What is Tommy John Surgery?
The surgical procedure to fix a torn ligament on the inside of the elbow ( Ulnar Collateral Ligament aka UCL) has been nicknamed “Tommy John Surgery”. The problem is very common in throwing athletes, mostly baseball pitchers, though a recent NFL playoff quarterback injured his UCL when the elbow ligament was stretched during a tackle.
Ligaments are ropey structures that hold two bones together. When ligaments are stretched or completely torn, the joint opens up like a hinge, causing pain and instability in the joint. In the elbow, it may cause stretching and possible injury to the ulnar nerve, which courses directly behind the ligament, producing tingling and numbness in the small and ring fingers of the throwing arm. Diagnosis is best made with a physical examination and an MRI.
The Tommy John Surgery Procedure
The procedure involves taking a tendon from elsewhere in the body, such as the forearm or hamstring, and using it to replace the damaged UCL. The new tendon is attached to the bone on either end of the elbow joint, creating a new ligament that helps stabilize the joint. The procedure is typically performed under general anesthesia and usually takes 1-2 hours.
The success rate of the procedure is quite high. Most patients are able to return to their previous level of activity after a period of rehabilitation, which typically lasts around 12 months.
UCL Injury Causes
Total pitch count appears to be the main factor causing injury to the UCL, due to repetitive micro-trauma. In 2002, over 400 pitchers, aged 9 to 14 were studied (1). Compared to those who threw less than 200 pitches, those throwing 201-400, 401-600, 601-800, and 800+, had an increased risk of tearing UCL of 63%, 181%, 231%, and 161% respectively. Types of pitches mattered also, with curveballs causing more pain and sliders causing more injury to the UCL. Teaching younger pitchers a change-up or knuckleball places less stress across the elbow and can substitute for the more harmful curves or slider pitches.
Research thus recommends pitch counts at various ages, useful for coaches, parents, and players to prevent injuries. Many smartphones have apps that can be available to track pitch counts. Recent studies (2) show nearly all pitchers can attain pre-surgery velocity for all types of pitches following a specific rehab protocol. Recovery is usually 12-18 months for pitchers and less time for other position players.
Dr. Frank Jobe, the originator of the surgery, once said that if he had developed the surgery 10 years earlier, it may have been coined “Sandy Koufax surgery.” Sandy Koufax’s career ended “with essentially the same thing as Tommy John” (3).
References:
(1) Lyman, S., et all. Effective pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. AM J Sports MED 30 (4): 463-8. 2002
(2) Analysis of performance in major league baseball pitchers following UCL reconstruction between 2010-2020. Submitted for publication, personal communication.
(3) Pouliot, Matthew (July 15, 2002). “Dr. Frank Jobe: It could have been Sandy Koufax surgery”.
(4) Keri, J. (Sept. 13, 2007) Interview with Dr. Frank Jobe. ESPN.com
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