What Is Tommy John Surgery and Who Needs It?

Published on September 26, 2023 .

If you are a sports fan, particularly baseball, you have probably heard of "Tommy John surgery." Tommy John surgery involves repairing a damaged or torn ulnar collateral ligament (UCL). UCL injuries can range in severity from mild sprains to complete tears; the symptoms may include pain, swelling, and elbow joint instability. In some cases, UCL injuries may require Tommy John surgery to repair or reconstruct the damaged ligament.

Tommy John surgery is the procedure that repairs the ulnar collateral ligament (UCL), which stabilizes the elbow.
Tommy John surgery is named for the Major League Baseball pitcher who had the surgery done in 1974.
UCL injury can occur from repetitive (cumulative) trauma or one significant trauma.
UCL injuries are often seen in athletes who throw overhead, like a baseball pitcher.
Tommy John surgery can be performed as an outpatient without a stay in the hospital.

Symptoms of ulnar collateral ligament (UCL) injury

The most common symptom of UCL injury is pain on the inside of the elbow. The pain can occur as a sudden onset of severe pain caused by an immediate tear, sometimes with a "popping" sensation. The pain can also occur gradually, with mild pain worsening over time. Other symptoms include numbness and tingling of the ring and 5th fingers.

Why is it called Tommy John surgery?

Tommy John surgery is named for the Major League Baseball (MLB) pitcher Tommy John, who underwent this procedure in 1974 when Frank Jobe, MD, performed it. In this procedure, the UCL is replaced by a tendon from somewhere else in the body.

What is the UCL?

The UCL connects the humerus (arm bone) with the ulnar bone of the forearm. The UCL is on the inner side of the elbow; it helps with elbow stabilization during movement, especially with elbow joint straightening (extension) and bending (flexion).

Causes of UCL injuries

UCL injuries often result from cumulative stress (overuse) and traumatic events. The UCL is commonly associated with activities that involve repetitive throwing motions, such as in baseball or softball. Still, injuries can occur in other sports and activities. Below are the types of movements and activities that can cause UCL injuries.

Repetitive throwing

The most well-known cause of UCL injuries is the repetitive overhead throwing motion in baseball, softball, and similar sports. Pitchers are particularly vulnerable due to the repetitive high-velocity throwing involved in their athletic position.

Other overhead sports

Athletes in sports like tennis, javelin throwing, and volleyball, which involve overhead movements, can also experience UCL injuries; however, they are less common than in baseball.

Weightlifting

Certain weightlifting exercises, especially those involving heavy weights and extreme elbow extension and flexion, can stress the UCL. Examples include heavy triceps extensions or overhead presses.

Falls or trauma

A direct blow to the elbow, such as during a fall or when playing a contact sport, can lead to a UCL injury, resulting in a partial or complete ligament tear.

Occupational activities

Certain occupations that require repetitive elbow motions, such as painters, carpenters, or assembly line workers, can lead to UCL injuries over time.

Repetitive stress

Even without sports or physically demanding jobs, prolonged and repetitive stress on the elbow joint from hobbies or other activities can potentially lead to UCL injuries.

Improper technique

Poor throwing or lifting techniques can increase the risk of UCL injuries, often seen in athletes who were not properly trained or overexert themselves.

What are the steps taken in Tommy John surgery?

There are multiple steps that are followed pre- and post-op for Tommy John surgery.

Examination and imaging scans

Before surgery, a definitive diagnosis must be made by examination and imaging scans. The examination involves various movements to check the elbow for stability. Imaging scans like a plain X-ray and a magnetic resonance imaging (MRI) scan help diagnose UCL tear. Sometimes, MRI scans require a contrast dye that is injected directly into the joint to make an accurate diagnosis.

Surgical procedure

The procedure is done under general anesthesia in the operating room and as an outpatient procedure where the patient does not stay overnight at the hospital.

A small incision (cut) is made, the damaged UCL tendon is removed, and a graft is placed. The graft can come from various sources, including a tendon from the patient's body (often the forearm, hamstring, toe, or sometimes the opposite elbow) or a donor tissue. The surgeon then attaches the graft to the bones using screws, drilled tunnels, or other fixation methods.

Rehabilitation

After surgery, the person should undergo a comprehensive rehabilitation program to restore elbow strength and range of motion. The rehab process is crucial for the athlete to regain full function in their elbow and return to their sport.

What is the Tommy John surgery recovery time?

The recovery timeline varies, but it typically takes at least 12 to 18 months for athletes to return to their pre-injury performance level. The early stages of rehab focus on reducing swelling, regaining motion, and building strength. Gradually, the athlete begins a program under the supervision of physical therapists and medical staff.

Athletes are usually cleared to return to competitive play when they have fully recovered, regained their strength and range of motion, and passed various functional and performance tests. The timing of return varies based on individual progress and medical assessments.

What does Tommy John surgery cost?

With insurance, you can still expect to pay anywhere from $500 to $5,000 for Tommy John surgery. Without insurance, it can cost anywhere from $10,000 to over $26,000.

In addition, there are extra costs, including physical therapy rehabilitation, doctor follow-up visits, and medications. Once again, these costs depend on whether you have insurance or not.

It’s been estimated that the full recovery cost for an MLB baseball player needing Tommy John surgery is $1.9 million.

While Tommy John surgery has a high success rate in restoring elbow stability and function, not all athletes can fully regain their pre-injury performance levels. Additionally, the surgery is not limited to athletes. It can be performed on anyone with a UCL injury who seeks to restore the full function of their elbow.

Rehabilitation and adherence to the post-operative protocol are critical for a successful outcome. An evaluation and discussion with a qualified orthopedic surgeon are essential for anyone considering Tommy John surgery to determine the best treatment plan for their condition.