How to Prepare for Tommy John Surgery

Frequently Asked Questions

Why do baseball players need this surgery?

This surgery is typically performed on pitchers after they tear or rupture their UCL (ulnar collateral ligament) and need a reconstruction.

Why is it called Tommy John surgery?

The surgery is named after the first baseball player who had the surgery and successfully returned to playing baseball.

How the Surgery Works

The surgeon will remove a tendon, typically from your body, but occasionally a donor’s, to be used in place of the UCL. Holes are drilled in your bone and the tendon is looped through and secured. There are different techniques but figure-eight and docking techniques are both common.

Who gets this surgery?

Only people with an actual torn or ruptured UCL get this surgery. Unfortunately, this number is growing and includes 25% of Major League and 15% of minor league pitchers. It’s also becoming more common in youth and high school pitchers who now make up 25% of all Tommy John surgeries.

Pitching and Children

Elbow and shoulder pain while pitching aren’t common in kids. If your child is in pain, see a doctor.

Other recommendations by the American Sports Medicine Institute include:

• A pitcher shouldn’t also be a catcher for the team (too many throws)
• Avoid having your child play on multiple teams with overlapping seasons
• Don’t let your child pitch for more than 100 innings in one year
• Take 4 months off with no competitive pitching, and 2-3 of those months with no overhead pitching at all
• Follow your league’s limits for pitch counts and rest days

Common Myths

Does Tommy John surgery improve performance?

• No. Optimistically, you will return to your previous level of performance and competition (as do 70-80% of players who follow rehab protocols).

Does the surgery improve pitching speed?

• No. Doctors have confirmed that players that throw harder after surgery do so because of improved conditioning during rehab.

How long does it take to return to competitive throwing after UCL surgery?

• Players usually return to playing baseball 12-16 months after surgery, but it varies based on the individual.

Can people have Tommy John surgery twice?

• Yes, that’s called a UCL revision. Rehabilitation takes longer and a lower rate of pitchers successfully return to pitching.

Recovery

The first step in your recovery will be an immobilizing brace. This will lock your elbow in place and give your new UCL time to heal. After a week or two, you might be moved into a hinged brace. These braces lock at a specific angle but can be adjusted for the best post-operative position. As you progress, you might also need a sling to give your arm support, especially with the weight of the brace. You’ll appreciate how the sling distributes the weight across your back instead of directly on one arm and shoulder.

As you continue to heal, your doctor will give you the okay to begin the rehabilitation process. An elbow extension stretch helps stretch out a stiff elbow and improve your range of motion.

For this stretch, you’ll need a raised surface like a table, a towel, and a light resistance level TheraBand resistance band.

1. Start by tying a TheraBand resistance band to a the table leg or a dumbbell on the floor
2. Next, lay down on the table, roll the towel and place it under your upper arm
3. The other end of the resistance band should be tied to your wrist Relax your arm into full extension for 15 minutes
4. Repeat four times a day

Eventually, you’ll move on to strengthening exercises before beginning to pitch again. Some recommended exercises might include two handed plyometric exercises like chest passes and overhead soccer throws using a soft weight ball. Later, you can use the same ball for one handed throws and wall dribbles.

Players typically return to baseball 12-16 months after Tommy John surgery, but the timing varies depending on the individual and the severity. It’s important for players, coaches, and parents to remember that each injury has its own timeline.

References
American Sports Medicine Institute. (April, 2013). Position Statement for Adolescent Baseball Pitchers. ASMI.org. Retrieved from http://bit.ly/KVzwMX.
Andrews. Tommy John FAQ. mlb.com. Retrieved from http://atmlb.com/2C9RSoT.
Ellenbecker, T.S., Wilk, K. E., Altchek, D. W., & Andrews J. R. (July, 2009). Current Concepts in Rehabilitation Following Ulnar Collateral Ligament Reconstruction. NIH.gov. Retrieved from http://bit.ly/2iVFosL.
Tommy John Surgery (Ulnar Collateral Ligament Reconstruction). Hopkinsmedicine.org. Retrieved from http://bit.ly/2iUpOgM.

Medical Disclaimer: The information provided on this site, including text, graphics, images and other material, are for informational purposes only and are not intended to substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other healthcare professional with any questions or concerns you may have regarding your condition.