Dr. Andrew Fagan Article

Tommy John surgery a pain in the elbow to baseball players

Pitchers most commonly affected

We have all heard baseball announcers talk about players who have undergone Tommy John surgery after a throwing injury at the elbow.

But what is it, exactly?

Over the course of time, a baseball player’s elbow withstands a lot of force from repetitive hard throwing. This is most common in pitchers.

The ligament on the inside of the elbow, the ulnar collateral ligament (UCL), can become stretched, frayed and torn over time. This can cause irritation of the neighbouring ulnar nerve on the inside of the elbow, and thus cause pain with throwing.

As the body goes through the throwing cycle from the acceleration phase to the deceleration phase, force is transferred from the arm through to the baseball. This transfer of force creates torque at the UCL and leads to the injury.

The surgical procedure involves grafting a tendon from the athlete’s own body or using a tendon from a cadaver.

Holes are drilled on either side of the elbow joint. The tendon is woven into a figure eight pattern through the holes and anchored into place to simulate the UCL ligament.

Normally the ulnar nerve is slightly moved to prevent future pain symptoms as scar tissue can accumulate in the area and cause pressure on the nerve.

The surgery was named after the first Major League Baseball (MLB) player to have the procedure successfully completed. Tommy John returned after rehabilitation to win 164 additional career MLB games.

The problem can also occur in mature children and collegiate-aged athletes.

Studies show that the greatest determinant of sustaining the injury has to do with the amount of pitches thrown by an athlete. There are different guidelines to suggest how many pitches an athlete should make in a game, and how much rest time they should have between games.

After an athlete has the procedure done, rehabilitation takes about six months for position players, and at least a year for pitchers.

Over time, results have shown that 80 per cent of MLB players who have the procedure completed have returned to the same level of pitching as before the injury.

Dr. Andrew Fagan is a licensed chiropractor, kinesiologist and clinical acupuncture provider. You can reach him at dr.fagan@porthopehealthcentre.com or 905-885-5111