tendon from the 32-year-old Tommy John’s wrist in 1975 and using it to rebuild John’s left elbow. John subsequently worked 13 more seasons and was still casting about this spring, trying to find work at age 45.

Jobe was trying to do similar pioneering work in rotator cuff surgery in the early ‘80s, but with more problems.

Of course, rotator cuff surgery was the hot procedure of its time. A few years before, few laymen had ever heard the term.

Forthwith, a brief history:

“A lot of it had to do with being more clear-cut with our definitions,” Jobe says. “I think we had rotator cuff injuries before, but we’d always say, ‘He threw his shoulder out.’ Or ‘sore-armed pitcher.’

“In those days, it was sort of a general sense that if you had a surgical scar on your arm or your shoulder, you were through.

“We didn’t have any good tools to work with. We didn’t have the specialized X-ray studies. It was just in those days that we began to do arthrograms (inserting a needle-like probe, through which one could see into a joint). We didn’t understand the forces in the shoulder. We knew it was a semi-ball-and-socket, that it was very loose, had a lot of range of motion. We knew it was hard to pick up subtle changes. If it dislocated, we knew we had to fix that but we didn’t know how to pick up subtle instability.

“As you recall, we used to operate on a lot of rotator cuffs about 8-10 years ago. And we could not make heads or tails out of why some of them got well and went back to pitching, and some of them didn’t. It didn’t correlate to the size of the tear or anything I could put my finger on.

“At that point, I just said, ‘Well, I don’t understand rotator cuff injuries.’ ”

In 1988, Jobe published a study in the Journal of Bone and Joint Surgery, admitting it.

“I almost didn’t want to publish it,” he says, laughing, “because it looked like I hadn’t done a good job. It had to be published because it was true. We worked the facts over and over and we just couldn’t predict. It was sort of an article, saying, ‘Well, I don’t understand what I’m doing.’

“Then a while later, we began to realize the reason we didn’t know what we were doing was that we were operating on the wrong diagnosis. As we began to arthroscope more of these, I began to see that everybody that had a rotator cuff tear had anterior instability. Then, in retrospect, I said, ‘That’s the answer!’

“It was like a light bulb going off--’My God, there’s the problem!’ It’s this subtle instability on the front of the joint when you stretch out the capsule and the ligament a little bit. You couldn’t tell by X-rays or MRI (magnetic resonance imaging) or anything else.

“So now we’re smart enough to look for the instability first. And if the patient doesn’t respond to exercises to strengthen the rotator cuff, then you repair the anterior capsule and you don’t have to repair the rotator cuff unless it’s torn through and through.”

Pitchers like Valenzuela are now given specialized exercises--holding a small weight straight out, thumb down, and raising it up--to strengthen the anterior capsule.

Once Fernando, the gifted kid with the beautiful mechanics, shunned exercises. Now he is religious about them. This season looms as his big test.

Some organizations, such as the Dodgers, advise their pitchers strongly not to throw sliders.

Some pitchers--Bob Welch, Terry Forster, Rick Sutcliffe--can’t control any other breaking pitch and sneak sliders in. Sutcliffe has had most of his success since leaving the organization.

Another couple of million years of evolution and they’ll be OK.

THE PITCHER’S NIGHTMARE

SHOULDER: Hard-throwing overhand pitchers are most susceptible to shoulder injuries, generally pulled muscles or shoulder strain. These injuries normally heal with rest and rehabilitation. The rotator cuff injury, thought to be career-ending, has just recently been found to be treatable, at least sometimes. The rotator cuff is made up of small shoulder muscles that help the front, side and rear deltoid muscles overlap. Tearing the rotator cuff muscles generally requires surgery to repair. However, strengthening the muscles surrounding the rotator cuff can sometimes help patients avoid surgery.

ELBOW: The elbow is susceptible to a variety of injuries, from strains (pulling or slight tearing of muscles and tendons), to sprains (tearing or rupture of the ligaments) to the more common bursitis (inflammation of muscles, tendons, the bursa). Another common ailment is bone spurs, the result of wear and tear over long periods as bone fragments chip away from the elbow and float in the socket. Most elbow injuries can be treated, although chips that won’t disolve must be surgically removed. The injuries are most commonly caused by the violent action the elbow is subjected to by the throwing motion. Breaking pitches are considered the most common culprit, because of the sudden, jarring pressure put on the area during release and follow through.