“Tommy John” Surgery

Tommy John surgery repairs an injured elbow ligament. It’s most commonly done on college and pro athletes, especially baseball pitchers. But it’s sometimes done on younger people as well. Tommy John surgery is also called UCL reconstruction. UCL is short for ulnar collateral ligament.

The surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type.

During Tommy John surgery, the injured UCL is replaced with a tendon taken from somewhere else in the patient’s body or from a cadaver donor.

How UCL Injuries Develop

The UCL is located on the inside of the elbow. It connects the bone of the upper arm (humerus) to a bone in the forearm (ulna).  Anyone can get a UCL injury from repetitive stress to the elbow or from trauma. But throwers have the highest risk. That’s because throwing motions that twist and bend the elbow put extreme stress on the ligament.

Over time, the UCL can develop tiny or large tears. The ligament stretches and lengthens to the point where it can’t hold the bones tightly enough during throwing activities.

Most UCL injuries occur in baseball players. But other sports are sometimes linked to UCL injuries.

Symptoms of a UCL Injury

Symptoms associated with a UCL injury include:

  • Pain on the inside of the elbow
  • A sense of looseness or instability in the elbow
  • Irritation of the “funny bone” (ulnar nerve): This is felt as tingling or numbness in the small finger and ring finger.
  • Decreased velocity or control when throwing a baseball or other object

Diagnosis of UCL Injuries

Diagnostic tests include:

  • X-rays
  • MRI
  • MRI after dye has been injected into the elbow

Because such tests are not 100% accurate, however, it can be difficult to diagnose a UCL injury.

Candidates for "Tommy John" Surgery

UCL injuries are usually first treated with conservative (non-surgical) therapies. These therapies include:

  • rest from throwing
  • ice
  • nonsteroidal anti-inflammatory drugs (NSAIDs)

Patients then typically undergo physical therapy. This strengthens surrounding muscles to compensate for the injured UCL.

Tommy John surgery is most commonly recommended for athletes who:

  • Don’t respond to non-surgical treatments
  • Want to resume strenuous overhead or throwing activities

Surgical Procedure

The patient’s arm is opened up around the elbow. Holes to accommodate a new tendon are drilled in the ulna and humerus bones of the elbow. A harvested tendon (often the palmaris tendon)—from the forearm of the same or opposite elbow, or from a cadaver—is then woven in a figure-eight pattern through the holes and anchored. The ulnar nerve is usually moved to prevent pain as scar tissue that forms can apply pressure to the nerve.

Dr. Wilson is specialty trained in complex sports medicine procedures such as this.  Request a consultation with him today if you would like to discuss this procedure further.