What is Tommy John Surgery and Why are so Many MLB Baseball Players Getting it Now?

By Kyle Hammond, MD, Emory Orthopaedic, Sports & Spine Orthopaedic Surgeon

A number of major League baseball pitchers have recently had to undergo “Tommy John Surgery”, a procedure used to reconstruct a torn ulnar (medial) collateral ligament (UCL) in the elbow. An injury to the UCL in the elbow is typically caused by repetitive overhead throwing motions, such as pitching a baseball. Collegiate and professional athletes in several sports such as tennis, gymnastics, wrestling, softball, football and track&field have also undergone the procedure, but baseball pitchers are the most prevalent group.

The increased incidence of UCL injuries and tears in MLB pitchers is multifactorial, but is mostly related to the increased stress that these athletes place on the inner aspect of their elbow through pitching, in order to compete at the level of a professional player.

• “Pop” and pain in the inner elbow
• Inability to throw, or decreased ability to throw a ball at the same velocity
• Continuous pain on the inside of elbow
• Instability, or feelings of looseness in the elbow
• Numbness in the small finger and ring finger

If you have any of the above symptoms, it is important to be evaluated by a sports medicine physician right away to determine if you can prevent further damage to your UCL, or the cartilage in your elbow. Continuing to play can cause further damage to the elbow and eventually lead to the need for Tommy John Surgery.

Tommy John Surgery is a surgical procedure where the ulnar collateral ligament in the elbow is replaced with a tendon from another part of the body, or from a donor. An orthopaedic surgeon typically performs this procedure by drilling holes into the bones above and below the elbow where the UCL normally attaches. Typically, a graft from a tendon in the forearm is used to reconstruct the ulnar collateral ligament. An athlete is advised to enter into an intensive rehab program after the surgery and typically do not return to sports for 12 – 18 months after the surgery, in order to let the area fully heal.

Unfortunately many high school baseball players complain of elbow problems, each year. Injuries and predispositions that result in Tommy John Surgery, typically start developing from an early age. A young baseball player who pitches too much before maturing has a much higher likelihood of getting hurt than one whose pitch count is closely monitored. In addition, a young player who has improper throwing mechanics, or shoulder strength and motion can also increase their chances of having elbow troubles.

• It is important for coaches and parents to understand the importance of “pitch counts” and limiting a student athlete’s use of his arm.
• Also, we encourage parents to get a full sports medicine physical in the off season to evaluate if the student athlete has physical findings that might predispose them to injury.
• There are exercises an athlete can do to strengthen the muscles in the right places so that the student athlete can avoid potential injury.

• Hip, legs & core strengthening and flexibility are an important foundation for the throwing athlete.
• Rotator cuff strengthening exercises are a mainstay, but the other muscles surrounding the shoulder blade (peri-scapular) can play a vital role in stabilizing the throwing shoulder.
• Upper & lower extremity stretches are also critical to preventing injury.

It is important for parents, coaches and athletes to understand the risks of pushing too hard in an athletic arena. Tommy John Surgery is a serious procedure and it takes a long time to recover after the surgery. Although, through our surgical technique a high percentage of athletes are returning to their sports, there are still athletes who are not able to return. In addition, when an athlete has to have the procedure a second time, they have a drastically lower chance of returning to their sport. Practice caution so that you can have a long, successful athletic career.

Dr. Kyle Hammond is an orthopaedic surgeon new to the Emory Orthopaedics faculty. He recently completed his fellowship at the University of Pittsburgh Medical Center. While at the University of Pittsburgh he was the Associate Head Team Orthopaedic Surgeon for both the Duquesne University Football team and the University of Pittsburgh Men’s Basketball team. He also worked as a Team Physician for the Pittsburgh Steelers, the Pittsburgh Penguins, the University of Pittsburgh athletics, Robert Morris College athletics, as well as the Pittsburgh Ballet.

Dr. Hammond sees patients at Emory Johns Creek Hospital, as well as Emory Orthopaedics & Spine Center in Atlanta. Dr. Hammond has a special interest in the overhead/throwing athlete, ligament injuries to the knee, Tommy John surgery, joint preservation surgery, and is one of the few fellowship trained hip arthroscopists and concussion specialists in Georgia.