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What is Tommy John Surgery?

This year, an epidemic has swept over the game of baseball as a multitude of its brightest young Major League pitching stars have been forced to undergo a popular ligament reconstruction procedure called “Tommy John” surgery. In the last year alone, New York Mets ace Matt Harvey, Atlanta Braves star Kris Medlen, and perhaps the most promising young talent in the entire game, Jose Fernandez of the Miami Marlins, have gone under the knife. These three are the cream of the crop when it comes to pitching talent, however, they represent only a small fraction of the nearly 40 Major League pitchers who have had the surgery since the start of the 2014 season.

The injury that necessitates the surgery is the tearing of the ulner collateral ligament, or UCL, located in the medial elbow of a pitcher’s throwing arm. Players at other positions or in other sports sometimes require the procedure as well, but baseball pitchers make up the vast majority of patients. In fact, the procedure is named for former Los Angeles Dodgers pitcher Tommy John, who was the first-ever recipient of the surgery.

A person’s UCL connects the humerus bone of the upper arm to the ulna, which is a bone located in the forearm. Repeated stress from the motion of throwing a ball lengthens and stretches the ligament. If the stress becomes too great, it can no longer hold the respective bones tightly, and winds up tearing. Symptoms usually experienced are pain, elbow numbness, irritation, and instability, and a significant decrease in throwing ability. Some pre-surgery treatments can include rest, icing the elbow, and non-steroidal, anti-inflammatory drugs (NSAIDs).

While recipients of the procedure almost always fully recover, the severity of a UCL injury and subsequent Tommy John surgery is significant because of the long recovery time, as major leaguers are typically unable to resume active pitching duties for at least a full year, thus ending the current or upcoming season of anyone who elects to go under the knife.

A multitude of reasons have been put forth by experts and the media as to why the recent rash of injuries has taken place. These include increased pitching velocities that result in significant arm stress, as well as the unusually high number of games, and thus pitches, thrown by young players throughout the year. Teenage pitchers often play for travel teams, which means they may be pitching at high velocities year-round, causing undo stress on their developing arms. The average age of pitchers who received the surgery this year is just over 24-years-old, which is exceptionally young when compared to the pitchers who first required the surgery decades ago.

Whatever the reason, UCL injuries are actively changing the game of baseball, with many of the best pitchers currently sidelined by the injury, and teams adjusting internal procedures, management of pitchers, and even assessment of contracts or acquisition of prospects all based around the probability of injury. Unfortunately, there is no single or easy solution to this ongoing problem.


The information supplied in this article is not to be considered as medical advice and is for educational purposes only.