Better Me

Does Your Elbow Injury Mean You Need Tommy John Surgery?

If you’re even a casual baseball fan, you’ve probably heard of Tommy John surgery, or ulnar collateral ligament reconstruction surgery. It’s a procedure that repairs the ulnar collateral ligament (UCL) in the elbow. It gets its name from Tommy John, a major league pitcher for the Los Angeles Dodgers who had the surgery in 1974 and continued to play professional baseball after he recovered.

You hear a lot about Tommy John surgery during baseball season because the stress of pitching makes UCL injuries common—as many as half of all professional pitchers may need Tommy John surgery.

But it’s not only pitchers and baseball players who may injure their UCL. You can also see it in:

  • People who participate in other competitive throwing sports, such as javelin
  • Tennis players
  • Wrestlers and gymnasts, who may hyperextend their elbows
  • Anyone who falls and lands on an outstretched arm

UCL injuries can strike people of any age. “They are most common in throwing athletes, age 16 to 40 since that’s the age range where athletes typically play sports and are able to throw at their peak velocity levels and frequencies,” said Keith Kocher, a Banner physical therapist.

What are the symptoms of a UCL injury?

If you injure your UCL, you’ll probably feel pain in the inside of your elbow, especially when you put stress on the inside of the elbow while it’s bent. You may notice pain when you shave or wash your hair. If you’re an athlete, you may notice pain when you accelerate a throw or fully extend your elbow. With a severe UCL injury, you may have trouble moving your elbow because of pain and stiffness. The ulnar nerve may also be irritated from the injury, causing tingling in your little finger.

How can UCL injuries be prevented and treated?

“The only way to prevent UCL injuries is to avoid high-risk activities,” Kocher said. These injuries are common in baseball pitchers because players are throwing more pitches at higher speeds and at younger ages. So, limiting pitchers to a specific pitch count may help reduce the risk.

Not all UCL injuries require Tommy John surgery. In mild to moderate cases, rest and rehab can allow the tissue to heal and mature. “A common mistake is to allow the pain to go away and then return to sports too soon,” Kocher said.

Some people try platelet-rich plasma (PRP) to promote healing, but research on the effectiveness of PRP is ongoing. Kocher said there’s no definitive evidence that it helps, but the process does give people more time to rest. Acoustic shock therapy, a type of extracorporeal shock therapy, might also help, but more research is needed.

If Tommy John surgery is needed, the damaged ligament in the medial elbow is replaced with a tendon from elsewhere in the body. Recently, surgeons have been trying to repair the damaged UCL or apply an internal brace along with the reconstruction. “This approach shows promise, but we don’t have long-term follow-up yet,” Kocher said.

The bottom line

Baseball pitchers and other athletes are prone to injuring their elbows. Mild and moderate injuries can heal with rest and physical therapy, but more severe cases may need surgery. If you would like to connect with a health care provider who can help you reduce your risk of injury, Banner can help.

Other useful articles

Orthopedics Sports Medicine