Tuesday, May 26, 2015

Tommy John surgery: Separating fact and fiction

For those of us that follow baseball, it seems like every time we turn around another pitcher is going down with a major injury.

Tommy John surgery: Separating fact and fiction


For those of us that follow baseball, it seems like every time we turn around another pitcher is going down with a major injury. The most recent notable name is Matt Harvey from the New York Mets.  Like many before him, he started having pain with pitching while experiencing decreased velocity and poor control of his pitches.

After visiting with several doctors, he was eventually diagnosed with an Ulnar Collateral Ligament (UCL) tear of his elbow. After seeking advice from several other pitchers with a similar injury, including the Phillies’ Roy Halladay, he eventually decided to undergo “Tommy John Surgery” or UCL reconstruction. Rather than try non-operative treatment, he elected to undergo surgery to maximize his chances at returning to the mound and be as competitive and dominant as he once was.

These clinical scenarios are not only common, but they can get a lot of media attention depending on the caliber of the pitcher involved. With increased attention, increased misconceptions are developed as well usually because a lot of the medical information is interpreted out of proper context. Lately, in my office, I’ve been seeing a lot young pitchers with minimal elbow pain and discomfort terrified that they may need Tommy John Surgery and miss a year of pitching. I’ve had other pitchers, and even parents and coaches, ask if they should have Tommy John Surgery in the absence of an injury, in efforts to try to increase velocity and control.

I would like to provide some facts about UCL tears and Tommy John Surgery and dispel some of the myths as well.


  • The UCL is a ligament on the inside of the elbow that connects the ulna bone of the forearm to the humerus bone of the upper arm. During pitching, this ligament helps to stabilize the elbow and resist the tremendous, repetitive forces the elbow experiences during elite level pitching.
  • UCL injuries cause pain on the medial side, or inside, of the elbow. Often times, the pitcher will notice pain with hard pitching, but may not be uncomfortable with regular throwing. In some circumstances, there may be numbness or tingling associated with the pain as well.
  • UCL injuries often need surgical reconstruction, aka Tommy John surgery, to be fixed.  Sometimes partial tears can be managed with rest and appropriate rehabilitation. Full tears in professional pitchers typically need surgery in order to allow the pitcher to return to their pre-injury level of play.
  • Recovery and return to pitching after Tommy John surgery can take upwards to 18 months. Usually, most pitchers do very well after surgery, however, about 5-10 percent of pitchers are never able to return to their pre-injury level of play.


  • The UCL can be made bigger or stronger by lifting weights. Only the muscles around elbow can be made stronger with weight training and supervised rehabilitation. Ligaments do not “get stronger” the way muscles do, although sometimes they can get thicker with overuse.
  • If you are a pitcher and have elbow pain, you should be worried that you have a UCL tear. Although a common source of anxiety amongst pitchers, there are many other structures in the elbow that are injured much more frequently than the UCL. The most common reason to have elbow pain in a pitcher is muscle soreness or irritation.
  • Tommy John surgery can be make someone without a UCL injury a better, stronger, more effective pitcher. Recent research has shown that up to a 1/3 of pitchers, coaches, and parents in a recent survey that having a UCL reconstruction was a good idea in the absence of a UCL injury to improve performance. This is definitely not the case. Improving core and pelvic strength, refining pitching technique, and minimizing pitch counts and volume to acceptable limits are all safe ways to enhance pitching performance. Surgery should be reserved for patients with established UCL injuries that have been seen and evaluated by the appropriate medical staff and personnel.
  • Tommy John surgery can get you back to sports faster than non-operative treatment can. Definitely false. The rehabilitation after surgery is a very long process that requires a lot of patience on the part of the pitcher. Non-operative treatment, for partial tears in particular, can be anywhere from 6-12 weeks. Most non-operative treatment regimens include rest from pitching, core and pelvic strengthening, shoulder and scapular stabilization, hamstring and quadriceps strengthening, and pitching technique modification. 

Read more Sports Doc for Sports Medicine and Fitness.

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J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
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Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Justin D'Ancona Philly.com
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
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David Rubenstein, M.D. Sports Medicine Surgeon, Rothman Institute
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Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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