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Tommy John Surgery

The upper arm bone called the humerus and the lower arm bones called the radius and ulna are held together by ligaments. The ulnar collateral ligament (UCL) is located on the inside of the elbow and connects the humerus to the ulna. The UCL is designed to maintain elbow stability.

A torn or unstable UCL is the most common elbow injury seen in athletes, especially baseball pitchers who have frequent and repetitive overhand throws which place extreme stress on the elbow. When an injury occurs if it doesn’t heal correctly, it can cause a loose and unstable elbow.

What causes injury to the UCL?

The damage to the UCL is caused by overuse of the throwing arm in baseball. Overuse can cause stretching, fraying and tearing of the UCL and can become a career-ending injury.

UCL injuries in the non-throwing athlete have also been identified. Tennis is a sport linked to UCL injury due to repetitive use. Combat sports such as wrestling, contact sports like football, and tumbling sports like gymnastics all create a risk of injury to the UCL. Studies reviewing the incidence of UCL injuries in non-throwing athletes report they account for about one quarter of all UCL injuries. In contact sports the injury was sustained with contact. In the non-throwing athlete, a UCL injury was caused by acute trauma, not overuse or a direct hit.

What are the symptoms of a UCL tear in the overhead thrower?

  • A sudden pop
  • Pain along the inside of the elbow
  • Elbow instability
  • Numbness and tingling in the hand
  • Decreased velocity and accuracy of overhead throws
  • Weakened grip
  • Loss of elbow function
  • Bruising and swelling

How is a UCL injury diagnosed?

Dr. Hackett will perform a physical exam, review your medical history, and order imaging tests including X-rays CT scan, ultrasound, and MRI. He will evaluate your condition and lifestyle to determine the best treatment option for positive and efficient recovery.

When is surgery indicated?

  • For a complete tear
  • When extensive nonoperative management fails to improve after a partial tear. 

What is Tommy John surgery?

TJS is surgery to reconstruct the UCL with a surgical graft. It is performed for athletes or individuals who have an unstable or torn UCL.  Dr. Hackett trained directly under Dr. Frank Jobe the surgeon who invented the Tommy John procedure and is a specialist in complex injuries of the elbow.

The procedure was created in the mid nineteen seventies by a team physician for the LA Dodgers and named after the pitcher Tommy John, the first to undergo this procedure. He had the procedure in 1975 and returned to play as the first pitcher ever to return to play after this type of surgery.

The Tommy John procedure has transformed the treatment and outlook for throwing athletes.

Over the past 35 years the surgical technique has evolved such that outcomes have improved significantly.

When will Dr. Hackett recommend Tommy John surgery?

He will recommend Tommy John surgery for overhead athletes who desire to return to play quickly. With TJS many overhead throwers with UCL tears have been able to successfully return to high levels of competition.

The goal of TJS is to restore stability by replacing the damaged ligament with a tendon. The graft is a tendon taken from another part of the patient’s body (an autograft) or from a donor (an allograft).

TJS is a common procedure for professional athletes, collegial and even high school players. In fact, it is so common that in 2020, 29 MLB players had the procedure. Many commentators hold that without the Tommy John procedure, Major League Baseball would not be the same.

The incidence of UCL injuries continues to rise, especially in adolescent baseball pitchers ages 15 to 19. UCL reconstruction return to play rates are reported at almost 90% in high school athletes.

Recovery can take 9 -18 months with structured rehabilitation to return to competitive play. The success rate is 85-95%. Revision rates are low – about 1-7%. Tommy John surgery is the gold standard for surgical management of a complete UCL tear in throwing athletes.

Can a UCL injury be managed without surgery?

A low to medium grade partial UCL tear (grade 1) can often be managed with a period of rest and activity modification, icing, anti-inflammatory medications and physical therapy.  Recent research suggests that the use of platelet rich plasma can facilitate healing. Three to four months of nonoperative management supports high success with return to play rates up to 100% for grade 1 injuries. It can allow an athlete to return to competitive throwing in 3-4 months.

Often a UCL injury may be treated first with nonoperative management, unless the athlete desires to continue throwing. In that case, TJS is the best option to restore full function. UCL tears caused by a traumatic injury can be treated nonsurgically with structured rehabilitation. Return to play rates are high for football, gymnastics and professional hockey. Augmenting treatment with Platelet Rich Plasma can accelerate and enhance the healing potential of UCL injuries.

Tommy John surgery is indicated for those patients who remain persistently symptomatic after a failure of conservative management. However, in the traumatic UCL tear UCL repair can be an effective treatment in these patients. Dr. Hackett will discuss your options with you and recommend the best treatment to meet your needs.

The UCL tear in a throwing athlete has the potential to be a career-ending injury so the best treatment option is Tommy John UCL reconstruction surgery. Tom Hackett performs UCL reconstruction using the most advanced techniques available to restore elbow stability, mobility and function.

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