Tommy John surgery (medically called ulnar collateral ligament reconstruction surgery) is a procedure where the UCL in the elbow is removed and substituted with a tendon from another area of the body. This tendon may be taken from the hip, forearm, hamstring, foot, knee, or other arm of the patient. Tommy John surgery is common performed on baseball players, particularly pitchers. The first procedure was performed by Dr. Frank Jobe in 1974, and is named after Tommy John, a former major league pitcher. Symptoms associated with a UCL injury include a sense of instability or looseness in the elbow, pain on the inside of the elbow, a decreased ability to throw a baseball (or other object), and irritation of the funny bone. Tommy John surgery has made it possible for thousands of pitchers and other athletes to return to their former level of play.
The UCL can become torn, frayed, or stretched through the repetitive stress of the throwing motion. During a hard throw, there is a significant amount of stress placed on the UCL. Thus, a baseball pitcher is at high risk, because of the force behind each pitch. Some studies have suggested that certain types of pitches or a pitcher’s throwing style can cause an UCL injury. In 2002 however, a study came out that stated it was the number of pitches thrown that had the greatest impact on the UCL. Pitch type is still a factor, as a pitcher who throws a slider has an 86% increased chance of suffering an elbow injury such as a torn UCL. While some people believe a curveball can cause a UCL injury, it tends to be associated with shoulder pain and rotator cuff problems instead.
UCL injuries are treated with conservative therapies at first. These therapies include ice, rest, and non-steroidal anti-inflammatory drugs. After these treatments, patients go through physical therapy to help strengthen the muscles around the elbow to help compensate for the injured UCL. In most cases, however, surgery can be done right away. During the surgery, a tendon is taken from somewhere in the patient’s body, such as their hamstring, forearm, wrist, hip, toe, foot or knee. Surgeons drill tunnels in the humerus and ulna, and pass the new tendon through the tunnels, before weaving it into a figure-8 pattern to entirely reconstruct the ligament. The most common complications of Tommy John surgery are numbness and tingling in the ulnar nerve but these usually disappear shortly after surgery. Johns Hopkins Medicine has more information about the UCL, Tommy John surgery, and more details about the procedure.
Athletes who undergo Tommy John surgery are usually out of action for about a year, and in some cases, two years are required for athletes to return to their previous talent level. There are three phases to rehabilitation. The first phase is immediately after surgery. Athletes wear a splint for about a week or two to make sure the elbow is immobilized. Athletes can participate in gentle range of motion exercises for the shoulder, hand, and wrist, and gradually the elbow joint. They can also do exercises to strengthen the shoulder and arm. Phase II starts 6 weeks after surgery. At this point, many patients can start participating in elbow strengthening exercises. It is important to avoid overusing or over-stressing the new tendon during these exercises however, and increase the intensity and frequency of the exercises gradually. Phase III begins after about 5-6 months. Athletes can start tossing a ball without a wind-up. A month later, if there are not setbacks, athletes can use an easy wind-up as they throw. After 7-8 months, baseball pitchers can return to the mound and participate in light throwing sessions until they are completely recovered. Today, over 4/5 of patients return to their previous level of competition, and some even exceed it.