As baseball teams prepare for opening day with the highly anticipated return of pitchers and catchers, the spotlight shines brightly on the rigorous demands placed on a pitcher’s arm. One injury that has become all too common among pitchers is known as a Tommy John injury, or a career-threatening condition that requires ulnar collateral ligament (UCL) tear treatment.
Associate Professor for Orthopaedics & Rehabilitation, Jim Hsu, MD, is very familiar with not only this term, but the mechanism of injury, treatment, and recovery process as well. As a surgeon specializing in sports medicine, the ligaments of the elbow have been a foundation in his educational training and clinical practice.
Dr. Hsu completed an orthopaedic surgery residency at the Washington University in St. Louis, followed by an orthopaedic sports medicine fellowship at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles, where he served as a fellow physician for professional athletic teams including the Los Angeles Dodgers, Angels, and Lakers. During his Kerlan-Jobe fellowship, Hsu worked directly with the pioneer of the Tommy John procedure, Frank Jobe, MD, whose innovation has continued to save the careers of countless competitive and professional athletes worldwide.
What is Tommy John Surgery?
Tommy John surgery, or UCL reconstruction, repairs a torn ligament in the elbow of the throwing arm. The ulnar collateral ligament is essential for elbow stability, particularly during the high-velocity, high-effort, and repetitive motions of pitching. When this ligament becomes damaged, it can result in excruciating pain, reduced performance, and an unstable elbow joint.
During the surgery, a tendon from another part of the patient’s body or from a donor is used to replace the damaged ligament. This new tendon is threaded through highly precise holes that are drilled into the bones of the humerus and ulna, and ultimately assumes the role of the original ligament.
What is Involved with Tommy John Surgery Recovery?
Recovery from the surgery begins with a period of immobilization, followed by progressive physical therapy designed to restore strength, flexibility, and function. The final stage involves a carefully monitored return to throwing, ensuring that pitchers can safely regain their level of performance.
“During rehabilitation after UCL reconstruction, it is important to evaluate the entire kinetic chain for throwing, quite literally from the ground up,” Hsu said. “A UCL injury may have been the result of motion and strength imperfections elsewhere such as shoulder pain or hip and trunk weakness, which need to be identified and targeted for improvement, or the UCL treatment may fail again from repeated elbow overuse. This comprehensive nature is a chief reason a proper post-Tommy John surgery rehabilitation process can take more than 12 months.”
Why is Arm Care Important?
Given the high frequency and intensity of pitching in baseball, proactive arm care practices are paramount in preventing UCL injuries. Some strategies recommended by orthopaedic sports medicine surgeons like Hsu include:
- Strengthening and Conditioning: A comprehensive training program that includes not only arm conditioning but also core and lower body strength is vital. This holistic approach helps distribute the physical load more evenly across the body, which reduces undue stress on the elbow.
- Proper Mechanics: Ensuring that pitchers utilize biomechanically sound techniques is critical. Optimal mechanics can mitigate unnecessary stress on both the elbow and shoulder, which further decreases the risk of injury.
- Regular Monitoring and Rest: Incorporating adequate rest periods between pitching sessions and consistently monitoring for any signs of discomfort or fatigue are crucial preventative measures. Early detection of potential issues can also prevent the escalation into serious injuries.
Is Tommy John Surgery More Common Now?
In recent years, the number of Tommy John surgeries has seen a notable increase among baseball pitchers. This trend can be attributed to several factors such as the rise in pitch velocity and the cumulative stress from throwing more pitches with sustained intensity. Additionally, the early specialization in baseball, where young athletes focus solely on the sport from a young age, has led to higher stress on developing arms without adequate periods for rest and recovery.
Orthopaedic sports medicine specialists at Yale School of Medicine are working to advance UCL injury treatment with minimally invasive surgical techniques. “A recent and increasingly performed option is UCL primary repair,” Hsu said. “Rather than being replaced with new tissue, the torn ligament is preserved, directly repaired, and protected with suture tape reinforcement known as the internal brace. In select patients with optimal tissue condition and timing, UCL repair has the potential to significantly reduce rehabilitation duration and expedite return to sports.”
While Tommy John surgery has allowed many pitchers to return to the mound, the emphasis on preventive care is more important than ever. Focusing on proper training techniques, ensuring early interventions, and understanding the surgery are critical steps to minimizing the incidence of UCL injuries and extending the careers of pitchers at all levels of competition.