Ulnar collateral ligament injuries/”Tommy John” surgery
The anterior band of the ulnar collateral ligament is a strong, cord-like ligament on the inner aspect (near the “funny bone”) of your elbow. It can be injured traumatically or, more commonly, with repetitive overhead sports such as baseball and tennis. Sudden injuries occur with trauma, frequently due to elbow dislocations. While a sudden injury to this ligament can also result from throwing, our overhead athletes more commonly develop a gradual degeneration of this ligament which can ultimately leave it too weak to sufficiently stabilize the elbow through the normal throwing motion. When this happens, rarely is there sudden onset of pain. Rather, a gradual soreness develops and velocity and location can suffer as a result. This can also happen to quarterbacks, volleyball hitters and tennis players although it is less common in these athletes than in baseball players.
Research of ulnar collateral ligament injuries in throwers is not clear cut on cause in terms of pitch count, types of pitches thrown, etc. What is clear however, is that a high volume of throws coupled with higher throwing forces (and velocity) will contribute over time to stress and cumulative injury of the ligament. Less than ideal throwing mechanics, whether a result of poor form or fatigue, will significantly increase the stress the elbow sees during throwing which is why pitch count, conditioning and proper mechanics are important.
If a UCL injury is suspected, we will likely order an MRI or an ultrasound. Partial tears are frequently treatable with rest and therapy along with correction of throwing mechanics. Occasionally platelet-rich plasma (PRP) injections are recommended for partial tears. In patients with more severe tears, most of our patients involved in physical activities, including elite non-throwing athletes, return to their normal activities with nonsurgical management. The subset of patients who have difficulty regaining activity are overhead or throwing athletes.
If nonsurgical options fail to resolve your problem or if the damage is too extensive, surgical treatment may be recommended. This involves a reconstruction of the ligament typically using tissue from elsewhere in the patient’s body often either the wrist or the knee. This is then inserted into the elbow to function as a new UCL though a period of healing is required prior to return to athletics. The surgery is done on an outpatient basis.
In select injuries, a repair of the damaged ligament (as opposed to a reconstruction with alternate tissue) with placement of an internal brace can be performed. This is appropriate only in acute tears with specific anatomic characteristics and the recovery is similar to a reconstruction.
Typically return to throwing occurs 6-9 months after surgery but often requires over a year of healing and rehabilitation to return to high-level throwing on a routine basis. Success rates are quite high for this procedure if time is appropriately invested in your rehab program. Your physicians at Motor City Orthopedics have a high level of experience with these types of injuries and can safely get you back to sports.