Just What the Doctor Ordered: The Legend of Tommy John

In the mid 1960’s, still in his prime, Sandy Koufax retired from Major League Baseball because of a “dead arm.” Ten years later, Dr. Frank Jobe pioneered a major achievement in sports medicine at UCLA Medical Center: he successfully reconstructed the ulnar collateral ligament (UCL) for Tommy John, who went on to have many more productive years in the major leagues.

The UCL stabilizes the medial or inside part of the elbow, and is the main ligament that provides stability to the elbow in the thrower. In the throwing motion, the arm is brought forward in such a way that a lot of stretching force is concentrated on the inside part of the elbow, with compressing force being concentrated on the outside of the elbow joint, stressing the UCL.



Over time and with repeated use, this ligament can stretch resulting in pain when throwing due to the elbow not being tight in the throwing action, creating excessive side-to-side motion at the elbow. Many pitchers will worsen the condition by continuing to throw despite significant pain, eventually creating the uncomfortable “dead arm” sensation.

Symptoms include pain and swelling over the inside part of the elbow, and decreased throwing velocity. If therapy and rest do not work, then surgery may be indicated. Steroid injection is not recommended, since they can further damage the ligament.

The procedure that Dr. Jobe performed involved the removal of a tendon from elsewhere in the body; then Dr. Jobe used it to replace John’s torn elbow ligament. The tendon that is placed in the elbow is typically taken from the wrist or hamstring area (Note that a tendon usually connects a muscle to a bone).

This procedure has now been performed on over 100 major league pitchers, with about an 85 percent success rate. The real success has resulted from improvements in the rehabilitation process. For pitchers, rehabilitation usually takes about 12-15 months. In addition to the elbow, the process involves strengthening of the shoulder.

At one month, light stretching exercises are begun. At two months, pitchers typically begin light strengthening exercise, with light throwing beginning four to six months after the surgery, and finally full throwing is allowed at 9-12 months, on average.

Athletes in other sports have used the surgery, too. For a great example of this, and for some interesting information about a unique rehab regiment, read about Carolina Panthers quarterback Jake Delhomme’s recovery from Tommy John surgery.

For fantasy purposes, consider the following: the key to a successful rehabilitation and recovery is that a pitcher not push himself. That reality defies a lot of what has brought these athletes to the pinnacle of their profession, but it is imperative to avoid putting too much stress on the reconstructed elbow while it is still healing. As previously stated, a pitcher will usually begin throwing again between four and six months after the surgery. So, a pitcher beginning ahead of this time frame might be moving too quickly.

Also bear in mind that different teams have different needs and expectations. In 2003, the Yankees signed Jon Lieber to a multi-million dollar deal only five months into his rehabilitation, knowing that he would miss the entire 2003 season. The Yankees signed him at that time as an insurance policy, to build some depth in the rotation.

As for Francisco Liriano, the young Twins star seems to be right on track in his return from the surgery in early November of 2006. The Twins will probably be cautious with him and limit his innings. Santana’s move to the Mets is a huge loss to their rotation, but they certainly do not want to rush Liriano and cause the 24-year old to suffer a setback. Follow his progress in spring training closely before drafting him and expecting him to return quickly to dominant form.

While surgery is actually called ulnar collateral ligament surgery, its namesake remains with John in baseball circles, perhaps because he was such a long shot to recover from the revolutionary surgery. Fortunately that is not the case anymore, but the rehabilitation is still long, delicate and demanding.

*** Posted by Brett Smiley on behalf of the Doctors ***

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