Tommy John surgery is a common nickname for UCL, or ulnar collateral ligament, reconstruction of the elbow. It is an unfortunately common surgery performed on baseball pitchers.
A UCL injury of the elbow typically develops over time. Common symptoms include elbow and forearm soreness, decrease in velocity and difficulty locating pitches. An orthopedic surgeon can make the diagnosis by physical exam and radiographic studies like an MRI. The injury can be a partial or a complete tear of the ligament.
Tommy John surgery for a UCL injury
A partial tear might not require surgery. Rest and sometimes a platelet-rich plasma (PRP) injection can often help the injured ligament heal. If the pitcher still has pain and cannot pitch as well as he would like to, then surgery can be performed.
A complete rupture of the ligament is a very difficult problem. High-level throwing athletes, including college and professional baseball players, are usually good candidates for surgery. Athletes who are not going to continue in throwing sports might not need surgical treatment.
The orthopedic surgeon makes a new ligament using a tendon graft. Typically, one of the small tendons in the wrist, either on the same side or the opposite wrist, is used. The tendon is passed through drill holes in the humerus and the ulna to make a new ligament.
Return to pitching after Tommy John surgery
Recovery and rehabilitation after Tommy John surgery take many months. The athlete works with a physical therapist to regain elbow range of motion while avoiding stress on the healing graft. Strengthening is gradually progressed throughout the early phases of the process. Usually somewhere around 4 to 5 months, the athlete is allowed to start a long toss program, but it is usually 6 to 7 months or more before he is allowed to start pitching.
It can take 10 to 14 months before the athlete is able to pitch or throw at the same level of competition as before the injury. It is not uncommon for the pitcher especially to say that it is his second season back from surgery before he feels that his elbow is back to normal.
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