Tommy John surgery

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Tommy John surgery
Intervention
ICD-9-CM 81.85

Tommy John Surgery, known in medical practice as ulnar collateral ligament (UCL) reconstruction, is a surgical graft procedure in which the ulnar collateral ligament in the medial elbow is replaced with a tendon from elsewhere in the body. The procedure is common among collegiate and professional athletes in several sports, most notably baseball.

The procedure was first performed in 1974 by orthopedic surgeon Dr. Frank Jobe, then a Los Angeles Dodgers team physician who served as a special advisor to the team until his death in 2014. It is named after former major league pitcher Tommy John, the first baseball player to undergo the surgery, whose 288 career victories ranks seventh all time among left-handed pitchers. The initial operation, John's successful post-surgery career, and the relationship between the two men is the subject of a 2013 ESPN 30 for 30 Shorts documentary.[1]

Procedure[edit]

Tommy John, for whom the surgery is named, in 2008.

The patient's arm is opened up around the elbow. Holes to accommodate a new tendon are drilled in the ulna and humerus bones of the elbow. A harvested tendon (often the palmaris tendon[2])—from the forearm of the same or opposite elbow, below the knee (known as the patellar tendon), or from a cadaver—is then woven in a figure-eight pattern through the holes and anchored. The ulnar nerve is usually moved to prevent pain as scar tissue that forms can apply pressure to the nerve.[2]

Prognosis[edit]

At the time of Tommy John's operation, Jobe put his chances at 1 in 100. In 2009, prospects of a complete recovery had risen to 85–92 percent.[3]

Following his 1974 surgery, John missed the entire 1975 season rehabilitating his arm before returning for the 1976 season. Before his surgery, John had won 124 games. He won 164 games after surgery, retiring in 1989 at age 46.

For baseball players, full rehabilitation takes about one year for pitchers and about six months for position players. Players typically begin throwing about 16 weeks after surgery.[4]

Risk factors[edit]

The UCL can become stretched, frayed, or torn through the repetitive stress of the throwing motion. The risk of injury to the throwing athlete's ulnar collateral ligament of elbow joint is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during a hard throw.[5] R.A. Dickey, however, became a very successful Major League Baseball pitcher despite having no UCL in his pitching arm.[6]

While many authorities suggest that an individual's style of throwing or the type of pitches they throw are the most important determinant of their likelihood to sustain an injury, the results of a 2002 study suggest that the total number of pitches thrown is the greatest determinant.[7] A 2002 study examined the throwing volume, pitch type, and throwing mechanics of 426 pitchers aged 9 to 14 for one year. Compared to pitchers who threw 200 or fewer pitches in a season, those who threw 201–400, 401–600, 601–800, and 800+ pitches faced an increased risk of 63%, 181%, 234%, and 161% respectively. The types of pitches thrown showed a smaller effect; throwing a slider was associated with an 86% increased chance of elbow injury, while throwing a curveball was associated with an increase in pain. There was only a weak correlation between throwing mechanics perceived as bad and injury-prone. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increase the likelihood of injury[8] it seems that the greater risk lies in the volume of throwing in total. Research into the area of throwing injuries in young athletes has led to age-based recommendations for pitch limits for young athletes.[9]

In younger athletes, for whom the growth plate (the medial epicondylar epiphysis) is still open, the force on the inside of the elbow during throwing is more likely to cause the elbow to fail at this point than at the ulnar collateral ligament. This injury is often termed "Little League elbow" and can be serious but does not require reconstructing the UCL.

Complications[edit]

There is a risk of damage to the ulnar nerve.[10]

Misconceptions[edit]

Some baseball pitchers believe they can throw harder after Tommy John Surgery than they did beforehand. As a result, orthopedic surgeons have reported that parents of young pitchers have come to them and asked them to perform the procedure on their un-injured sons in the hope that this will increase their sons' performance.[11] However, many people—including Dr. Frank Jobe, the doctor who invented the procedure—believe any post-surgical increases in performance are most likely due to the increased stability of the elbow joint and pitchers' increased attention to their fitness and conditioning.[12] Jobe believed that, rather than allowing pitchers to gain velocity, the surgery and rehab protocols merely allow pitchers to return to their pre-injury levels of performance.

