Portland Sea Dogs relief pitcher Aaron Kurcz bends his right elbow and reveals the tell-tale scar, the one so many of his peers are sporting.

It runs from forearm to bicep and forms the shape of a boomerang.

The symbolism is apt. For 14 painstaking months, Kurcz was left to ponder the question that is plaguing baseball these days: What caused my pitching elbow to fray, and will the so-called Tommy John surgery enable me to return to where I was?

“I never thought I’d end up having to get (the surgery). It doesn’t make any sense to me who needs it and who doesn’t,” said Kurcz, 23.

Kurcz is one of hundreds of professional baseball players who have had the surgery to repair their ulnar collateral ligaments since it was first performed on Tommy John, a major league pitcher, in 1974. Before Dr. Frank Jobe made medical and baseball history with his notion of taking a tendon from elsewhere in the body to replace the UCL, players saw their careers end with what was typically called a dead arm.

The procedure has made headlines this season when an alarming number of major leaguers – 25 through Wednesday – had to go under the knife in 2014, including four pitchers who appeared in the 2013 All-Star game.

More startling, though less widely reported, has been the rising number of teenagers who required the surgery. Dr. James Andrews, the pre-eminent physician in this field, said more than 30 percent of high schoolers chosen in the major league draft from 2010-12 had the surgery. That is more than double the rate from 2002-09.

Andrews performed 19 surgeries on pitchers at the high school level or below in 2002; in the next eight years he averaged 38 procedures.

For Kurcz and many others, the surgery appears to have been successful. He has struck out 36 batters in 30 innings with a 2.12 ERA, and said his fastball has reached 97 mph, the same as before surgery.

But researchers like Glenn Fleisig, who works with Andrews at the American Sports Medicine Institute, caution that such feel-good stories mask an insidious trend, where pitchers overworked as youngsters are breaking down as their pro careers are primed to take off. And surgery is no panacea.

“Your human body is better than anything that’s surgically fixed. The best the surgeons are hoping to do is to make it as good as the original,” Fleisig said. “The notion that it is going to be better than ever is not true. Over the course of time your body doesn’t do as well as having the natural joints and ligaments. If a major-league pitcher is 35 years old and he comes back for four more years, he’s a happy camper and he’s richer than you and me.

“But if a 15-year-old has the surgery, he may do well at 16 or 18, but how is he going to be doing at 25? We’re worried about the long-term impact.”

REACHING KIDS IN TIME

These days, the problem extends beyond teenagers to pre-teens.

Stan Skolfield has worked at the OA Performance Center in Saco for 14 years. A former trainer in the Boston Red Sox organization, in the Cape Cod League and with the University of Southern Maine baseball team, his specialty is helping pitchers develop safer throwing motions. And to rehabilitate youngsters sent to him with arm injuries, two or three each week. He used to work primarily with athletes ages 15 to 18; in recent years, he’s seeing more 10- to 12-year-olds.

The issue isn’t torn ligaments because pitchers that young are still developing growth plates in their elbows and shoulders. It’s fractured bones.

He blames overuse and improper mechanics, compounded at times by a generation of children that may not be as fit as kids in the past.

“Asking someone with no anatomical background to assess and teach arguably the most complex human movement out there is flat-out dangerous,” Skolfield said of youth baseball coaches. “You really have to have your timing right not only to have good performance and pitching, but to make sure you’re not picking up tension in the wrong areas (of the arm). It’s no wonder that we’re seeing some of the injuries that we are.”

At the Maine Orthopaedic Center in Portland, Dr. Sean Hanley has been dealing with so-called Little Leaguer’s elbow for years. He has seen a slight increase in elbow and shoulder injuries in recent years but said it’s hardly an epidemic.

His goal is to reach affected youngsters before they need surgery. Often, he said, rest and an exercise program are enough. But that requires players and parents to recognize the pain and tightness in their joints early enough, before the growth plates begin pulling away from the bone or developing similar abnormalities.

“It’s not only pain while you’re throwing, because you may be able to get sort of excited and amped up and throw through that a little bit. But it’s pain afterwards that lasts for more than a day or two. You don’t want a 12-year-old to be complaining of pain for two or three days after they throw. If they are, then they’ve done too much,” Hanley said.

“Pitching is the one thing you don’t want your kid to specialize in at an early age because they are so prone to develop problems later on.”

WONDERING WHAT WENT WRONG

Increasingly, those who study the issue wonder if it’s not just pitching that is causing the problem. The overhead throwing motion, when repeated thousands of times, can take its toll on a developing arm, so much so that Little League now has limits on when a child can play pitcher and catcher in the same game. The theory is throwing the ball back to the mound after every pitch is nearly as stressful as pitching.

Kurcz said he doesn’t feel like he was overused as a strong-armed pitcher growing up in Las Vegas. He played the sport year-round but alternated between the mound and shortstop until he went to college.

“I don’t know if that directly relates to me having Tommy John or my arm problems,” he said. “The coaches weren’t leaving me out there to dry on the mound, just throwing and throwing and throwing.”

