By Daniel Fox, SPT
What Is Tommy John Surgery?
Tommy John surgery, more formally known as Ulnar Collateral Reconstruction (UCLR), is a surgical procedure first performed by Frank Jobe in 1974 on MLB pitcher Tommy John. The surgery consists of repairing/replacing a torn UCL, which is a small ligament on the inside of the elbow that serves to stabilize the elbow. It is frequently performed in overhead throwing athletes and has notably shown a significant rise in the past 10 years amongst baseball players of all ages.
The Increase in UCLR Prevalence
Between the years 2007 and 2011, 790 athletes documented in a private player database underwent Tommy John surgery. This number is likely smaller than the actual representation, due to not every player in the country being included in these kinds of databases. Over half of these athletes (58.6%) were between 15-19 and 22.2% were between 20-24 years old. Major League Baseball has seen a rise in this category as well as over 400 Tommy John surgeries have been performed from 1974 to date.
In recent 2018 study, 115 out of 134 Division I baseball players who had undergone the surgery were identified as pitchers. Which equates to a surgery rate 5.9 times higher than non-pitchers. The majority of these surgeries were performed on freshman and sophomore pitchers, during the season, and who played in warm-weather states. Recent studies have also shown a relationship between elbow injuries and lack of external rotation, total rotation and lack of flexion of the throwing arm. Studies on youth pitchers have shown a correlation between elbow injuries and higher number of games played, pitches thrown and innings pitched.
What Can You Do?
- Sport Diversification: Warm weather states show higher prevalence for Tommy John surgeries due to the fact that baseball is accessible virtually all year round and young athletes are choosing to specialize in one sport. Decrease the amount of stress and strain on your arm/your child’s arms by giving rest time to participate in other sports/activities.
- Play Different Positions: To decrease the amount of stress to the throwing arm by taking a break from the mound to play other areas in the field that involve less repetitive throwing.
- Limit Pitch Counts: Limit the number of pitches thrown per game, week, month and year to keep the arm healthy. http://m.mlb.com/pitchsmart
What Can Physical Therapy Do?
- Address Individual Differences: Physical therapists can identify and address limitations in elbow, shoulder, core and hip range of motion, strength and stability to help limit the risk of injury.
- Mid-Season Prehab Programs: Physical therapists can design and implement mid-season programs that include stretching, strengthening, stability and recovery work in order to ensure that your arm stays healthy throughout the season.
- Rehab: For those who unfortunately have to have elbow surgery, Physical Therapy can get you back on the field through individualized rehab programs.
- Erickson BJ, Nwachukwu BU, Rosas S, et al. Trends in medial ulnar collateral ligament reconstruction in the united states: A retrospective review of a large private-payer database from 2007 to 2011. Am J Sports Med. 2015;43(7):1770-1774. Accessed Aug 13, 2018. doi: 10.1177/0363546515580304.
- Rothermich MA, Conte SA, Aune KT, Fleisig GS, Cain EL, Dugas JR. Incidence of elbow ulnar collateral ligament surgery in collegiate baseball players. Orthopaedic Journal of Sports Medicine. 2018;6(4):232596711876465. http://journals.sagepub.com/doi/full/10.1177/2325967118764657. doi: 10.1177/2325967118764657.
- Erickson BJ, Chalmers PN, Bush-Joseph CA, Romeo AA. Predicting and preventing injury in major league baseball. Am J Orthop. 2016;45(3):152-156. Accessed Aug 13, 2018.
- Erickson BJ, Harris JD, Tetreault M, Bush-Joseph C, Cohen M, Romeo AA. Is tommy john surgery performed more frequently in major league baseball pitchers from warm weather areas? Orthopaedic journal of sports medicine. 2014;2(10):2325967114553916. https://www.ncbi.nlm.nih.gov/pubmed/26535277.