UCL TEAR AND TOMMY JOHN SURGERY
In medical terms, Tommy John Surgery, is Ulnar Collateral Ligament (UCL) reconstruction. This is a surgical procedure, in which the Ulnar Collateral Ligament (inner elbow), is replaced after a tear, with a tendon graft taken from another body part. This procedure was named after Tommy John, the first major league baseball player to have this procedure in 1974, by Dr. Frank Jobe, of the Kerlin-Jobe Clinic.
Typical causes of Ulnar Collateral Ligament tear are increased tension with repetitive throwing, on the medial elbow of overhead athletes, including baseball pitchers, javelin and other throwing sports. More traumatic causes, such as elbow dislocation during a fall with outstretched arm, can lead to a UCL tear, resulting in instability and pain.
The most common symptom of a UCL tear is medial (inner) elbow tenderness and pain, about 2cm distal to the medial epicondyle, especially during the acceleration phase of throwing. This pain can be become chronic, and lead to irritation of the Ulnar nerve (Funny Bone), resulting in increase in numbness/tingling of the 4th and 5th digits (ring and pinky fingers), as well as the slow decline in the athlete’s ability to throw. There can be a sudden loss of elbow ROM, mostly extension, and a manual Valgus stress will produce pain, as the medial jt. gaps.
Surgical Intervention (As shown in the second and third diagrams), holes are drilled in both the ulna and humerus bones. The tendon graft is inserted into and threw each hole, and woven into a Figure 8 pattern, to create greater strength and medial elbow stability. To give the new graft, even more strength, the remnants of the original ligament are woven into the new tendon graft.
Treatment/Rehab Rehabilitation following a UCL reconstruction/Tommy John surgery, is a 3-phase process: Phase I: (1 – 6 weeks) - Immobilizer splint for initial 7-10 days - Gentle ROM (after 10 days) for the wrist, hand and shoulder, as well as a ROM splint to regain full motion of elbow joint. - Gentle therapeutic exercise for the entire upper extremity and shoulder girdle. Phase II: (6 weeks – 4 months) - Progressive strengthening exercises for the shoulder girdle and elbow. - Avoidance of any activities that may aggravate or overstress the elbow. Phase III: (4 – 9 months) - Throwing progression: 4-5 months = no wind-up 6 months = partial wind-up 7-8 months = throwing from the mound 9 months = return to competition
References: Brandon J. Erickson, M.D.; The Epidemic of Tommy John Surgery. 4/2015; American Journal of Orthopedics; Retrieved from: http://amjorthopedics.com
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