PORT ST. LUCIE, Fla. -- The thought first wormed its way into Matt Harvey's mind at the University of North Carolina, because that's where he saw the epidemic up close. When two of Harvey's Tar Heel teammates tore the ulnar collateral ligaments in their elbows, they struggled to recover from the resulting Tommy John surgeries.
Harvey began thinking about surgery, too.
"There were definitely a few times when I looked at my arm and said, 'I don't want to have a scar,'" he recalled.
As a hard-throwing pitcher placing daily stress on his elbow, Harvey found it difficult to wipe the thought from his brain. It lodged there as he climbed through the Mets' system and watched others in the organization -- including then-prospect Jacob deGrom -- undergo the procedure. It remained there until the summer of 2013, when Harvey's own UCL snapped, forcing him to the operating table.
The unavoidable scar now snakes up Harvey's elbow, plain to see at a far bank of Spring Training lockers. Three of the four starting pitchers who neighbor Harvey there -- deGrom, Zack Wheeler and Steven Matz -- have also undergone Tommy John surgeries. The fourth, Noah Syndergaard, will make his Grapefruit League debut Thursday (1:10 p.m. ET on MLB.TV) amid soaring expectations -- a 6-foot-6 flamethrower primed to join the game's elite.
Seemingly only one thing can hold him back.
"I've thought about it quite a bit," Syndergaard said. "But I trust myself to put my body in the right situations to be able to perform at a healthy level."
Though the causes of UCL tears remain largely unquantifiable, Syndergaard advertises many of the risk factors. He throws harder than all but a handful of pitchers in baseball history, topping out at 101 mph. He is young -- just 23 -- and coming off a season in which he amassed 65 2/3 more innings than the year before. He has spent his early days in Florida working on a slider, a pitch that typically places extreme stress on the elbow.
Understanding all that, Syndergaard prides himself on proper nutrition, strength and conditioning techniques. The Mets, in turn, have maintained strict care of Syndergaard since the day they traded for him, limiting his innings increases to 14 and 13 percent -- quite conservative numbers -- his first two seasons. Pitching coach Dan Warthen fusses over Syndergaard's mechanics. Even last year, when postseason play shot his workload 49 percent higher, the Mets took measures to dampen his innings.
"I don't lose sleep over it," is how Syndergaard responds to a question about elbow fragility, but that doesn't keep the issue from populating his mind. How could it, with reminders scarred into the arms he sees every day?
"You're always optimistic that these things will be avoided," general manager Sandy Alderson said, "but it's fairly commonplace."
Take Harvey, for example, another large-bodied pitcher with a tireless work ethic and textbook mechanics. After Harvey reached the big leagues, his worries about surgery did eventually start to ease. But all it took was one twinge for those old fears to resurface.
"I think now, there are things I could have done better in high school or in college to maybe prevent it," Harvey said. "But I don't know. I'm not saying [Noah] works that much harder than everybody else, because we all work hard. I think as time progresses, guys pay more attention to stretching the shoulder, strengthening the shoulder. If I could go back -- I don't know if this would have prevented me from having [surgery], but if I could go back and really do 20 extra minutes every day of stretching or arm care, you never know what could happen."
Though the Mets have endured a rash of high-profile Tommy John surgeries in recent years, including two on their big league staff last March, Alderson said he doesn't consider his team unique in that regard. Velocity readings around the game have never been higher, adding stress to elbows that are popping at alarming rates. In baseball circles, it's no longer news; teams such as the Mets have studied the phenomenon independently and are using that data to fine-tune care of their pitchers. But right now, the application is limited mostly to babysitting workloads.
"I figured eventually, it would happen," admitted Wheeler, whose UCL tore last March. "I was hoping it wouldn't. … But it's a part of your job. Your arm's going to hurt."
Even now, with a fresh elbow tendon growing stronger by the day, Wheeler fears another tear. He will for the rest of his career, just as Syndergaard knows he will be always be at risk.
All he can do is lean on a work ethic that he calls "second to none" and hope his lottery number never gets called.
"Anything can happen," Syndergaard said. "You try to prevent it as much as possible, but at the same time you're not always in control. Some guys go through their entire careers without having any problems."
He looked up. "Hopefully, I will be one of those guys."