Tommy John Surgery - Knowledge About it

• How do these Injuries develop?

• UCL Injury Symptoms:

• Diagnosing UCL Injuries:

• Who Gets Tommy John Surgery?

• How Tommy John Surgery is performed?

Tommy John Surgery:

The Tommy John Surgery is a famous surgical procedure which is used to repair the injured ligaments of the elbow. This surgery is commonly used for pro athletes, college and baseball pitchers. However, this surgery is also performed for other younger persons.

The Tommy John Surgery got its name on former LA (Los Angeles) Dodger pitcher Tommy John. He underwent the initial elbow surgery in 1974. The Tommy John Surgery is also known as Ulnar Collateral Ligament. In short, it is UCL Reconstruction. In this surgery, the surgeons remove the damaged tendons and replace them with the healthy tendons taken from any other part of the body. Today, there are several other types of surgeries being used to treat the UCL. Now we took a look at the true Tommy John Surgery as it is commonly used for the treatment of athletes having injured ligaments.

UCL injury and Tommy John surgery

How do these Injuries Develop?

The UCL is present inside the elbow. It is a connecting tendon which joins humerus (bone of upper arm) to the ulna (bone of forearm). A trauma or repetitive stress on the muscles of the elbow can be a major cause of UCL injuries. The throwers (ball thrower, disc thrower or others) have the highest risk of UCL injuries. Actually, an athlete puts high pressure and stress on the elbow ligaments while twisting and bending the elbow to throw something. With the passage of time, the UCL can lead to small tears or large tears in the ligaments. In this condition, the ligaments will not hold the bones tightly as required during sports activities.

Majority of the UCL injuries happen during baseball games. However, other sportsmen can also face this injury. These sports include the following.

• Tennis.
• Soccer.
• Javelin throw.
• Gymnastic.
• Softball.
• Football.
• Cheer-leading.
• Boxing.

UCL Injury Symptoms:

There are several symptoms of these injuries. The most common UCL injury symptoms include:

• Severe pain inside the elbow.
• Instability of elbow.
• Loosening of the elbow.
• Irritation in the funny bone (Ulnar Nerve). This causes numbness or tingling in the ring and small finger.
• Reduced potential to throw something such as a baseball.

Rarely, UCL injuries also cause problems in other activities such as:

• Exercising.
• Running.
• Batting in baseball.
• Routine activities in daily life.

Read More: Skier’s Thumb – Gamekeeper’s Thumb – UCL

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Diagnosing UCL Injuries:

In the majority of cases, the physicians like to have a physical examination or medical history of the patient in order to diagnose the UCL injuries. Diagnostic procedures may include:

• MRI.
• X-Rays.
• MRI after injecting the Gadolinium Dye in the elbow.

Remember, all these tests are not 100 % accurate to diagnose the UCL injuries. However, these can be useful to get an idea about the complex nature of UCL injuries.

Who Gets Tommy John Surgery?

UCL injuries can be treated with the help of several non-surgical therapies. The most common and effective therapies include:

• Icing.
• Rest.
• Use of NSAIDs (non-steroidal anti-inflammatory drugs).

Patients of UCL injuries usually use physical therapies. This is excellent to strengthen the elbow muscles. This also helps to control the swelling and pain in injured UCL.

In some cases, the athletes need to use Tommy John Surgery as a first option. It requires by the people (athletes) who:

• Who shows no progress after use of non-surgical choices?
• Want to resume throwing activities as soon as possible.

How Tommy John Surgery is performed?

During the Tommy John Surgery, a surgeon takes a healthy tendon from any part of the patient’s body such as:

• Toe.
• Forearms.
• Wrestling.
• Hamstring (thigh).
• Foot (Achilles Tendon).
• Knee.

Also, the surgeon may use a tendon which was obtained from the body of a deceased person. During the Tommy John Surgery, surgeons make a tunnel in humerus and ulna. The healthy tendon used in called “Graft”. They pass through this tunnel. The ligament is then woven in “8” (figure-eight) shape in order to allow ligament reconstruction. The remnants of the previous ligament linked to the newly grafted tendon in order to provide support and added strength.

Only 5 to 20 % of the surgeries face complication during the procedures. However, this depends on the surgeon, his professional experience and type of technique used by him. Ulnar nerve damage is the severer type of complication. Patients may also face other types of complications such as hematoma.

Read More: ACL Injury – Anterior Cruciate Ligament – What to Know

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Rehabilitation:

After Tommy John Surgery, a patient may take 1 year for rehabilitation. In some cases, the athletes can take 2 years before resuming sports activities. Remember, other UCL surgeries may or may not require a similar time period. The rehabilitation process closely monitored by the surgeons and fitness experts. Usually, they use a three-phase rehabilitation process.

Phase 1: The patients take the following steps after Tommy John Surgery.

• Keep elbow immobile by wearing splint (7 to 10 days only).
• Gentle range of motion workouts (moving wrist, hand or shoulders).
• Using the range of motion brace. This helps to stabilize elbow joints.

Phase 2: This starts after 6 weeks of surgery.

• Elbow strengthening workouts.
• Avoiding stressful activities for next 4 months in order to ensure that the graft will not face stress.

Phase 3: This is the final rehabilitation phase. Patients may take the following steps after getting a surgeon’s approval.

• Tossing the ball (without wind-up motion) after 5 months of surgery.
• Starting wind-up while throwing balls (only after 6 months of surgery).
• After 7 months, you can return to the mound (baseball pitchers).
• After 9 months, you can throw the ball in competition if you don’t feel any type of pain and your range of motion is easy.

In 1974, Tommy John faced UCL injury which was considered game-ending injury for him. Surgeon Frank Jobe (MD) operated the first UCL Reconstruction to give new hope to athletes. Today, more than 85 % of patients successfully returned to their games with original fitness after the Tommy John Surgery.

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