Dr. James Andrews, the renowned orthopedic surgeon, who fixes elbows as easily as we screw in light bulbs, is not often available to talk about his elbow ligament transplants – a.k.a. Tommy John surgery – so when I learned he would be on a conference call to promote a golf tournament with John Smoltz and Greg Maddux I eagerly accepted the invitation to join it.

The golf tournament is the 54-hole American Century Championship July 17-19 in Lake Tahoe, featuring more than 80 sports and entertainment stars. Smoltz is among the likely winners. End of promotion and now to Dr. Andrews.

I asked him the first question: Despite all of the pitching precautions teams take today – pitch counts, innings limits, six-man rotations – pitchers are still getting hurt, their elbows in particular requiring season-losing surgery.

According to unofficial data from the commissioner’s office, 276 players have had the reconstruction operation beginning in 2000. That includes 26 players who have had a pair of operations and three who have had a trio. The single-season high has been 44 in 2012. In this calendar year 13 players have had ligament transplants in their elbows.

“You know, that’s a very good question,” Andrews began his response. “And being on the research committee for Major League Baseball, we’re trying to answer that right now.”

Andrews referred to a committee that includes him and 10 other doctors and will seek explanations for the epidemic of elbow injuries.

“But the one thing we have that we’ve found out,” Andrews continued, “is that if you take a close enough history – now this did not apply to John Smoltz – but if you take a close enough history, the younger professional pitchers that we’re seeing now at such an increased rate of injury, you’ll find out that most of them had some type of elbow injury when they were playing youth sports.

“And that’s the group of pitchers that’s just coming through the professional ranks now, and they were the first group that really played one-sport specialized in year-round baseball. And, as you know, John Smoltz had a long career before he had to have any surgical procedure done.

“And he was one that played, I think, John you can correct me, four different sports in high school and had a long career before he had an injury. Now, obviously you can’t prevent all injuries in baseball. If you play baseball long enough, you’re lucky if you get through your career and never have to have a surgical procedure.

“But the increased incidence right now is probably related to specialization when they’re young baseball players and youth leagues and high school leagues, and they’re playing baseball without rest, and they have fatigue factors and get hurt a little bit and it shows up later on, early on in their professional careers.”

In other words, to a great extent, pitchers are elbow operations waiting to be performed.

I asked a follow-up question.

Going back to the ’50s and ’60s and even into the ’70s, I asked, you had pitchers throwing 300 innings, certainly 250 – Robin Roberts and Warren Spahn, Tom Seaver, Steve Carlton – and they never had this injury. Why is it necessary to restrict pitchers today?

“You’re trying to compare apples and oranges to some degree in athletics,” Andrews said. “In those pitchers, back in those days, they weren’t throwing with the same pressure on them from a financial standpoint as these pitchers are today.”

With all respect due the good doctor, I have to take exception to the idea that today’s pitchers deal with greater financial pressure than the Spahns of an earlier era.

Today’s pitchers have guaranteed contracts worth an average of $3 million a year. Pitchers with losing records gain raises in salary arbitration. In the days before arbitration and free agency, pitchers had real pressure. They had one-year contracts and pitched for their next season’s salaries.

Continuing with his explanation, Andrews said:

“Nor were they pushed as hard to some degree. And the pitchers of today are throwing harder. They’re bigger and stronger. And they are doing more, as I said, at a younger age. So their wear pattern on their throwing arm is greater before they get to that level.

“Other than that, we don’t really have an answer for that. But I don’t think you can compare pitchers back in that category and the pressure to throw and to throw hard and to throw at higher velocities compared to the pitchers that we have today.”

I can accept Andrews’ last arguments more than his initial thoughts. Pitchers do throw harder, and teams look for the hardest throwers. But I think teams have erred in the limitations they impose on pitchers beginning in the minor leagues.

“When you go into the minor leagues” Smoltz said, “and you take a kid out after 75 to 90 pitches, what do you expect him to do in the big leagues? Our problem is just getting worse if we keep allowing some paper or somebody to determine what is a universal number that we should be looking at.”

Tommy John, the pitcher, not the surgery, always used to say a pitcher should throw more – not pitch – to develop his arm, and Smoltz agreed:

“Kids do not throw enough. They pitch too much. Meaning I threw a lot when I was a kid in Michigan, which is seasonal change, allows me to play other sports but I didn’t pitch a lot. There’s a difference. I played Strikeout, we played backyard baseball. We did things that kids don’t do … everything that a kid does today is organized and pressured into a pitch to impress.”

Hearing the same advice from a Hall of Famer and a 288-game winner should make an impression on pitchers, amateurs or professionals. General managers, managers and pitching coaches may also benefit from listening.

Hearing what Smoltz had to say prompted me to ask him a question. The limits, I said, are imposed by the team. “How can they do what you did if they’re not allowed to practice what you did?”

“That’s why I said I feel sorry for them because they adhered to, I think, flawed philosophies,” he replied. “Everybody wants a piece of paper to work out the issues on how baseball should be played. Everything’s a number. Everybody’s got the answer to fix issues, and all I say I wouldn’t say – I wouldn’t say a word if it was getting better.

“It’s getting worse. Ever since we discussed and became focused with the pitch count, it’s getting worse. And the reason – the pitch count is not the same for Greg Maddux as it is for me. It’s not the same; not everybody fits in the same category. But we’ve universally made this a number.

“It’s like if I told you every single day at work you’re going to get sick. Sooner or later you’re going to get sick and more or less you’re going to feel like you might be getting sick and every day what bothers me in this game is this is trainable. Guys can train for this. We’ve been doing it for years. I think the training’s wrong. I think the philosophy’s wrong.”

I couldn’t have said it better myself.

Here is a list, not necessarily complete, of players who have had Tommy John surgery beginning in 2000.