Monday, May 14, 2012

What is Tommy John Surgery?

It seems everyday we hear the words, “He has a partially torn ulnar collateral ligament and will require Tommy John surgery.”

Most know that Tommy John surgery is an elbow surgery which takes pitchers about a year to recover but that’s about it.  Pitchers Duel will explore what Tommy John surgery is and what are the possible causes.

Before 1974, a blown ulnar collateral ligament meant a career was over for a pitcher.  But thanks to Dr. Frank Jobe and Tommy John, it is now a career saving operation.  When Dr. Jobe opened up John for the surgery he thought he might have a one percent chance at coming back.  Now, with advancements in medicine, the recovery rate for a pitcher after surgery is an outstanding 92 percent. 

The body is something that will never be fully understood.  It can do things that would otherwise be unimaginable and during the Tommy John surgery, the body puts its magic to work.

The doctor will first remove the injured UCL and drill two holes into the ulna and humerus bones that make up the elbow joint.  Using a spare tendon (usually from the patients throwing forearm or a cadaver) the surgeon will figure eight the tendon in these holes and then the body does its work.

How Dr. Jobe figured this out is spectacular.  The tendon starts a process called “ligamentization.”  This is when the tendon starts to realize it is now becoming a ligament and has a new task at hand.

During the ligamentization period, the arm is wrapped in a soft cast to prevent the arm from moving and possibly damaging the new ligament.  After the that period of time, the work begins. 

The rehab time for Tommy John can range anywhere from ten months to eighteen months.  During this rehab process, the pitcher will go through physical therapy, strengthening, rigorous workouts and a precise throwing program.

These are the reasons some pitchers come back stronger after their Tommy John surgery.  Taking time off to learn about the body and the game of baseball along with getting stronger in every physical aspect, is what makes some pitchers better. 

Players who have had the surgery have talked about picking their coach’s minds and “learning how to pitch.”  These are also reasons why some pitchers come back with tremendous results.

Why the UCL gets damaged is clear.  The arm was not designed to throw overhand at great speeds.  But why do some pitchers have long careers without the surgery is a different question.  After speaking to Dr. Mark Cohen, a surgeon for the Chicago White Sox, he came up with two main reasons why.

Dr. Cohen said mechanics and overuse are two of the reasons.  A good example is Stephen Strasburg when talking about mechanics.  Strasburg is known for the “inverted W.”   This means that during the pitchers motion, right before acceleration, the pitcher’s elbows are both above the shoulders which puts a tremendous amount of stress on the elbow, especially the UCL. 

Overuse in high school baseball is also a reason why pitchers need surgery down the road.  If a coach has a division one pitcher, he isn’t afraid to use him.  Throwing 100-120 innings during the spring and summer can be a lot of stress on a 17 or 18 year old pitcher. 

Dr. James Andrews is one of the best known surgeons in the United States for Tommy John surgeries and he suggests players take a couple of months off after the season to let the arm heal naturally.  With rest, he believes players are able to get the strength back they need and that the surgery may be preventable.

Tommy John surgery is too common in the baseball world and can be a long road to recovery.  Without it though, some careers may never be saved.

The harder you work, the luckier you’ll be.

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