Tommy John Surgery
Dodgers pitcher Tommy John surgery also named as Ulnar Collateral ligament (UCL) treatment or reconstruction. In 1974 the first surgery was done, which was first introduced and performed by Frank Jobe, M.D, which was typically an outpatient procedure. It was performed under general anesthesia.
Facts About Tommy John Surgery
Tommy John surgery is used to repair a torn Ulnar collateral ligament inside the elbow, the bone (Ulna) lowers the Humerus of the arm. In this treatment, the Ulnar collateral ligament is replaced by a tendon from elsewhere in the body.
- Javelin throwing
- Pitching sports
Ulnar Collateral Ligament:
The Ulnar Collateral ligament (UCL) is a small ligament on the inner side of the elbow. Lower the Humerus bone, which provides stability to resist the valgus force (movement in an oblique way) at the ankle joint. It usually occurs through traumatic elbow injuries such as elbow dislocation, injuries in gymnastic practices. Wrestling or falls from the height. Similarly, Repetitive injuries at the same side cause complete tear or rupture of the ligament.
- Popping sound when playing sports.
- Inability to move elbow because of severe pain.
- Numbness, tingling and weakness sensations occur.
- Swelling in the inside part of the angle.
- Weak hand grip to hold anything.
Tommy John’s surgery is performed under general anesthesia by an orthopedic surgeon, Frank Jobe, M.D. The method begins with an incision inside of the elbow. Through which the ligament is replaced by a tendon taken from elsewhere in the body, known as a graft.
A donor’s tendon is utilized instead of the patient’s muscle. Tendon is inserted through the drilled holes in a figure 8 pattern. Tendon is then attached to the bone surfaces with individual sutures then the incision is closed with stitches. A graft is typically taken from one of the following tendons:
- Palmaris longus tendon from the forearm
- Hamstring tendon
- Big toe extensor tendon
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Endoscope/laparoscope is used in the procedure of Tommy John surgery. After that, If we need to repair the instrument which used to insert in the injured area and repair the torn ligament. It could take 4-inches long incision inside the elbow, resulting in the scar after the surgery which forms “C” shape while bending of the elbow.
Tommy John surgery typically requires an overnight stay in the hospital, followed by extensive rehabilitation therapy. For the few weeks, the elbow should keep immobile, keeping it with a support, or held in place and have to follow the surgeon’s instructions.
After that, physical therapy begins to regain strength and range of motion. The Patient can start physical therapy right away, focusing on your wrist, fingers, shoulder, and biceps to help avoid muscle atrophy. However, the Patient could be provided by pain medication during the early days of surgery.
The rehabilitation process after the operation requires a minimum of four months to increase in motion. And strengthening before beginning the process of returning to sports, and for the professional athletes, it could be a long time to recover.
The Ulnar Collateral Ligament (UCL) comes with a chance of infections and issues related to anesthesia. After this procedure, there can be complications in the nerves and blood vessels. Therefore, It may lead to temporary or permanent neuropathy including numbness and weakness in the patient’s body.
The risks with any surgery are:
- Complications from anesthesia such as breathing problems
- Blood clots such as a deep vein thrombosis
- Damage to nearby nerves or blood vessels
The complications would occur such as chronic pain when throwing, inability to move elbow in two dimensions successfully. Stretching or extend the elbow which may rupture the new tendon which requires another UCL reconstruction surgery again.