Lincoln Sanborn can tell a similar tale. He starred at Bonny Eagle High for four years, playing pitcher and third base, went to St. John’s University in New York on a scholarship, then transferred to St. Joseph’s College to play for his father, Will, the coach at St. Joe’s for 22 years. In the summer of 2012, he was pitching for the Old Orchard Beach Raging Tide when he felt something wrong with his elbow.

Sanborn took a day off from throwing, then was able to toss the baseball only 25 feet. It was diagnosed as a sprain and he began physical therapy. By the fall he was limited to playing first base for St. Joseph’s. His elbow, he said, “was still killing me.”

A Massachusetts doctor performed an arthrogram – an MRI in which dye is inserted into the joint – and it showed a high-grade partial tear. Surgery was done the next day, Oct. 17.

Sanborn missed the 2013 season, during which he visited a baseball facility in Texas and had his throwing mechanics broken down and corrected.

“I could see why it led to elbow stress,” he said in hindsight.

This spring he returned to the mound for the Monks, with slightly reduced velocity at first. But he fought through the pain and doubts, and ended up 7-1 with a 2.15 ERA. Sanborn is spending the summer with Old Orchard Beach again, but his injury also left father and son wondering what went wrong. Did playing third base while not pitching contribute to the arm problem?

“I have to wonder,” Will Sanborn said. “We just don’t know much about the causes. Is it one pitch? Is it overuse? Did it fray over time? You never know.”

Lincoln Sanborn is pain-free now and will pitch for St. Joseph’s next year while pursuing a master’s degree. He has a desire to coach baseball. Like 85 to 90 percent of Tommy John patients, his has been a positive outcome.

Kurcz, too, withstood a year of rehab and uncertainty to emerge in good shape.

“The first four months are no thrill. You don’t even pick up a baseball,” he said.

But he spent time strengthening his leg and shoulder muscles, and added about 15 pounds to his then 162-pound frame. He feels stronger than ever and believes he found his ideal playing weight.

“When I first started throwing again, I felt a little of the same pain that I felt before the surgery. So that was a big red flag to me and I started getting nervous,” Kurcz said. “My doctors kept telling me that’s normal. I would just kind of push myself through sometimes. I know my ligament’s strong.

“I would say I’m back to where I was.”

KIDS NEED THEIR REST

Theories about why Tommy John surgeries have spiked in recent years are rampant. Children playing baseball year-round is a common one.

It’s also true baseball has entered the strikeout era; pitchers are throwing harder than ever and are more prized for doing so. Fifteen of the 20 hardest pitches ever recorded have come since 2004, according to eFastball.com.

Fleisig said it’s probably a combination of both. His research found that children who spent more than eight months per year engaged in competitive pitching were five times more likely to need elbow or shoulder surgery. Those who participated in so-called winter showcase events, where scouts with radar guns dutifully take note of velocity, were eight times more likely.

“Through proper mechanics or biomechanics, we’ve actually had pitchers perform at levels we’ve never seen before,” Fleisig said. “It’s kind of a blessing and a curse. We’ve helped pitchers maximize their performance, but the ligaments and the tendons are the weak links. They are not trained as well as the muscles. We’re really pushing the limit on the human body.

“These pitchers have the mechanics to throw as hard as possible but they’ve also been overused as children.”

Skolfield has witnessed the overuse first-hand. He said it’s not uncommon for a pitcher as young as 11 to start throwing in January for one team, and continue right through to October for another team or two. If he’s good, every coach naturally wants him to be on the mound. But the season may be longer than that of a fully developed major leaguer.

“You’ve got to look beyond just how many pitches did he throw in the game. How many warmup pitches did the kid throw? What’s he doing in between games?” Skolfield said. “Getting over 100 innings (in a year) is dangerous. That’s a lot of accumulated stress on that arm.

“Once that kid’s season ends, stop. Put the ball down. Don’t throw. Go do another activity and give that body time to rest. Even your big-league guys are going to take two or three months before they throw again.”

PREVENTION CAN BE DONE

This advice for parents comes too late for Mark Hyman. It wasn’t until his teenage son, Ben, was forced to undergo arm surgery that he began questioning what was happening around the country with regards to youth sports, particularly baseball.

Hyman spent a day with Jobe, the surgery’s pioneer who died in March, while researching his 2009 book “Until it Hurts: America’s Obsession with Youth Sport and how it Harms Our Kids.”

Jobe told Hyman that he thought he was merely coming up with a solution for one major-league pitcher’s elbow injury, that he never envisioned 30 years later the procedure would be being performed on children.

And yet the percentage of youth sports injuries related to overuse keeps increasing, Hyman noted. Such injuries are always preventable, simply by introducing variety or moderation into a child’s sports activities.

Hyman speaks with the hard-earned wisdom of a parent, to other parents. He feels your pain.

“The current system is not serving them well. We’re creating obstacles for kids who could go a lot further if we thought more strategically about how to protect them,” Hyman said. “In the short term it’s so seductive to see your 11-year-old strike out all the other 11-year-olds. It’s helpful to remember that the goal is to have your kid still playing and being effective at 16, 17 and 18. It’s hard for a parent to look six, seven years down the road and see what’s ahead for their child when it comes to sports. It was for me.”

Staff Writer Mike Lowe contributed to this story