June 11, 2020

Why do they call it Tommy John Surgery?

Hand, Wrist and Elbow | Sports Injury


Tommy John is a retired pitcher who played Major League Baseball from 1963 to 1989. His MLB career includes playing for the Cleveland Indians, Chicago White Sox, Los Angeles Dodgers, New York Yankees, California Angels and Oakland Athletics.  pi. While playing for the Los Angeles Dodgers in1974, Tommy injured his ulnar collateral ligament and became the first person to undergo ulnar collateral ligament (UCL) reconstruction surgery. When the surgery turned out successful and Tommy John returned to the MLB, the surgery was named after him.

Anatomy of the Elbow

Your ulnar collateral ligament (UCL) is located on the pinky side or inside of your elbow and attaches your upper arm (humerus) to your forearm (ulna). It’s one of two ligaments connecting your ulna and radius in your forearm to your humerus in your upper arm.

Your radial collateral ligament (RCL) and UCL are thick pieces of tissue that connect these bones and run along the inside and outside of the elbow. These ligaments surround the joint and form a capsule around it. A tissue called synovium lines the capsule and produces and holds synovial fluid. Synovial fluid surrounds the joint and the cartilage and aids the cartilage with lubrication of the joint and helps decrease friction when you move.

The UCL is responsible for stabilizing your elbow during a throwing motion and has to be able to withstand a great amount of stress. Repetitive motion can cause deterioration of the ligament, commonly in sports like baseball and javelin throwing.

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What causes UCL injury?

The UCL is the major stabilizer of the elbow and repeated motion can cause it to break down and wear away over time. If you or your team’s baseball pitcher needs Tommy John Surgery, it usually means overuse caused the UCL to fray, tear or become loose. If your elbow’s stabilizer is loose, you won’t be able to use it without extreme pain. 

A fall on an outstretched arm can also cause stretching, fraying and small tears in your UCL.


How can you tell if you tore your UCL?

If you are experiencing pain on the inside of your elbow and participate in a sport with a lot of overhead motion, such as baseball, gymnastics or volleyball you may have damaged your UCL. 

Symptoms of a torn UCL include: 

  • Pain on the inside of the elbow
  • Decreased stability
  • Tingling in your ring and pinky
  • Irritation or discomfort of your funny bone (or ulnar nerve)
  • Unable to throw at full ability
  • Swelling on the inside of your elbow
  • Weak hand grip


What are signs that you need Tommy John surgery?

To determine if you need ulnar reconstruction surgery, your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination. An X-ray or MRI may be necessary to confirm the diagnosis and determine if there are other problems.

How is Tommy John surgery done?

Before Tommy John surgery is performed, your physician, may recommend non-surgical procedures, including:

If surgery is needed, Tommy John Surgery is usually an outpatient procedure under general anesthesia. A tendon is taken from a different part of your body or from a donor is called a graft and used to replace your damaged UCL.

After you are put under general anesthesia, a small incision is made on the outside of your elbow. Your muscles and tissues are moved out of the way, and the damaged tissue is removed by your surgeon. The graft is then attached to the ulna and the humerus with buttons or screws. 

To give the grafted tendon extra strength, it is often attached to any remnants left of the original UCL.

What is the recovery time for Tommy John surgery?

After surgery, your arm will be put in a sling; however, you will still be able to exercise your bicep, shoulder and hand. You should follow the physical therapy from your therapist to prevent atrophy.

About two weeks post operation, you will likely be given the go ahead to begin improving your range of motion by moving your elbow joint. A brace will still be required outside of physical therapy and a sling can be used to rest the joint.

Full extension of your arm should come about a month after surgery and your brace is no longer needed. After a few more months of physical therapy, a full range of motion should be possible, and you should begin exercises to strengthen your elbow. 

Typically, patients regain normal range of motion two to four months post-surgery.

Returning to your sport may take a little longer since you will again be putting stress on your elbow joint. Ease yourself back into baseball, gymnastics, volleyball or whichever sport keeps you active. 

A continued stretching and strengthening program is important to keep your elbow joint healthy and ensure you don’t re-injure yourself. To return to your normal full season of play, nine months to a year of gradual progression is usually recommended.

Tommy John surgery is not ideal for any pitcher, but it could save your career in the Major, Minor or Little League and keep your elbow healthy moving forward.

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Learn more about OrthoIndy Sports Medicine

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