TOMMY JOHN SURGERY: Facts, Myths, Risk Factors and Prevention

During my 18 yrs as a Physical Therapist no topic has induced more discussions with my clients than Tommy John surgery (AKA ulnar collateral ligament reconstruction or UCL). Questions range from "What is it?", "Should I still draft Matt Harvey to my fantasy baseball team?", to "How can I prevent my Little Leaguer from hurting his elbow?". Here is my attempt to satisfy all.

WHAT IS IT?

This triangular ligament connects the humerus (upper arm bone) to the ulna (inside forearm bone) and provides stability to the elbow. Throwing athletes who sprain their UCL may experience sharp pain along the inside of their elbow or hear a "pop," after throwing. Sprains are defined as an overstretching or tearing of ligamentous tissue and are graded on a scale of I to III. Grade I sprains being the most mild, usually respond well to (RICE) rest, ice compression and elevation along with skilled physical therapy. A grade III sprain is complete tearing of the ligament resulting in elbow joint instability and usually requires "Tommy John surgery."

Tommy John surgery involves using a graft from either another tendon in the body such as Palmaris Longus (an unused forearm muscle) or a portion of hamstring to reconstruct the UCL. Sometimes tissue is harvested from a cadaver.

FACTS AND MYTHS:

Myth: Pitchers who have had TJ surgery throw harder than they did prior to surgery.
Fact: Pitchers actually lose 2-3 mph from their fastball following surgery. They may gain velocity as a result of vigorous rehabilitation with emphasis on core strength, motion analysis, improved mechanics and a regimented throwing program.

Myth: TJ surgery is no big deal.
Fact: Typical recovery for a throwing athlete is 18 months for return to sport and almost 2 yrs before their performance level catches up. Only 75% of pitchers are able to return to the Major Leagues at all following TJ surgery.

Myth: UCL sprains occur primarily in professional throwing athletes.
Fact: UCL sprains have reached epidemic proportions in children as young as 6 over the past 15 yrs. The best way to combat this problem is to prevent it from occurring. This starts at an early age.

RISK FACTORS:

#1 Risk factor for UCL sprain is competitive year round baseball. I call this Tiger Woods Syndrome. Once a parent discovers their child has a gift in a particular area they isolate training to this one activity.

#2 Throwing with fatigue. Kids are throwing too many pitches and are not allowing themselves enough recovery time between bouts of hard throwing.

#3 Showcases. These are events where the child is required to throw as hard as they can for a short duration. Frequently the athlete is given insufficient time to warm-up and they overthrow to impress their audience or a radar gun.

#4 Participating in 2 leagues at once. Doing so may not leave the elbow enough recovery time resulting in repetitive micro-trauma and injury.

PREVENTION:

Active Rest: Participate in multiple sports to cross train. If your child is playing a throwing sport one season, have them compete in a lower body sport such as soccer, basketball or track the next.

Attempt 2-4 months off from competitive throwing after each baseball season. This does not mean they shouldn't play catch in the yard from time to time; just don't repetitively max out.

Pitch count: Coaches and parents should not allow their little leaguer to throw more than 80-85 pitches per game. They should monitor the child's pitch count and watch for signs of fatigue such as getting wild or a drop in velocity.

Young athletes should participate in activities that promote core strength, lower body conditioning, functional strength training vs. isolating particular muscle groups and encourage them to use sound throwing mechanics.


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