Tommy John Surgery

By SportMedBC Safety Coordinator, Seb Hartell

With the 2013 Major League Baseball season passing the quarter pole, injuries, unfortunately, continue all throughout the league. My favorite team, the Toronto Blue Jays, have been hit hard by the injury bug. The list runs long; from the ankle problems of Jose Reyes and Brett Lawrie, to four starting pitchers currently on the disabled list, it’s almost like the injuries won’t stop.  

But when it comes to baseball injuries, every organization and all fans have come to fear those nasty words – TOMMY JOHN SURGERY

When news breaks that a pitcher requires Tommy John Surgery, hearts break as the recovery process can take over a year. In addition, a pitcher’s workload is generally limited the following season and there are no guarantees that the pitcher can regain their pre-injury form. Unbelievably, over 40 major leaguers had Tommy John Surgery last season. For some (see below – former San Francisco Giant Brian Wilson), it was their second time.

Most baseball fans have heard about Tommy John Surgery, but many know very little about the details of the operation. Named after the former Major League pitcher, the surgery is a graft procedure which replaces the Ulnar Collateral Ligament (UCL) of the elbow with another ligament or tendon in the body.

The UCL is a thick triangular band located on the medial aspect of the elbow that is made up of three smaller bands (anterior, medial and posterior). It originates from the humerus and inserts into the ulna, a bone in the forearm. The UCL applies stability to the elbow joint against valgus stress and allows for proper arm control throughout a throwing motion. 

Injury to the UCL happens in most throwing sports and is very common in baseball. Poor throwing mechanics, fatigue and muscular imbalances can all cause more stress placed on the UCL, leading to injury. Immediate treatment following injury should include rest, ice, compression and elevation (R.I.C.E.). Consult a SportMed Practitioner to properly assess the injury and establish the necessary rehabilitation. 

The goals of the initial phase of rehabilitation are to reduce pain and swelling while protecting the injury site. The elbow is typically immobilized for 10 days, therefore hand grip exercises and gentle shoulder and wrist mobility exercises are most appropriate. 

Gradually gaining full range of motion is the key goal to the second phase of rehabilitation, as well as safely improving muscular strength. Important exercises include isometric forearm exercises, external shoulder rotations, along with low-weight resistance exercises for the elbow, forearm and wrist. The final phase of rehab is essential to increase power, strength and endurance throughout the arm and shoulder. It’s also important to focus on proprioception, coordination and flexibility. This is the phase where the athlete would begin to perform sport specific exercises.  

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