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Tommy John Surgery

Tommy John surgery repairs an injured elbow ligament. It's most commonly done on college and pro athletes, especially baseball pitchers. But it's sometimes done on younger people as well.

The surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type.

Tommy John surgery is also called UCL reconstruction. UCL is short for ulnar collateral ligament.

During Tommy John surgery, a surgeon replaces the injured UCL with a tendon taken from somewhere else in the patient's body.

Other types of surgery for repairing the UCL have also been developed. Now, WebMD takes a look at the original Tommy John surgery that is still used today and has let thousands of athletes return to their previous level of play.

How UCL Injuries Develop

The UCL is located on the inside of the elbow. It connects the bone of the upper arm (humerus) to a bone in the forearm (ulna).

Anyone can get a UCL injury from repetitive stress to the elbow or from trauma. But throwers have the highest risk. That's because throwing motions that twist and bend the elbow put extreme stress on the ligament.

Over time, the UCL can develop tiny or large tears. The ligament stretches and lengthens to the point where it can't hold the bones tightly enough during throwing activities.

Most UCL injuries occur in baseball players. But other sports are sometimes linked to UCL injuries. These sports include:

  • javelin throw
  • tennis
  • gymnastics
  • soccer
  • softball
  • football
  • wrestling
  • cheerleading

Symptoms of a UCL Injury

Symptoms associated with a UCL injury include:

  • Pain on the inside of the elbow
  • A sense of looseness or instability in the elbow
  • Irritation of the "funny bone" (ulnar nerve): This is felt as tingling or numbness in the small finger and ring finger.
  • Decreased ability to throw a baseball or other object

Only rarely do UCL injuries interfere with non-throwing activities, such as:

  • activities of daily living
  • exercising
  • lifting weights
  • batting in baseball
  • running

Diagnosis of UCL Injuries

Sometimes, a doctor can diagnose a UCL injury through just a history and physical examination. Diagnostic tests include:

  • X-rays
  • MRI
  • MRI after gadolinium dye has been injected into the elbow

Because such tests are not 100% accurate, however, it can be difficult to diagnose a UCL injury.

Candidates for Tommy John Surgery

UCL injuries are usually first treated with conservative (non-surgical) therapies. These therapies include:

  • rest
  • ice
  • nonsteroidal anti-inflammatory drugs (NSAIDs)

Patients then typically undergo physical therapy. This strengthens surrounding muscles to compensate for the injured UCL.

But some athletes may be candidates to have surgery right away. Tommy John surgery is most commonly recommended for athletes who:

  • Don't respond to non-surgical treatments
  • Want to resume strenuous overhead or throwing activities

WebMD Medical Reference

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