Understanding the Pros and Cons of Tommy John Surgery

Tommy John Surgery

Named for former All-Star baseball pitcher Tommy John, Tommy John surgery is more formally known as UCL (ulnar collateral ligament) reconstruction. As you might suspect, it’s used to repair a damaged UCL. In particular, the UCL is replaced with a grafted tendon from somewhere else in the body, most frequently the forearm, hamstring, or big toe.

Now, Tommy John surgery certainly has the potential to be beneficial. That said, it’s not necessarily the best option for you. There are pros and cons to undergoing this surgery, you see.

Wondering what they are? Then read on. We’re going to help you understand the upsides and downsides of Tommy John surgery.

The Benefits of Tommy John Surgery

There are numerous benefits that come with undergoing Tommy John surgery. Some of the most prominent of these benefits include the following:

Pain Relief

UCL tears can be extremely painful, particularly in cases of severe tears. Fortunately, Tommy John surgery helps to relieve that pain. This is because it involves literally removing the torn ligament and replacing it with a grafted one.

Now, this isn’t to say that Tommy John will eliminate pain entirely. In fact, in the weeks following the procedure, pain can be extreme. However, once you’ve gotten through the initial recovery, you shouldn’t feel much discomfort at all.

Increased Range of Motion

When the UCL is torn, the elbow has trouble extending to the extent that it once did. As such, it’s difficult to use one’s arm like normal. This is particularly true for baseball pitchers who require extensive use of their pitching arms.

Tommy John surgery improves the range of motion in the elbow, thereby allowing the affected to use their arm like normal. It has prolonged countless Major League pitching careers. However, even for those who aren’t Major League pitchers, the improved range-of-motion benefits can be life-altering.

Improved Elbow Stability

It’s not just the increased range of motion that Tommy John surgery provides, but improved elbow stability as well. After Tommy John surgery has been performed, the elbow can stay in a locked position under much greater pressure. Essentially, the surgery returns the elbow to the function it experienced before the UCL tear occurred.

When elbow stability is optimized, so too is strength in the arm, not to mention precision of movement. So, in essence, Tommy John surgery improves the use of the affected arm entirely.

A Prolonged Career

If you’re a baseball pitcher or someone who requires extensive use of their UCL, Tommy John surgery can prolong your career substantially. Many MLB pitchers have extended their careers with the help of surgery, some for well over a decade.

Some of the names that come to mind include John Smoltz, Jacob deGrom, Stephen Strasburg, and, of course, Tommy John himself. So, if you’re looking to prolong your athletic career, Tommy John surgery is a legitimate option for you.

It’s an Outpatient Procedure

While Tommy John surgery is certainly invasive in nature, it’s actually an outpatient procedure. Once your hand doctor has completed the procedure, you’ll be able to go home immediately.

Yes, you’ll take almost a year to recover fully. However, you’ll get to do it on your own time.

The Downsides to Tommy John Surgery

We’ve discussed the benefits of Tommy John Surgery. Now, let’s talk about the downsides of the procedure. They include the following:

It’s Not Always Successful

While Tommy John surgery has proven to prolong the careers of baseball pitchers substantially, it’s not always a successful surgery. Some pitchers find that they’ve lost substantial velocity after undergoing Tommy John surgery. Others find that pain and discomfort linger even after surgery has been facilitated.

All in all, Tommy John surgery has a return-to-play rate of between 80% and 95%. So, while your odds of having a successful procedure are still very good, they’re not excellent.

Complications Can Arise

Not only is Tommy John surgery sometimes unsuccessful, but, in some cases, it actually leads to further complications. These include things like arm stiffness, elbow weakness, increased pain, and rupture.

Again, these complications are not common. However, when considering whether to undergo the procedure or not, they should be weighed.

It Has a Long Recovery Period

Another con of Tommy John surgery is that it has a long recovery period. Generally speaking, it takes 9 to 12 months for a patient to fully recover from Tommy John surgery. When it comes to baseball pitchers, it can take even longer before they’re physically ready to start throwing again.

This is an intensive surgery. It involves replacing the UCL entirely. As you might expect, the new UCL isn’t ready to go overnight.

In fact, for the first month or so after the surgery, you’ll need to wear an elbow brace. Depending on your specific recovery, you might need to wear the brace even longer.

It’s Expensive

The last con of Tommy John surgery is that it’s expensive. In almost all cases, it requires the patient to pay the full extent of their health insurance deductible. Depending on the quality of the patient’s insurance, they might have to pay even more than this.

Without health insurance, Tommy John surgery costs somewhere between $15,000 and $50,000, depending on the extent of the surgery and the reputation of the surgeon.

How Does Tommy John Surgery Work?

Tommy John surgery is an invasive procedure that must be carried out by a licensed and experienced elbow surgeon. In particular, you should seek out a surgeon who’s experienced with performing Tommy John surgery.

