The “Tommy John” ligament is technically called the ulnar collateral ligament of the elbow. It is the primary stabilizer to the elbow in a throwing athlete as the elbow is flexed between 20 degrees and 120 degrees. It gained its name, the Tommy John Ligament, in 1974 when a professional baseball player Tommy John tore his ulnar collateral ligament and subsequently had it reconstructed, he was able to return to full pitching activities. Ulnar collateral ligament injuries are most commonly seen in baseball players, but they are not unique to this sport. They also are seen in football, Javelin throwing, volleyball, tennis, gymnastics, wrestling, water polo, and tennis. An injury to the Tommy John can occur either from continuous overuse or from a single traumatic event. When a patient tears the Tommy John, there is usually is significant pain on the inside of the elbow with overhead activities. There are two types of tears. Most commonly, we see partial tears. These are seen most likely with repetitive overhead sporting activities. There also is a complete tear. This can be seen with repetitive activities, but most commonly occurs after a traumatic incident. The orthopedic community has seen a dramatic rise in the diagnosis of ulnar collateral ligament injuries over the past 10 years as there has been an increased level of activity in the sports which produce these injuries. Baseball has become a year-round sport. There has been an effort to limit the injuries to the elbow by limiting the number of pitches players can make during a game or during the weekend. Despite this, Tommy John injuries are still very common.
What are my treatment options?
At Advanced Orthopaedic Specialists, there are basically two treatment options for the injured ligament and this hinges on if the ligament is partially torn or completely torn. If there is a partial tear of the ligament, we recommend nonoperative treatment. We treat the patient with physical therapy, anti-inflammatories, and a prolonged period of rest. Once the patient becomes asymptomatic, we will start a graduated throwing program in the hopes of return. We have had excellent results with partially torn Tommy John ligaments with this regimen. It also is an option for a partially torn ligament to perform a stem cell injection into the ligament. We commonly use platelet rich plasma or “PRP.” This technique is done in the office where a sample of the patient’s blood is drawn. We centrifuge the blood and remove the platelets and inject these into the injured site under ultrasound guidance. With a PRP injection into the Tommy John ligament, we typically follow this with a period of rest, immobilization, and then after approximately one month, a gradual return to sports with a graduated throwing program. We feel strongly that in partial tears less than 50% of the ligament, the athlete can have an excellent result and return to full play with a conservative program. If a ligament is torn more than 50%, we still attempt this regimen; however, success is not quite as good.
If the patient has complete tear or if they have failed nonoperative treatment for a partial tear, it is an option for surgical reconstruction. Reconstruction of the ulnar collateral ligament is commonly performed at Advanced Orthopaedic Specialists. We have performed this in the junior high, high school, and collegiate-level athletes and anticipate a full return to sport. The ligament is reconstructed with a tendon, which is taken from the forearm of the patient and inserted into the place of the old ulnar collateral ligament. The surgery takes approximately one hour and the patient is discharged home the same day. The patient is placed into a splint for one week and then into a brace that allows range of motion. The brace is discontinued at six weeks. Physical therapy is started at the one week point. With physical therapy, we go through a series of steps with passive range of motion where the therapist moves it, followed by active range of motion where the patient moves it, followed by strengthening. At approximately 14 weeks, we slowly resume a throwing program. Most athletes, with the exception of pitchers and catchers, are able to return to their sport at approximately six months. It typically takes a pitcher or catcher approximately 9 to 12 months before they are able to return to full play. The success with an ulnar collateral ligament reconstruction is approximately 90%, good to excellent, were the patient can return to their level of playing.
If you have been told you had a Tommy John ligament injury, please contact us at Advanced Orthopaedics Specialist where we specialize in the treatment of the injured athlete.
Written by, Dr. Christopher Arnold
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