UW Health Sports Medicine 

Sports Medicine Corner: Tommy John surgery


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June 23, 2010

Turf toe? What in the world is turf toe? University of Wisconsin graduate assistant athletic trainer Ryan Dean answers questions many fans have about common sports injuries in a new series on UWBadgers.com, The Sports Medicine Corner. In part six of the series, Dean examines a procedure many have heard of but few understand: Tommy John surgery.

Tommy John surgeryMADISON, Wis. -- Since 1974, one revolutionary surgery has saved the careers of countless baseball pitchers with severe elbow injuries. The surgery first performed by Dr. Frank Jobe to repair damaged elbow ligaments is named after its first recipient, Major League pitcher Tommy John.

While the surgery has succeeded in bringing countless numbers of players back to their full potential, the recovery process is a long and difficult one, resulting in up to two years of rehabilitation before returning to participation.

What is it?  Tommy John is actually the name given to the surgery used to fix an elbow injury known as a medial (or ulnar) collateral ligament sprain. The surgery is named after former Major League Baseball pitcher Tommy John who was the first individual to undergo the procedure.

Where is it?  Tommy John surgery repairs the medial (or ulnar) collateral ligament or UCL.  This ligament is located on the inside of the elbow joint and stretches from the humerus (upper arm) to the ulna (one of two forearm bones). 

Why is it important?  The UCL is a very important ligament for any overhead throwing sport such as baseball and football. The ligament is one of the main structures that hold the elbow joint together during the throwing motion. A rupture or tearing of this ligament weakens the stability of the elbow joint and makes forceful overhand throwing difficult and painful.

Who’s at risk?  While anyone can injure their UCL, individuals that perform repetitive overhand throwing motions are at a higher risk. These individuals include baseball players and football quarterbacks. Among baseball players, pitchers are at an even higher risk because of the higher quantities and higher velocity with which they typically throw. 

In the past decade, there has been an increase in the number of high school-age athletes that have undergone Tommy John surgery. While no real correlation has been found to relate age and this injury, some of these younger athletes have actually turned to the surgery as a form of athletic enhancement. By undergoing the procedure, a number of these athletes have found their pitching velocities increase despite never being injured in the first place. 

How is it injured?  The UCL can be injured in a variety of ways. Because of the repetitive stress of overhead throwing, the ligament can slowly be injured over time resulting in a significant injury.  The UCL can also be damaged by outside trauma to the elbow joint such as a twisting motion or a force to the outside of the elbow. In these instances, the UCL may be stretched and partially or completely torn.

Then what?  For the general public or minor injuries, a UCL injury will likely be treated conservatively with no surgery. However, athletes with partial or complete tears who perform overhand throwing motions may require surgical repair. In these events, a Tommy John surgery is performed. During this surgery, the damaged ligament is replaced with a ligament from somewhere else in the body such as the forearm, hamstring, knee or foot.  The new ligament is weaved through the elbow joint to reconstruct the UCL.

How long?  A UCL repair via Tommy John surgery can result in a long, exhaustive recovery period. For non-pitchers, the recovery period can take anywhere from six months to a year. A pitcher, who must focus more on velocity and accuracy, will typically have a recovery period lasting between 12 and 18 months.

Rehab?  Tommy John surgery rehab contains a variety of components. The athlete must regain full range of motion of the elbow joint before progressing to regain full strength of the arm and shoulder muscles. During the progress of rehabilitation, individuals will slowly return to throwing activities. These activities will begin with light throwing over a short distance and progress to longer and longer distances. For pitchers, the final component of rehab focuses on increasing velocity and accuracy from 60 feet, 6 inches (the distance between the pitching mound and home plate).

Who Had It?  There have been numerous professional athletes who have had to undergo Tommy John surgery. Professional baseball players Jose Canseco, David Wells and John Smoltz have all undergone the procedure. NFL players Jake Delhomme and Deion Sanders have also had the surgery.

Links
More information on UCL reconstruction
An example of Tommy John rehab protocol Get    Acrobat  Reader

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Ryan Dean
UW Sports Medicine

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