Tommy John is changing the face of baseball now more than he ever did as a professional pitcher; and it’s all because of a surgery named after him.
The surgery, officially known as an ulnar collateral ligament (UCL) reconstruction, has changed and extended the careers of dozens of professional baseball pitchers in the last few years alone. In fact, a combined 59 Major League Baseball (MLB) pitchers underwent Tommy John surgery in 2014 and 2015.
Tommy John surgery is performed when baseball pitchers tear an important stabilizing ligament in their throwing elbow and all nonsurgical treatment options to return to play have failed.
“When the UCL sustains a tear, the throwing athlete (most often a pitcher) usually complains of pain on the inside, or medial part, of the elbow as well as a loss of velocity and control,” says Randy S. Schwartzberg, M.D., a board certified sports medicine specialist at Orlando Orthopaedic Center. “If non-surgical treatment fails, the surgical treatment involves replacing the ligament with a tendon graft. This is the procedure termed Tommy John surgery or UCL reconstruction.”
Dr. Schwartzberg says, in most cases, the UCL needs to be completely replaced in order to fully stabilize the structure of the elbow. Although small partial tears can often be managed nonoperatively, more significant tears usually need ligament reconstruction to allow the player to return to throwing and pitching commensurate with their prior level.
What Causes UCL Tears?
“Damage to the UCL can occur suddenly or gradually after continued stress on the throwing athlete’s elbow,” says Dr. Schwartzberg.
Baseball pitchers are most susceptible to this injury because of the extremely high stresses seen by the medial part of the elbow during the throwing motion. With repetitive use, the ligament becomes compromised and tears. Then, it is unable to stabilize the medial part of the elbow against the high stresses seen during throwing.
In youth baseball, the tearing of the UCL is occurring with greater frequency in young pitchers due to overuse. “These young athletes are at particular risk because of their developing bones, muscles, tendons, ligaments and their open growth plates,” says Dr. Schwartzberg. “Coupled with the fact that many young pitchers now play year round and may demonstrate poor throwing mechanics, the rise in throwing injuries is no surprise.”
“Other causes include contact sports where one may fall on an outstretched hand, ultimately dislocating the elbow,” says Bradd G. Burkhart, M.D., a board certified sports medicine specialist and colleague of Dr. Schwartzberg’s at Orlando Orthopaedic Center. “UCL ligament tears can also be experienced by other athletes, such as wrestlers and gymnasts as well, though these types of injuries are seen far less outside of baseball players.”
What are the Symptoms of UCL Tears?
Symptoms associated with a UCL injury include pain on the inner side of the elbow, looseness or instability in the elbow, decreased ability to throw, and a “pop” or “tearing” sensation at the site of the injury.
“Athletes will also notice newfound elbow stiffness and they may feel a slight numbness or tingling in the small and ring fingers of the injured arm,” says Dr. Schwartzberg. “Swelling and bruising may also be noticeable after roughly 24 hours post injury.”
What Happens During Tommy John Surgery?
Tommy John surgery is performed under general anesthesia by a trained orthopaedic surgeon who typically specializes in sports medicine. Ligament reconstruction begins with an incision on the inner part of the elbow where the damaged ligament is removed. From there, holes are drilled to accommodate the new tendon grafts, often taken from the palmaris longus tendon found in the forearm or the gracilis tendon in the leg. These holes are drilled in the ulna and humerus bones of the elbow precisely where the ulnar collateral ligament attaches.
“Then we place the new tendon into the sockets created in the ulna and humerus. The graft is then secured with fixation devices to allow an accelerated rehabilitation approach,” says Dr. Schwartzberg.
What Happens After Tommy John Surgery?
For most patients, recovery from Tommy John surgery will take six to nine months. It may take some pitchers up to one year to return to their previous level of activity.
“After one week in a splint, the throwing athlete is placed into a hinged elbow brace with no range of motion restrictions. Rehabilitation commences with progressive functional activities leading up to an interval throwing program at the four month postoperative mark,” says Dr. Burkhart.
“Although range of motion and strength about the elbow returns within a couple of months of the surgery, the throwing athlete still has a large amount of work to ready the elbow for throwing,” said Dr. Schwartzberg. “Rehabilitation of the entire body is paramount for the pitcher. A quality program will address the legs, core strengthening and shoulder work in addition to the elbow. A properly supervised interval throwing program and professional pitching mechanics evaluation are also important. With this approach, most pitchers can ultimately return to their prior performance levels.”
For more resources on overuse injuries in youth baseball players, including video and prevention tips, visit OrlandoOrtho.com.
By Corey Gehrold