The stress placed on the elbow while delivering a fast ball is an extreme version of what can happen to anyone who puts excessive pressure on the elbow joint with repetitive motions over time. Whether you excel in gymnastics, wrestling, baseball, or javelin, repetitive stress on the joint can cause swelling, cartilage damage, bone spurs, and tearing of the ulnar collateral ligament.
The ulnar collateral ligament is typically injured from overuse and not from a single event or injury. The frequency of ulnar collateral ligament injuries has increased as a result of over-practice by young athletes.
An Ulnar Collateral Ligament Repair or Reconstruction, commonly known as Tommy John surgery, is designed for patients who have suffered severe ulnar collateral ligament injuries. It is used to restore strength and flexibility to elbow joints after the ulnar collateral ligament has been torn or sprained.
The Tommy John surgery is not always a required procedure. There are sometimes other alternatives: rest, bracing, orthobiologic injections, and physical therapy. In general, the most severe cases affecting the ulnar collateral ligament will require surgical intervention, especially if the ligament has suffered a partial or complete tear.
In the past, Tommy John surgery was most common for professional athletes whose elbows have been overworked. However, currently an alarming and increasing number of young athletes have had to undergo this surgery with the greatest increase occurring in our athletes between 15 to 19 years old.
A specialist doctor can perform a physical exam to assess the symptoms related to the ulnar collateral ligament. If an ulnar collateral ligament is suspected, then an MRI will provide a clear image of the location and the likelihood that the injury will require surgery or can be successfully treated without surgery.
Dr. Romeo discusses youth sports injury prevention:
Ulnar Collateral Ligament Tear FAQ
Why is it called Tommy John surgery?
The technique was developed by a Los Angeles Dodgers team physician, who used it to repair a UCL injury suffered by pitcher Tommy John in 1974 by replacing the ulnar ligament with a tendon taken from elsewhere in the body. Since that pioneering procedure, experienced surgeons like skilled Chicago orthopaedic surgeon Dr. Anthony Romeo have perfected the technique. The surgery is most often used for active athletes who require full functionality of these ligaments for overhead or throwing sports.
In this video, Dr. Romeo describes Tommy John Surgery (Ulnar Collateral Ligament Repair):
Is ulnar collateral ligament (UCL) tear a condition that affects only athletes?
No, but athletes are affected far more often than non-athletes. Injuries of the ulnar collateral ligament have a strong association with vigorous athletic activity, especially baseball.
Is an ulnar collateral ligament tear or sprain a serious injury?
Sometimes. Damage to the ligament does not always affect the way the joint will perform routine daily tasks. An non-athlete patient may be able to manage the injury by resting the elbow, avoiding future activities that place stress on the joint, and following a course of physical therapy to strengthen the muscles that help support the ligament. High-profile athletes, however, frequently opt for Tommy John surgery to restore their velocity and strength.
You are most likely to have lot of pain if you experienced a significant injury event, rather than gradual fraying or tearing of the ligament over a period of years. Patients who report their injury happened suddenly often describe hearing a popping noise and feeling a clicking or grinding sensation in the joint. These more serious injuries often cause swelling and bruising too.
Ulnar Collateral Ligament Repair (Tommy John surgery) Details
During this procedure, the inside of the elbow is opened and holes are drilled in the ulna and humerus bones. A tendon is taken most commonly from the wrist from the same arm and is used as a graft. The tendon is woven through the holes in the bone and then secured in place. The ulnar nerve may require transposition if symptoms are present before the surgery.
In this video, Dr. Romeo describes Tommy John surgery and recovery from the procedure.
Tommy Johns Surgery Recovery
If you undergo Tommy John surgery, you will be sent home in an elbow brace that will keep the joint immobile for about three months. Dr. Romeo will provide specific instructions to manage any post-op pain.
A rehabilitation period is required to allow the body to adapt to the presence of the tendon and to prevent further injury. The total time for full rehabilitation depends on the position the athlete plays. For some athletes, it may take up to a year, while others may return to sports at around six months. The actual rehabilitation period will be determined on a case-by-case basis in order to protect the tendon after the procedure.
During this period of recovery, physical therapy will help you build strength and sharpen muscular coordination. At home you will ease into an exercise routine focused on increasing the range of motion of your elbow, wrist, and shoulder. The average patient will be able to resume most daily activities within six months. The transplanted tendon will require nine months to a year to heal fully. Nine in ten patients typically make a full recovery and are able to return to sports after a recovery period of rest and physical therapy.
For more information about causes and treatment of ulnar collateral ligament tear or sprain, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.
Want to watch the procedure? Here is a full-length video of the UCL reconstruction procedure.
Ulnar Collateral Ligament Repair Videos & Animations
Adolescent Throwing Injuries, Pitch Counts and Overuses: Why Aren’t Throwing Injuries Decreasing?
Why we prefer to use MRI versus Ultrasound when treating baseball players with an Ulnar Collateral Ligament (Tommy John) injury of the elbow
Ulnar Collateral Ligament Injuries – What is the best treatment
Tommy John Surgery (Ulnar Collateral Ligament Repair) Video
Tommy Johns Surgery Animation Video
Additional Ulnar Collateral Ligament Links
Want to know more? Here’s some of Dr. Romeo’s recent medical journal articles about Tommy John surgery:
- Exceeding Pitch Count Recommendations in Little League Baseball Increases the Chance of Requiring Tommy John Surgery as a Professional Baseball Pitcher
- Rate of Return to Pitching and Performance after Tommy John surgery in Major League Baseball Pitchers
- Timing of Return to Batting Milestones After Ulnar Collateral Ligament Reconstruction in Professional Baseball Players
- Open reduction Internal Fixation of Medial Epicondyle Fractures After Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers
- Do Outcomes or Subsequent Injuries Differ After Ulnar Collateral Ligament Reconstruction with Palmaris Versus Hamstring Autograft?
- Side of Hamstring Harvest Does Not Affect Performance, Return-to-Sport Rate, or Future Hamstring Injuries After Ulnar Collateral Ligament Reconstruction Among Professional Baseball Pitchers
- Do Major League Baseball Team Physicians Harvest the Semitendinosus From the Drive Leg or Landing Leg When Performing Ulnar Collateral Ligament Reconstruction on Elite Baseball Pitchers?
- Treatment of Ulnar Collateral Ligament Tears of the Elbow: Is Repair a Viable Option?
- The Ulnar Collateral Ligament Injury: Evaluation and Treatment
- Biomechanical testing of reconstructed ulnar collateral ligament: a systematic review of the literature
- Should We Limit Innings Pitched After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers?
- Medial ulnar collateral ligament reconstruction of the elbow in major league baseball players. Where do we stand?
- Trends in Medial Ulnar Collateral Ligament Reconstruction in the United States: A Retrospective Review of a Large Private-Payer Database from 2007-2011
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.