Tommy John Surgery Specialist

What is Tommy John Surgery?

Tommy John Surgery is a specialized procedure in which the Alta Orthopaedics team performs a UCL (ulnar collateral ligament) reconstruction.

The UCL is the elbow ligament on the inside of the elbow that can be damaged by high-level throwing athletes – for example, a baseball pitcher, football quarterback, or javelin thrower. UCL injuries can also occur in non-throwing athletes such as gymnasts, although this is far less common.

Traumatic injuries to the UCL, like elbow dislocations, can result in inflammation, ligament sprains, or complete ruptures of the ligament that may require UCL repair.

Athletes who have UCL injuries typically have pain on the inside of their elbow, and many notice decreased throwing accuracy and velocity.  Some require treatment to help repair a damaged UCL.  This most commonly takes the form of physical therapy or platelet-rich plasma (PRP) injections, but can require surgery in more severe cases.

What is the function of the UCL?

The UCL is one of several ligaments on the inside of your elbow that helps to keep the joint stable with motion.

The elbow contains three bones. The humerus is the upper arm bone, and the ulna and radius make up the forearm. The UCL travels from the medial epicondyle on the humerus to the sublime tubercle on the ulna.  The elbow serves as a hinge joint, enabling flexion and extension. It is also a pivot joint, enabling the forearm to turn palm up (supinate) and palm down (pronate).

Other important structures in the elbow include the:

Olecranon

This is the bump on the back of the elbow that's part of the ulna. It can easily be seen and palpated.

Medial epicondyle

This is where the UCL originates. It i's also an attachment point for the muscles that flex the wrist.

Sublime tubercle

This is the place on the ulna into which the UCL inserts.

Cubital tunnel

This is the area behind the medial epicondyle through which the ulnar nerve traverses.

It might help to visualize the UCL as a rope connecting the medial epicondyle to the sublime tubercle of the ulna.

What causes UCL injuries?

UCL injuries are generally a result of overuse and increased stress on the structures of the elbow.

In pitchers, there are specific factors that can increase the risk of sustaining a UCL injury, including:

• The number of pitches thrown
• The number of innings pitched
• The number of months spent pitching each year
• Continuing to throw with existing arm pain
• Throwing with high velocity

UCL injuries typically cause pain and stiffness, even after a warm-up session. Some athletes might also hear a "pop" sound as the UCL gives way.

How are UCL injuries treated?

The Alta Orthopaedics team begins treatment of UCL injuries with conservative therapies, which could include anti-inflammatory medications, physical therapy, and rest. Biologics like platelet-rich plasma (PRP) are also helpful in speeding up the healing process.

If these treatments do not relieve symptoms, your provider at Alta Orthopaedics might suggest Tommy John surgery to reconstruct your UCL.

Find out more about Tommy John Surgery or UCL repair by calling Alta Orthopaedics today or book an appointment online.