How To Avoid The Dreaded Tommy John Surgery

“You need Tommy John surgery” may be the five words a baseball pitcher fears most. This reconstructive surgery, first performed in 1974, has saved countless hurlers from an early retirement. But the recovery process is tough. Most people who have the surgery need at least a year to recover.

This surgery, also called an ulnar collateral ligament (UCL) reconstruction, is often necessary for baseball pitchers and other athletes who want to return to a high level of play. The good news is that surgery isn’t the only way to treat a UCL injury. For most people, rest and non-surgical treatment are enough.

Franciscan Physician Network sports medicine doctor Joseph Richardville, MD, cares for many athletes with UCL strains and tears. As team physician for the Indianapolis Indians, he also sees pitchers working hard to avoid these injuries. Here, Dr. Richardville answers some common questions about UCL injuries and how to diagnose, treat and prevent them.

What Is The Ulnar Collateral Ligament?

The ulnar collateral ligament is a strong band of tissue on the elbow’s inner side. It connects the inside of your upper arm to the inside of your forearm and stabilizes the elbow joint.

“The UCL isn’t overly stressed during everyday activity,” Dr. Richardville said. “But if your sport involves pitching a baseball, spiking a volleyball or throwing a javelin, you probably already know your UCL is at risk. The fast, accelerating movements associated with throwing activities stress the UCL, especially if you do them often.

“Another way to hurt your UCL is with a traumatic injury, such as an elbow dislocation or fracture. We see these in wrestlers, but they can happen to anyone.”

What Is A UCL Injury?

UCL injuries vary widely. In “throwing” athletes, the ligament stretches and thins over time.

“If you ignore the symptoms and don’t modify your activities, the ligament may stretch so much that it tears,” Dr. Richardville said. “The tear can be partial or go through the entire ligament.”

What Are The Symptoms Of A UCL Injury?

“The hallmark of a UCL injury is pain and tenderness on the inside of your elbow,” Dr. Richardville said. “As the injury progresses, your elbow might feel unstable, like it could give out. Other symptoms can include nerve irritation, numbness, tingling and sometimes swelling and bruising.”

You may feel a “pop” in your elbow when throwing or hitting overhead, followed by intense pain. This is the sign of a UCL tear.

What Should I Do If I Think I Have A UCL Injury?

If your symptoms are mild, you can begin by treating your arm at home.

• Make sure to rest your arm. Don’t resume overhead throwing activities if your elbow hurts.
• Apply ice to the affected area. Do this 10-15 minutes a day every 2-3 hours.
• Take non-steroidal, anti-inflammatory medicine (such as ibuprofen or acetaminophen) to reduce pain and swelling.

If your symptoms don’t go away or become moderate to severe, you need to see an orthopedic specialist. They can provide an accurate diagnosis and treatment plan.

How Do Doctors Diagnose And Treat UCL Injuries?

“We start with a physical exam to assess your range of motion, elbow strength and stability,” Dr. Richardville said. “X-ray imaging can help us see if a fracture or loose bone fragment may be the cause of your symptoms. The next step is ultrasound or magnetic resonance imaging (MRI) to determine whether you have a ligament tear.”

Rest, treatment and physical therapy can help you recover from a minor UCL strain or partial UCL tear.

“We want you to avoid overhead activities for six to 12 weeks,” Dr. Richardville said. “The pain typically calms down within about two weeks. Then, you can start physical therapy to strengthen and condition your arm. Overhead activities can resume later, depending on how your recovery is going.”

During your recovery, you need to take precautions.

• When you resume overhead activities, do so gradually.
• Review proper mechanics for overhead throwing and hitting to avoid future injury.
• Give yourself time. Ligaments can take months to heal, even after the pain has improved.

Who Needs Tommy John Surgery?

“If you have a complete UCL tear, you will probably need Tommy John surgery,” Dr. Richardville said. “Some athletes with a partial UCL tear will opt for surgery to ensure they can continue to perform at a high level. Research indicates that about 90 percent of athletes who have Tommy John surgery return to their previous performance levels.”

Can Athletes Reduce Their Risk Of UCL Injuries?

Yes. Athletes can reduce their risk of UCL injuries. Most UCL injuries are the result of overuse. Athletes at all levels can help prevent overuse and other sports injuries by following these tips.

• Don’t pitch through pain or fatigue.
• Maintain a stretching and strengthening routine.
• Use proper mechanics.
• Play more than one sport rather than focusing on one sport year-round.
• Warm up properly before practices and games.

“I also encourage athletes to check out online resources for more information,” Dr. Richardville said. “Major League Baseball’s ‘Smart Pitch’ guidelines offer pitch count limits and rest recommendations. I like ‘The Thrower’s Ten,’ a program from the University of Florida. It details 10 exercises to improve overhead athletes’ strength, power and endurance. The Franciscan Health blog offers an excellent guide to preventing baseball injuries.

“Most importantly, I remind athletes how important it is to care for your bodies. Tell a coach or parent if you experience pain while playing or practicing. The sooner your care team can diagnose and treat your condition, the sooner you’ll return to playing with your team and having fun.”