Made famous by the Los Angeles Dodgers pitcher who first had the surgery done in 1974, Tommy John surgery is known by anyone who even remotely pays attention to baseball or other athletics where throwing is involved, but how many people ACTUALLY know what the surgery is or why it is done? In recent years, the surgery has even become well known in the youth sports realm, and that is quite alarming. That means young children are getting major joint reconstructive surgery BEFORE those joints have reached skeletal maturity and stopped growing! That can cause major issues down the road.
What is Tommy John surgery?
Tommy John surgery is performed when the Ulnar Collateral Ligament (UCL) on the inside of the elbow joint has been torn. The UCL is a dense strong ligament that holds the upper arm bone (the humerus) to the inside bone of the forearm (the ulna). When the ligament is torn, the structural integrity of the elbow joint is compromised, and there is instability in the elbow joint that can lead to decreased performance and mild pain in very small tears and strains to severe pain with elbow movement, early-onset arthritis, and joint destruction in very severe tears that do not heal correctly. During the reconstruction surgery, the surgeon will use a graft, or tissue taken from someplace else in the body (usually a muscle-tendon), to reattach the humerus and ulna. They will drill holes in the bones, thread the tendons through the holes, and then connect the ends of the tendons, creating a lashing of a sort like you might use to tie two logs together. To watch a short video on how this surgery is done, follow this link! Tommy John Surgery Explained!
Does Tommy John surgery increase performance?
In recent years, there has been an idea passed around the athletic world that getting Tommy John surgery done will increase your throwing performance, especially in young baseball pitchers. The theory is this: the elbow joint is slightly less stable after the surgery, allowing for more range of motion. Tendons are slightly more stretchy than ligaments. Before a pitcher throws the ball, the elbow is in an externally rotated position, which puts strain on the inside of the elbow. As they follow through on the throw, the elbow slings forward along with the rest of the body to catapult the ball. Theoretically, if the elbow is FURTHER back before the ball is thrown, it will go farther and faster. There is NO hard evidence to support this theory, and doctors and sports performance professionals STRONGLY recommend the surgery only be performed if a true tear of the UCL has occurred. Not only does the procedure put the elbow at risk for re-injury, but there can also be complications at the site where the graft tissue was harvested from as well.
Bad Elbow Position Good Elbow Position
Does your child need Tommy John surgery?
If your child athlete starts to develop elbow pain, that does not mean they immediately should have the surgery. Premature surgery can lead to major complications down the road. All parts of the elbow are not fully formed and ossified (or turned into hard bone) until around the ages of 11-12 years. If the joint is damaged or changed prior to it fully ossifying, it impedes proper bone growth. In addition, the ulnar nerve lies over the top of the UCL and the surgery does pose a risk of nerve injury or scar tissue entrapment of the nerve after the surgery has healed. The surgery should ONLY be performed if the child has been evaluated by a doctor and an MRI has confirmed that there is a significant tear in the UCL.
How do you treat the pain and prevent the surgery?
Over the past few years, there has been a large uptick in Tommy John surgeries being performed in youth and high school athletes. Experts point to the fact that children and teens are "starting younger, throwing harder and throwing year-round, not giving their elbow time to rest and recover." In short, most developing elbow pain in youth athletes is due to overuse and lack of rest. Most of the UCL tears are a result of the accumulation of microtraumas and tears that do not heal fully before the athlete goes out to throw again. Organizations and clinicians came together to develop proper "Pitch Count Guidelines" to reduce the stress on young athletes' elbows and shoulders and allow them to recover properly. Those guidelines can be found by following the link here at LittleLeague.org. Proper rest, icing procedures, and regular visits to a sports medicine or rehab clinician to ensure tissues and joints are healing properly are the best strategies to treat the elbow strain pains and prevent a significant injury from occurring.
While Tommy John surgery can be a great way to fix a badly damaged elbow and get your athlete back in the game, it should NOT be the first treatment option for elbow sprain/strains and it will NOT increase the performance of the athlete!