Being an athlete can be a risky endeavor: there is a myriad of injuries and many other occupational hazards that sports people must be wary of. However, for baseball players (pitchers, in particular), there is one injury that’s among the most feared and which leads to a notorious procedure called “Tommy John surgery”.
Pitching puts a lot of stress on various parts of the arm. If this pressure is too intense on the elbow (due to the effort put in and the throwing mechanics of a pitcher), there’s a possibility of tearing the ulnar collateral ligament (UCL for short). This ligament of the elbow joint is what unites the humerus to the ulna and tearing it causes intense pain, as well as a loss of velocity and accuracy.
The real name of Tommy John surgery is “ulnar collateral ligament reconstruction” and, as it’s name implies, it’s objective is to reconstruct the UCL whenever it’s torn.
So why do people refer to it as Tommy John surgery? Well, in 1974 Tommy John was a successful pitcher for the Los Angeles Dodgers until he tore his UCL. He was the first athlete to ever successfully endure and recover from this procedure. It was performed by Dr. Frank Jobe and, at the time, he gave Tommy John a 1 in 100 chance of recovery.
What he did - and this was a breakthrough in sports medicine - was replacing the torn ligament with a tendon from a different part of his body (typically, this tendon is obtained from either elbow, from below the knee, or from a cadaver, accommodating it on holes drilled in the ulna and humerus.
Notice that we mentioned that a ligament is replaced by a tendon. Thus, it takes a while for this tendon to get used to its new functions (ligaments normally join a bone with another, while tendons join bones with muscle). The recovery time is usually around a year for pitchers and a little more than 6 months for position players (though it must be said - this procedure is much more often done on pitchers).
Once the procedure is done, the player wears an elbow brace for a week. By the second week, he’ll start exercises focused on regaining the range of motion. Not until at least four months do pitchers usually start throwing again, typically playing soft-toss from 45 feet.
At the 6 month mark they start increasing intensity and getting closer to throwing in game conditions, until the recovery is mostly done (at about a year). However, even though they can return to pitching at a year, it usually takes even longer to return to proper form. It is usually said that, while velocity comes back fairly early after the procedure, pitch command takes much longer to come back.
While it started as a very risky procedure, nowadays it is believe that in 85 - 92% of the cases, the recovery will be full.
Factors that can lead to a torn UCL
The UCL is damaged by the constant stress of the throwing motion, so it makes sense that both the mechanical movement of the pitcher while throwing as well as the amount of pitches thrown are both determinant factors. This is one of the things that causes teams to put innings caps on younger pitchers (and even more after they’ve had a TJ surgery, just like in Stephen Strasburg’s case). Also, it seems that the types of pitches thrown can have an effect on the UCL. The slider is the type of pitch most associated with this surgery, which is why some managers are very protective of slider-dependent pitchers (like the Giant’s Sergio Romo).
Notable players who have had TJ surgery
This is not meant to be a comprehensive guide to all players who have had TJ surgery but rather as a reference to help you know that, while it’s a difficult procedure, many pitchers have survived it and returned to being as good as before.
(For a full list of known TJ surgeries, check the compilation found here)
Did you know? R.A. Dickey does not have a UCL in his right elbow joint. Physicians are of the opinion that he shouldn’t even be able to pitch at all. This is one of the many things that make him unique and, in many ways, a miracle of a pitcher.