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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

What Happens During Tommy John Surgery

During Tommy John surgery, a tendon is taken from someplace in the patient's body, such as his or her:

Sometimes, surgeons use a tendon donated from the body of someone who has died.

Surgeons drill tunnels in the ulna and humerus. The tendon (called a "graft") is passed through the tunnels. It is then woven into a figure-eight pattern to reconstruct the ligament.

To give the graft added strength, any remnants of the original ligament are attached to the tendon.

Complications can occur in anywhere from 5% to 20% of patients, depending on the technique that is used. The most common complication is damage to the ulnar nerve.

Other complications can include infection or hematoma. Rarely, a complication will require additional surgery.

Tommy John Surgery Rehabilitation

Rehabilitation from Tommy John surgery usually takes about a year. In some cases, up to 2 years are needed for athletes to return to their previous level of ability. Other types of UCL surgery may not need this much rehabilitation.

Rehabilitation should be closely monitored by the patient's doctor and physical therapist. Some rehabilitation programs follow a three-phase process:

Phase I. After surgery, patients take these steps:

  • Wear a splint for 7 to 10 days to immobilize the elbow.
  • Do gentle range-of-motion exercises for the wrist, hand, and shoulder.
  • Wear a range-of-motion brace to gradually regain full motion of the elbow joint.
  • Do exercises to strengthen the arm and shoulder.
  • Perform total-body conditioning exercises.

Phase II. Starting about 6 weeks after surgery:

  • Most patients can begin to perform elbow-strengthening exercises.
  • For at least the next 4 months, most patients are advised to avoid activities that overstress the graft.

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