What Is Tommy John Surgery and How Do You Know If You Need It?


The cosmetic or reconstruction surgery industry is predicted to grow to approximately $22 billion by the end of 2023. Tommy John surgery is one of the many reconstructive surgeries that are shaping the industry. It’s named after Tommy John, a former Los Angeles Dodgers pitcher.

He underwent surgery in 1974 after injuring the muscles in his elbow. Since then, several other patients have undergone Tommy John surgery successfully. If you’ve heard about this type of surgery and want to know more about it, you’ve come to the right place.

Keep on reading!

Tommy John Surgery Explained

Tommy John surgery is medically known as ulnar collateral ligament reconstruction. It’s a procedure that repairs torn ligaments inside the elbow. The ulnar collateral ligament (UCL) is located inside the elbow and plays a role in securing the elbow joint.

UCL injuries are caused by repetitive stress or trauma to the elbow. People at the highest risk are those who play “throwing” or arm-heavy sports. These include baseball, tennis, cheerleading, gymnastics, javelin throwing, and wrestling among others.

The continued motions of throwing and twisting can bend the elbow and stress the ligament. Prolonged trauma can lead to tiny or large tears of the ligament. As it continues to stretch and lengthen, it loses its ability to hold your bones tightly enough.

Symptoms, Causes, and Diagnosis of Injured Elbow Ligament

Avoid concluding that you have a UCL tear just because your elbow is in pain. There are more intense symptoms you must look out for.

One of the things you’ll hear when the UCL tears is a “pop” sound. The inner elbow will feel sore just before the ligament breaks. Soon after that, you might be unable to throw or use your arm until it’s treated.

Feeling sore indicates that the ligament is strained. Other signs you’ll experience include:

  • A weak hand grip
  • Tingling in the hand
  • Elbow stiffness
  • Swelling on the inside of the elbow
  • A bruise on the injured area
  • Tingling in the little and ring fingers

If you’ve got any of these symptoms, don’t take them lightly. The problem could become compounded if you delay treatment.

In rare situations, UCL tears will interfere with non-throwing activities like exercising, weight lifting, and running.

Common causes of UCL include stress arising from repeated throwing motions. This causes the fibers in the UCL to fray, weaken, and stretch. With time, the muscles develop microtears, which eventually cause the ligaments to tear completely.

The condition is very common in young athletes and children between 10 and 18 years. Their involvement in more games and longer seasons puts them at risk. Their open growth plate in the elbow, also known as little league elbow, increases their risk too.

Falls that happen with the arm stretched outwards can also be a cause for a UCL tear.

Diagnosis of a UCL injury is mainly through a physical examination. Medical history could warrant the need for diagnostic tests like an MRI or x-rays. Diagnosis is usually challenging since the tests are not always 100% accurate.

How Does Tommy John Surgery Work?

As much as the surgery sounds like it’s invasive, you’d be surprised to know that it’s an outpatient procedure. This means that you’ll have your elbow reconstructed and go home the same day.   

It lasts between sixty and ninety minutes and is performed under general anesthesia.

Before the surgery, your physician will recommend that you take a rest for some time. Some rehabilitation exercises will also be necessary to improve posture, throwing techniques, and strength. For the pain, you also might be put on anti-inflammatory medications.

Graft Collection and Incision

The procedure begins by collecting a graft of the tendon that replaces the damaged UCL. The doctor can harvest it from any part of the body, or a donor can offer one. In a typical situation, a tendon is collected from the hamstring, big toe extensor, or Palmaris longus in the forearm.

Next comes the cleaning out of the joint. For the doctor to access the elbow joint and the injured ligament, they’ll make an incision that’s three to four inches deep. The incision is made to the outside of the elbow.

After the incision, the surgeon moves the muscles out of the way to check the extent of the damage. The damaged tissues are removed, and the graft attached to the remnants of the original ligament. The process helps in reinforcing the structure of the elbow joint.

Attaching the Graft

The process of attaching the graft must ensure it’s well secured. As such, the surgeon drills holes in the two bones attached to the UCL. These are the humerus and the ulna, which are the upper arm bone and lower arm bone, respectively.

Next, the surgeon threads the graft through the holes and secures it in place using screws, buttons, or sutures. Different doctors use different techniques. The most common methods are figure-eight and docking.

Tommy John Surgery Risks and Complications

Just like with other types of surgeries, the Tommy John surgery can lead to infection or complications. They arise from the anesthesia or the replacement tendon. The new ligament, if not well fixed, can also stretch and tear.

Sometimes, the ulnar nerve will be irritated by the surgery. The result is that it’ll have to be transferred to another part of the elbow. In rare cases, damage to the blood vessels in the elbow may occur.

Sometimes, the part of the body from which the graft was harvested may develop complications. These are easy to treat with medications depending on the type of complication. Generally, there’s a 3%-25% chance that a complication will occur.

During recovery, avoid straining the elbow. Talk to your doctor if you’re unable to resume normal activities using the affected joint. This is especially after twelve months after the date of the Tommy John surgery.

Recovery Timeline

After having a Tommy John surgery, it’s crucial that you take good care of the wound for proper healing. Rehabilitation takes up to twelve months, sometimes extending to two years. The best recovery happens when done under the supervision of your doctor and physical therapist.

An effective rehabilitation program follows a three-phase process. The length of each phase depends on an individual’s muscle recovery rate.

