Dr. Schwartzberg Tommy John Surgery
Ulnar collateral ligament (UCL) reconstruction is performed on athletes, most commonly baseball pitchers, when they tear this important stabilizing ligament in their throwing elbow and the nonsurgical treatment options have failed.
Named Tommy John surgery outside of the medical field, this procedure was first performed in 1974 by Dr. Frank Jobe on Major League Baseball pitcher Tommy John. At the time of the original Tommy John surgery, Dr. Jobe put his chances of recovering from the ligament injury at one in 100. Today, literature says that number is closer to the 90 percent mark thanks to advances in technology and modern medicine.
“When the ulnar collateral ligament sustains a tear, the throwing athlete often complains of pain on the inside, or medial, part of the elbow as well as a loss of velocity and control on their pitch,” says Randy S. Schwartzberg, M.D., a board-certified sports medicine specialist at Orlando Orthopaedic Center. “If non-surgical treatment fails for the UCL tear, the surgical treatment involves replacing the ligament with a tendon graft.”
To ensure that the UCL can return to functioning as the stabilizing structure of the elbow, a complete replacement is necessary. Although it can heal, it often heals in a lengthened position, resulting in a loose condition that can hinder the throwing athlete from ever returning to the type of play they were accustomed to prior to ligament injury.
“Damage to the ulnar collateral ligament can occur suddenly or gradually after continued stress on the throwing athlete’s elbow,” says Dr. Schwartzberg. Before discussing Tommy John surgery in-depth, the following is background on ulnar collateral ligament tears.
What Are the Risk Factors for Tommy John Surgery?
Dr. Burkhart Tommy John Surgery
Risk factors for tearing the UCL involve excessive use or repeated stress being placed on the ligament. In day-to-day activities, it’s very rare to injure the ulnar collateral ligament ligament. Most injuries occur in baseball because of the intense overhead motion and force used when winding up and releasing hundreds of pitches. Ultimately, the UCL becomes compromised and tears.
“Other risk factors may include contact sports where one may fall on an outstretched hand, ultimately dislocating their elbow,” says Bradd G. Burkhart, M.D., a board-certified sports medicine specialist and colleague of Dr. Schwartzberg’s at Orlando Orthopaedic Center.
“We also see UCL ligament tears in other overhead athletes, such as volleyball and tennis players as well. Throwing mechanics and form also contribute to risk factors of the injury.”
What Are the Symptoms of a UCL Injury?
Symptoms of a UCL injury that may ultimately lead to Tommy John surgery and a complete ligament reconstruction include pain on the inner side of the elbow. Many athletes also note a “pop” or “tearing” sensation at the site of the injury, according to Dr. Schwartzberg.
“Then swelling and bruising may be noticeable after roughly 24 hours post injury,” he says. “Athletes will also notice newfound elbow stiffness and they may feel a slight numbness or tingling in the small and ring fingers of the injured arm.”
Can a UCL Injury Be Treated Non-Surgically?
A mild tear to the ulnar collateral ligament may heal on its own. Non-surgical treatment for the ligament tear consists of medications, ice and rest to relieve pain and swelling. Functional rehabilitation supervised by a skilled sports medicine athletic trainer or physical therapist is the most important component of non-surgical management.