What Is Tommy John Surgery

by Editorial team

It can be heartbreaking when you realize you have been injured. Not knowing when you will be able to return to play the sport you love. If you are a baseball player you have likely heard about Tommy John Surgery, but maybe you're confused about what it is. We are going to break down the process of Tommy John Surgery and how soon you will be able to return to play baseball. 

What Is It?

Tommy John Surgery is the reconstruction of the UCL, ulnar collateral ligament. The UCL is a ligament that connects the humerus, which is the upper arm bone, to the ulna, the lower arm bone. 

It is most common for baseball pitchers to get Tommy John Surgery, but it is possible for baseball position players and athletes in other sports like tennis, gymnastics, or football too. It occurs when an athlete overworks the UCL ligament in the elbow from repetitive stress which causes the ligament to weaken and eventually tear. 

When the UCL ligament tears, from stress or overuse, this is when an athlete needs Tommy John Surgery to reconstruct their UCL. Sometimes the UCL is torn completely and other times it is a minor tear. In most cases, Tommy John Surgery is always needed no matter the degree of the tear. 

Why Is It Called Tommy John? 

There was a Major League Baseball pitcher named Tommy John who made his MLB debut at age 20 in 1963. He played for various MLB teams like the Indians, the White Sox, the LA Dodgers, the Yankees, the California Angels, and the Oakland Athletics. 

In 1974 Tommy John suffered from an injury, a damaged UCL in his elbow. He was the first to ever receive surgery to repair his UCL. The operation was successful and saved his baseball career and pitching arm. 

After just over a year of recovery, Tommy John went on to continue his career in the MLB until his retirement 26 years later in 1989. He had success following his surgery with appearances in multiple World Series and winning the AL All-Star, NL All-Star, NL Player of the Month, the hutch award, and the Lou Gehrig Award. 

Since Major League Baseball player Tommy John was the first to receive UCL reconstructive surgery that is why it is now referred to as Tommy John Surgery. 

Symptoms 

The most common symptoms for a torn UCL and need for Tommy John Surgery include: 

  1. Pain on the inside of the elbow 
  2. Sensation of looseness in the elbow 
  3. Lack of control when throwing 
  4. Loss of throwing velocity 
  5. Tingling or numbness in the hand, ring finger, or pinky finger

Sometimes an athlete can trace the pain back to one specific throw when they might have felt a popping sensation or sudden extreme pain in their elbow. 

If you are experiencing any of these symptoms you should see a doctor immediately. They will be able to give you an X-ray and an MRI to determine if you have torn your UCL. At times even from these tests, it is difficult for a doctor to tell the degree of the UCL tear until they see it in surgery. Some baseball players experience some of these symptoms and are lucky to have only strained their UCL which can usually be fixed by resting and some physical therapy. 

The Surgery 

The process of Tommy John Surgery is relatively straightforward and the only way to repair a torn UCL. The procedure is done under general anesthesia, it should only take about 60 to 90 minutes, and you can go home the same day. Not so bad! 

It can differ depending on the surgeon, but they will usually use a tendon from another part of your body or one that has been donated by someone who died. They can take a tendon from your 

  • Wrist 
  • Forearm
  • Toe
  • Hamstring
  • Hip 
  • Knee
  • Foot 

To reconstruct the UCL the surgeon has to drill a hole in the ulna and humerus and then the graft, the new tendon, goes through the holes in a figure-eight pattern. The original UCL is attached to the new tendon to add more support and strength. There are slightly different techniques used by each surgeon but this is the most common. 

The Recovery Process

The recovery process is probably the hardest part of having Tommy John Surgery to repair your UCL. It can be mentally draining but if you stay focused on recovery and rehabilitation you could be back to the field sooner than you expect! The typical length of recovery varies but in general is about a year if you plan to return to play baseball. Here is a general guideline: 

  1. Right after surgery, your elbow will be secured in a brace for 1 to 2 weeks. This is to protect the tissue to heal and reduce possible inflammation. 
  2. A week after surgery you can start range-of-motion exercises on your hand, wrist, bicep, and shoulder. This is to help you avoid muscle atrophy, where your muscle starts to waste away from no physical activity. 
  3. Around week 2 to 3 you can start to move your elbow joint a little more each day. This is when you would start physical therapy to increase the range of motion in your elbow. 
  4. Around one month after surgery, you should be out of the brace and able to fully extend your elbow. Now you will have regular physical therapy sessions to work on exercises to strengthen your elbow and work on flexibility.  
  5. 4 to 5 months after surgery you get to start tossing a ball again, but without the wind-up motion. 
  6. Around month 6 you get to start throwing the ball with an easy wind-up motion. 
  7. Usually, by month 7 baseball pitchers can return to practice on the mound. 
  8. By month 9 to 10, if you do not have any pain and have a normal range of motion and strength in your elbow, you are ready to compete in a baseball game again! 

Unfortunately, it is possible to tear your UCL a second time. To prevent this from happening be sure to strictly follow your doctor and physical therapist's recovery and rehabilitation plan. If you are feeling pain and not back to your normal strength, do not return too early! In addition, be sure to follow the preventative measures below to stay healthy so you can continue playing baseball. 

Higher Risk Players 

Many young baseball players have started specializing in one sport from a very young age to develop their skills early. This is putting much more strain on specific parts of their bodies for a longer amount of time, if they continue to play baseball. Studies have been conducted to test if this could be a reason the number of Tommy John Surgeries being performed on baseball players has significantly increased in the last decade. 

In general, pitchers are at a higher risk for Tommy John Surgery because of the repetitive stress they put on their elbow. The motion of throwing the ball can cause the UCL to start to stretch and loosen over time and eventually tear. Below we talk about how to prevent tearing your UCL and having Tommy John Surgery. 

How To Prevent 

When a baseball player gets Tommy John Surgery it’s the result of overuse and stress from throwing. To prevent the possibility of tearing your ACL here are some ways to help

  • Make sure to get a good warm-up before any kind of throwing, to decrease your risk of tearing your UCL. 
  • Work on your flexibility. Stretching before and after a game or practice will help your range of motion and prevent a sudden snap in your ligament. 
  • Abide by the pitching counts. Have a set number of pitches you will do to prevent your body from an injury from stress or overuse. 

These can help you prevent over-straining or stress on your UCL to hopefully never have to have Tommy John Surgery. Listen to your body and rest when you need it! 

Common Misconceptions

Tommy John Surgery should only be performed when you have torn or ruptured your UCL. Some common misconceptions are that with just an elbow injury they should have Tommy John Surgery, this is not true. It is also a common misconception that just getting Tommy John Surgery will increase your performance and pitching speed. The only thing the surgery solves is it will repair your torn UCL so that you can continue playing. 

Summary 

Tommy John Surgery has become more common for baseball players now. No one wants to not be able to play the sport they love because of an injury, so be sure to follow the preventative measures and listen to your body so you never have to have Tommy John Surgery! 

 

Be sure to check out Ryan Weiss's coaching program and his other training programs to elevate your game.

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