Phase 1

Immediately after the surgery, you’ll wear a splint for seven to ten days. This is to minimize movement of the elbow and to give the ligaments time to attach properly. It also reduces inflammation and protects the healing tissue from strain.  

During this phase, it’s highly recommended to engage in some gentle motions. They’ll mostly target the hand, wrist, fingers, and shoulder. The aim is to reduce muscle degeneration.

Phase 2

Phase two of the recovery takes place one or two weeks after the procedure. At this point, you can move your elbow, but your doctor might put you on a hinged brace. The purpose is to help control the movement of the joint so that you don’t overstretch it.

It’s also recommended to wear an arm sling for increased comfort. Your physical therapist and doctor will also concentrate on gradually improving the elbow’s movements. For the next four months, you should avoid overstretching the arm.

Phase 3

This is the final stage of recovery and takes place in four to five months after the surgery. With the approval of your surgeon, you’ll be able to resume the full use of your elbow. Lifting, throwing, and other hand activities won’t be hard to do.

By this time, a reasonable range of motion will be possible. 85% of patients who undergo surgery resume normal activities without any risk of damage to the graft. In case of any pain or strain on the joint during this time, consult your doctor.

The scar forms a “C” when you bend the elbow, and it’ll fade with time. However, it’ll always be a reminder of your Tommy John surgery and recovery journey. If you follow your doctor’s advice, you’ll be able to resume a normal life without struggle.

Don’t rush the healing process and you’ll see yourself spring back to action with a better performance.

Who Can Benefit From Tommy John Surgery?

UCL tear can happen to any athlete. The procedure is usually applied in cases of overuse of the ligament. Injuries resulting from overuse of the ligament mostly occur in baseball pitchers.

It’s also common in people whose occupations involve a lot of elbow stretching and bending.

If nonsurgical treatments don’t help in the management of your pain, the Tommy John surgery may be good for you. Although there are beliefs that the operation makes the elbow stronger, it’s still a challenge. It requires a substantial amount of skills and experience for it to be successful.

According to UCL surgeon Cosgarea, the surgery isn’t for everyone. Unlike in the case athletes, most people don’t engage in very strenuous activities for the elbow. Some expert surgeons don’t even see the surgery as an option for pro athletes.

Children and Tommy John Surgery

Young children who engage in recreational sports are prone to developing injuries because of muscle overuse. Before a doctor recommends Tommy John surgery for treatment, they will consider factors like:

  • Age of the child
  • The extent of the damage
  • Type of condition
  • Child’s medical history
  • Tolerance to specific treatments like therapies, medications, or procedures
  • Expectations about treatment procedures
  • Parent’s opinion or preference

The primary aim of any treatment option is to promote healing, control pain, prevent complications, and rehabilitate the joint. Initial treatments of injuries resulting from overuse include rest, ice application, compression, and elevation.

If you notice prolonged and visible deformity in any affected area, you should consult your child’s doctor. Severe pain that prevents the child from using any of their joints shouldn’t be ignored. The doctor might recommend other treatment options like medications, physical therapy, splint or cast, and activity restrictions.

Depending on the extent of the injury, Tommy John surgery might also be necessary. Overuse injuries in children heal faster than in adults. For this to happen, it’s crucial that the child strictly adheres to restrictions set by the doctor.

Important Things to Remember

Injuries resulting from sports activities are widespread. Any athlete could succumb to elbow injury if the type of sport they do entails lifting heavy objects or throwing. However, it’s important to note that UCL tears don’t happen overnight.

The initial tear of the ligament can happen immediately, but it always has its history in overuse and repetitive motion. It’s very crucial to take care of your elbow and take note of any changes. They could be indicative of a possible tear.

Before you settle for a Tommy John surgery, try using conservative treatment options. An operation is only recommendable after non-surgical options have been exhausted and haven’t produced results. Remember that surgery is never without risk, and it should always come as a last resort.  

A torn UCL should also not keep you from your daily activities. You can participate in non-throwing activities like skating, soccer, and running.

It’s recommendable to keep yourself on how to reduce the risk of a UCL tear. Getting information from experts on pre-season preparation is a good starting point. Ensure you’re well trained on proper throwing techniques, pitch counts, and warming up.

The cost of the procedure varies from place to place. In most cases, the cost of surgery won’t be inclusive of rehabilitation costs.

Final Thoughts

Tommy John surgery is a non-intrusive procedure that takes less than two hours to complete. It’s done under general anesthesia and leaves just a small scar.

You should exercise a lot of caution after the surgery to avoid causing further damage. Work closely with a physical therapist to fully rehabilitate your elbow. Complete healing may take six months, but can at times take up to two years.

Any pressure exerted on the graft may cause another tear. Tommy John surgery done the right way can extend your career for as long as you follow your healthcare’s advice.

If you have any question, feel free to contact us today or schedule an appointment.

The specialists at Hand Surgery Specialists of Texas have extensive experience diagnosing and treating elbow pain.  They will take the time to identify the source of your symptoms and thoroughly discuss your treatment options. Call (713) 686-7166 to schedule an appointment at one of their many offices in Houston, TX today!

Hand Surgery Specialists of Texas

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The Hand Surgery Specialists of Texas offers diagnosis and treatment for hand, wrist, and elbow problems in Houston, using the most advanced and minimally invasive medical techniques. Our orthopedic hand specialists and hand and finger surgeons are waiting to provide you with excellent care at one of our hand care centers in River Oaks, Webster, North Houston, Katy/Sugarland, or Baytown

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