Thomas St. Clair
30 April 2014
Tommy John Surgery
Tommy John Surgery is a surgery has been given its name from the professional baseball player on whom it was first performed. Medically speaking it is known as ulnar collateral ligament reconstructive surgery, which repairs the ulnar collateral ligament in the elbow. Since Doctor Frank Jobe completed the original procedure in 1974 over 150 Major League Baseball pitchers have received this remarkable surgery since then. With how impressively simple the surgery has become and the perfection of the rehab process Tommy John surgery is clearly the best-case scenario surgery among baseball pitchers.
Tommy John surgery takes a graft of a tendon from a pitchers wrist, knee, or hamstring depending on the size of the tendons. Then the elbow is opened up with an incision and two holes are drilled in the ulna and humorous and the graft is then woven in and out of the holes in a figure eight pattern and tied off. This pattern creates the strongest hold for the ligament. While the strength of the tendon is important it is also crucial to have strong knots at each end to further strength the graft and provide the best chance for rehabilitation.
While at the time of the original surgery it was thought of as far- fetched that it would work medically speaking it is a fairly simple procedure as far as reconstructive surgeries are concerned. Even Jobe, the first doctor to perform the surgery, said it himself in an interview with Fox sports “When you look at it from a retrospective view, it was pretty simple. What was so great about it? It was great to have a patient like Tommy John, someone who understood what we were doing.” (qtd. Forgrave)
Baseball is in large part a very unhealthy sport for people to play. Overhead movements in general are not good for the human body because of how unnatural the motion and then we placed a light ball in peoples’ hands and put them on a hill, which makes it even harder on the arm. Specifically the shoulder and elbow because of the sudden acceleration and deceleration. Many arm injuries today are preventable but many people including Tommy John himself do not believe people train their arms well enough to handle the kind of load they choose to place on it. Tommy John campares it to another sport with common overuse injuries, running, saying “Your arm is a muscle,” he once said. “I liken it to running a marathon. If I want to run a marathon, I have to get my mileage up. I’ve got to be able to run long mileage. In baseball, we’re trying to run a mini marathon with training on 50-yard sprints” (Weaver).
Baseball players are also being pushed to become specialized in one sport at a much younger age than before which has led to many people simply throwing too much when they are not fully developed. Rather than gaining overall strength from playing many different sports baseball players are becoming very asymmetrical in strength because of the amount of stress pitching put on their body in one consistent movement pattern.
Among the many surgeries that pitchers of all ages and abilities levels have the potential have at some point in their careers including but not limited to ones that repair a torn rotator cuff or labrum. Many pitchers will already have some form of fraying or slight tears in these areas and are unaware of them until they experience pain or loss of effectiveness. In many cases with shoulder injuries pitchers will do everything they can to avoid having to undergo surgery such as rest and rehab. More often than not they only lose more time that they could be spending rehabbing post operation but with the uncertainty of ever returning to form they see it as their only option.
At times some pitchers will take a similar approach with a UCL tear because they again may have had the injury before it became a problem. The typical procedure would be time off before again throwing on a slow progression which more often than not is unsuccessful. The largest difference however is that the surgery now is 85 percent effective which makes them more willing to have surgery immediately since there is such a strong chance that they will return to their same level. Such a success rate is impressive with any kind of surgery and is remarkable considering before Tommy John had his surgery Jobe told him he had a one out of one-hundred chance of pitching in the major leagues again. While there may be people who have still had success after not having surgery there are still astounding numbers of people who immediately have surgery. In the major leagues one out of every nine pitchers has at one time had Tommy John surgery. Tommy John himself recorded an amazing 164 wins after the surgery.
The surgery however is only half of the story or as Dr. Tim Kremchek believes less than half as Tom Gorman said in his article “he says that post-surgical rehab makes up at least 55% of the solution for an elbow injury and that the “difference maker is the rehab people, not the surgeon” (Gorman). In the more than thirty years since the original surgery there has been plenty of opportunities for trial and error in regards to the rehab people perform. Now upon leaving the surgeons office patients are presented with a plan for the next ten months of their lives. While the process is a long and grueling time for the patients they are fortunate enough to have this lengthy plan to ensure they are not part of the unlucky 15 percent that do not make it their previous level.
Within hours of surgery patients perform hand exercises to insure that they have all feeling and to try to prevent as much stiffness as possible. Within a few days they begin to try to regain some type of range of motion in their elbow while beginning to work on strengthening the other muscles in their arm. Within a month the athlete has gone from having their arm completely opened up to being able to perform simple task like brushing their teeth and running. After four months they are able to begin a normal weight training program and a very slow but progressive throwing program with the hopes of being back on the mound in four months.
The plan is mapped out so well because of the thousands of people who have had the surgery before them and makes the likelihood of returning that much greater. Which simply cannot be said for other arm surgeries that a pitcher could undergo. Although some still wish to talk about how common the surgery is as a negative point the people involved deeply in baseball see this as a positive aspect. Thomas Gorman explains this point further in his 2009 article about the surgery. “That Tommy John surgery seems all too common is perhaps the best measure of its success. While there is still a failure rate of 10 to 15 percent, most of these happen on younger subjects. It would be more accurate to say that the pitcher fails himself in most cases, rather than the surgery being the problem.” (Gorman)
Knowledgeable baseball players, especially pitchers never want to have to face a serious surgery that have considerable risks. Unfortunately for them the amount of surgeries seems to be on a very steady climb with little sign of slowing down. However, with how impressively simple the surgery has become and how the rehabilitation process continues to be perfected Tommy John surgery is the best-case scenario surgery for baseball players.
Forgrave, Reid. “Pitcher, Doctor Change Baseball.” FOX Sports. N.p., 21 June 2012. Web. 29 Apr. 2014.
Gorman, Thomas. “Inside Tommy John Surgery: Thirty Years of Fixing Pitchers.” Baseball Prospectus. N.p., 15 June 2009. Web. 29 Apr. 2014.
Weaver, Ed. “A Look at the History of ‘Tommy John Surgery'” Saratogian News. N.p., 6 July 2013. Web. 29 Apr. 2014.