PT Tip of the Month

What is Tommy John Surgery?

Tommy John surgery is a reconstructive surgery of the ulnar collateral ligament (UCL) of the elbow. The surgery is named after pitcher Tommy John, who was the first professional athlete to successfully undergo the surgery in 1974. Prior to the surgery, a UCL tear was almost always career ending for a pitcher, but the surgery has successfully saved many careers, including Tommy John's, as he went on to win 164 more games. In a recent study, 30 out of 31 patients were able to return to their previous level of competition after receiving the surgery.

Role of the UCL

The UCL is a ligament on the inside of the elbow that prevents the ulna (forearm) from separating from the humerus(upper arm). During the pitching motion, a high load is placed the ligament and with repeated throwing, it is possible for this ligament to become frayed or torn. When the ligament is torn, a pitcher will lose stability at the elbow causing his pitch location to suffer and his velocity to decrease. In addition to pitchers, other athletes prone to UCL tears are javelin throwers, tennis players, lacrosse players, and golfers.

 

The surgery

There are many ways to perform Tommy John surgery, but the general goal is to reconstruct the ligament in the elbow. A surgeon will usually start by removing a tendon from the patient’s forearm or hamstring. After drilling holes into the ulna and the humerus, he will then use this tendon to tie the bones together. As with any surgery, there is a small chance of complications, since there are many tendons, blood vessels and nerves located in and around the elbow. Another possible complication is a loss of full elbow straightening, however this can often be fixed with good rehab, and even if the elbow loses some motion, the athlete may not necessarily lose strength or function.

Recovery

The rehabilitation process after the surgery is long and intensive, usually taking 9-12 months for a full recovery. It often includes stretching, strengthening, plyometrics, and throwing. Immediately after the surgery only passive motion of the elbow and hand gripping exercises will be allowed. Slowly a patient will transition to gentle active motion. Next, a period of 2-4 months will focus on strengthening of the wrist and shoulder, but the patient must be careful to avoid valgus (sideways) forces on the elbow. After about 5 months, light throwing will be allowed, and this will gradually ramp up in both frequency and distance. A pitcher will not usually be able to return to full pitching until about a year after surgery.

Our physical therapists are experienced in the rehabilitation of Tommy John surgery and other elbow pathologies, so if you are experiencing signs and symptoms of elbow pain or will be undergoing Tommy John surgery and would like to be scheduled for a physical therapy evaluation, please contact 617-232-PAIN (7246) for our Brookline office and 617-325-PAIN (7246) for our West Roxbury office.

33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282