Tommy John Surgery
Chris Drumm, MD and Heidi James, MD
Chris Drumm is back and here he tells Heidi all there is to know about the baseball pitcher Tommy John and the eponymous surgery invented by Dr Frank Jobe to fix Tommy’s injured ulnar collateral ligament.
- Ulnar collateral ligament (UCL) injuries are common in baseball players, javelin throwers, and volleyball players.
- Increasing rates of frank tears in pitchers of all ages
- Can be acute or the result of microtrauma
- What to look for on history:
- Duration of pain
- Point in pitch cycle with pain
- Change in velocity after injury
- Presence of mechanical symptoms
- Most pain is during the acceleration phase
- Associated condition: glenohumeral internal rotation deficiency (GIRD):
- Microtrauma-related injury that occurs in the deceleration phase of pitching
- Increases the risk of UCL tear
- Examination:
- Tenderness over UCL
- Must assess the medial joint space
- Specific tests:
- Valgus stress testing
- Elbow is flexed to 30 degrees and the forearm is in a neutral position; a valgus stress is then applied to the elbow.
- Moving stress test
- Examiner applies a valgus stress to the fully flexed elbow and maintains stress while moving the elbow into full extension.
- Milking maneuver
- With the elbow flexed to 90 degrees and maximally supinated, the examiner grabs the thumb and applies valgus stress by pulling on the thumb.
- Diagnostic testing:
- Magnetic resonance imaging (MRI) and ultrasound are used but magnetic resonance arthrogram is the gold standard.
- Management:
- Conservative treatment: nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy
- Surgery
- Potential surgical complications:
- Paresthesias in area around graft retrieval
- Synovitis
- Ulnar neuropathy
- These injuries are being seen more often in younger pitchers because of increased training specialization.
PEARLS
- Ulnar collateral ligament (UCL) injuries are common in baseball pitchers (and in other throwing sports).
- When conservative measures fail, Tommy John surgery is an option.
- UCL injuries are increasingly common in young athletes due to early sports specialization.