Once you’ve consulted with your surgeon and have been deemed a suitable candidate, the procedure will begin. This entails the following:

General Anesthesia Is Administered

First and foremost, the patient is given general anesthesia. This numbs the body so that the patient can’t experience any pain during the procedure. Not only will your elbow be numb during the procedure, but so too will your graft donor area.

Graft Is Collected

First and foremost, the surgeon needs to collect a graft. This will be used to replace the torn UCL in the elbow.

Generally speaking, the graft is taken from the patient’s own hamstring or forearm tendon. In some cases, it’s taken from the big toe. Regardless, just a small portion will be extracted as it will grow once connected to the remaining UCL.

Joint Is Cleaned

Next, the surgeon will make a 3 to 4-inch-deep incision around the elbow. They’ll then reach into the affected area to remove torn portions of the tendon. This needs to be entirely eradicated before the graft can be attached.

Holes Are Dilled

Next, in order to ensure a secure attachment, the surgeon drills holes in the bones next to the UCL. These bones are the ulna and the humerus. Don’t worry; your arm will be numbed during the procedure, ensuring that you don’t feel any pain or discomfort.

Graft Is Attached

Now, it’s time to attach the graft. The surgeon weaves the graft in and out of the aforementioned holes, ensuring that it’s entirely secure. Once it’s in place, it’s held down by a series of buttons, screws, and sutures.

Incision Is Closed Up

Once the graft has been attached, it’s ready to start growing. However, before it can, the incision needs to be closed up. Your surgeon will complete the closing of the incision, after which, you can leave the office and start your recovery.

You Follow Up With Your Surgeon

Tommy John surgery takes almost a year to fully recover from. During this year-long recovery process, you’ll meet with your surgeon several times and discuss the progress of your healing. You’ll likely also be engaged with a physical therapy regimen.

When Is Tommy John Surgery Recommended?

Tommy John Surgery isn’t necessarily the best treatment option for everyone. In fact, many suffering from a torn UCL are better off without it. That said, in certain situations, Tommy John surgery is advised. These situations include:

When You Need High Function of Your Elbow

In many cases, a person can get by without the top-notch function of their elbow. A torn UCL isn’t necessarily going to prevent a person from picking things up and maneuvering things around. What it will prevent a person from doing, however, is, for example, throwing a baseball at high speeds, or lifting substantial amounts of weight.

In other words, if you work in an office and don’t engage in any intense form of exercise, you can probably get by without Tommy John surgery. On the other hand, if your job is physical in nature, or if you’re engaged in athletic activity on a regular basis, Tommy John surgery will likely help you greatly.

When You’re Struggling to Complete Everyday Tasks

Generally speaking, a torn UCL doesn’t impair your ability to complete everyday tasks. You can typically still pick things up, lift them above your head, and the like.

There are exceptions to this, however. There are cases in which the affected can struggle to move their elbow at all. In cases such as these, Tommy John surgery becomes a near necessity.

The alternative is to either wait for the function to return to the elbow or to just live through the dysfunction. The former is advised in some cases. The latter is never advised.

When Other Treatment Options Aren’t Working

Not satisfied with your elbow’s lack of function? Is pain still causing you a great deal of discomfort? Other treatment options haven’t had a positive effect?

If so, Tommy John surgery is something you should strongly consider. As noted above, Tommy John helps with both pain and function. If other treatment options aren’t having an effect, and you’re finding the situation unbearable, Tommy John surgery will likely provide you with the relief you seek.

Alternatives to Tommy John Surgery

While Tommy John surgery is the right solution for many patients, it’s not the right solution for all of them. There are alternative solutions that might better serve you, depending on the circumstances. We’ll review these below.

Physical Therapy

In minor cases, you don’t need to undergo invasive surgery like Tommy John. You can get your elbow back to normal simply by engaging in physical therapy.

This would entail resting your elbow the majority of the time while performing ligament strengthening exercises intermittently. You might be able to facilitate this yourself from your own home. That said, it’s best done under the guidance of a trained physical therapist.

UCL Repair With Internal Brace

In recent years, a new form of UCL repair has come along that enables the patient to heal in a much quicker time. It’s much less invasive than Tommy John surgery and involves the insertion of collagen tape into the area around the UCL. This tape provides reinforcement to the UCL, allowing it to maintain strength and structure.

Note, though, that this procedure is still new and still being studied. While you have the option to undergo this procedure, you should still take great caution in doing so. As of now, Tommy John surgery remains the premier treatment for this particular injury.

Dealing With Elbow Pain?

Are you currently dealing with elbow pain? Think you might benefit from Tommy John surgery? If so, and if you need a hand doctor in Houston, we here at Hand Surgery Specialists of Texas are the people to see.

We work not only with hands but elbows, wrists, fingers, and more. Regardless of the condition you’re facing, a trained hand surgeon on our staff can assist you.

Contact us now to schedule an appointment!

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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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