List of Major League Player Personnel Tommy John Surgeries[13][edit]

Matt Moore

Cory Gearrin

Bobby Parnell

Erik Davis

David Hernandez

Peter Moylan

Bruce Rondon

Patrick Corbin

Jarrod Parker

Brandon Beachy

Kris Medlen

Luke Hochevar

Cory Luebke

Matt Harvey

Matt Reynolds

Rafael Betancourt

Jeremy Hefner

Jason Marquis

Jordan Norberto

Daniel Hudson

Kyuji Fujikawa

Scott Elbert

Eric O'Flaherty

Jonny Venters

Joel Hanrahan

Gavin Floyd

Jason Motte

Chad Billingsley

Alex White

Fernando Rodriguez

Frank Herrmann

Rafael Furcal*

Randy Wolf

Juan Oviedo

Carl Crawford*

Josh Tomlin

Drew Hutchison

Neftali Feliz

Joe Wieland

Eric Surkamp

Todd Coffey

Luis Perez

Daniel Hudson

Felipe Paulino

Brandon Beachy

Charlie Morton

Andrew Carignan

David Herndon

Kyle Drabek

Danny Duffy

Marcos Mateo

Jose Contreras

Blake Wood

Cory Luebke

George Sherrill

Mike Pelfrey

Joe Beimel

Jeremy Bonderman

Brian Wilson

Scott Baker

Michael Kohn

Ryan Madson

Joey Devine

Jose Ceda

Joakim Soria

Joel Zumaya

Sergio Escalona

Arodys Vizcaino

John Lackey

Carlos Carrasco

Juan Gutierrez

Tony Pena

Zack Cozart*

Rubby De La Rosa

Brad Hawpe*

David Aardsma

Carlos Monasterios

Brett Anderson

Joba Chamberlain

Daisuke Matsuzaka

Rich Hill

Jorge De La Rosa

Mason Tobin

Jenrry Mejia

Cla Meredith

Adam Wainwright

Jamie Moyer

Hector Ambriz

Manuel Corpas

John Baker

Stephen Strasburg

Shawn Kelley

Erick Threets

Kris Medlen

Ben Sheets

Kyle Blanks*

Zach Miner

Chris Coste

Junichi Tazawa

Joe Nathan

Jose Arredondo

Clay Zavada

Jordan Zimmermann

Edinson Volquez

Tyler Yates

Mike Aviles*

Neal Cotts

Xavier Nady*

Josh Outman

Shawn Hill

Jason Isringhausen

Anthony Reyes

Jesse Litsch

Dan Giese

David Riske

Bill Bray

Scott Proctor

Alfredo Simon

Joey Devine

Ryan Feierabend

Oscar Villarreal

Pat Neshek

Shaun Marcum

Billy Wagner

Jaime Garcia

Mike Parisi

Tim Hudson

Sergio Mitre

Norris Hopper*

Matt Chico

Vance Wilson*

Jake Westbrook

Chris Capuano

Peter Moylan

Macay McBride

Andy Sisco

Mike Zagurski

Mark McLemore

Jason Isringhausen

Danys Baez

Russ Ortiz

Ambiorix Burgos

Willie Eyre

Chris Ray

Brendan Donnelly

Josh Johnson

Chris Carpenter

Anthony Lerew

Eric Milton

Vance Wilson

Carl Pavano

B.J. Ryan

Fernando Nieve

Chris Denorfia*

Arthur Rhodes

Adam Bernero

Michael Gonzalez

Denny Stark

Bruce Chen

Francisco Liriano

Eddie Guardado

Brandon Backe

Logan Kensing

Carlos Martinez

Tyler Walker

Julio Santana

Shawn Estes

Kelly Johnson*

Bartolome Fortunato

Victor Zambrano

Ricardo Rincon

Yhency Brazoban

Luis Ayala

Juan Padilla

Denny Stark

Brian Anderson

Al Reyes

Mike Hampton

Cesar Izturis*

Jorge Campillo

Tim Spooneybarger

Erubiel Durazo*

Brian Anderson

Mike Lincoln

Derek Thompson

Randy Wolf

Octavio Dotel

Ryan Bukvich

Grant Balfour

Carlos Almanzar

Frank Francisco

Francis Beltran

Rick VandenHurk

Ray Olmedo*

Scott Williamson

Jason Grimsley

Shawn Hill

Rafael Soriano

Luis Gonzalez*

Jason Stanford

Mike Lincoln

Jason Shiell

Fernando Rodney

Jorge De Paula

Miguel Asencio

Chris Spurling

Mike Fetters

Billy Traber

Joe Mays

Tim Spooneybarger

Runelvys Hernandez

Ryan Dempster

Mark Wohlers

Denny Neagle

Seth McClung

Brian Moehler

Ricky Bones

A.J. Burnett

Matt Wise

Andy Ashby

Jayson Durocher

Bob Wickman

Doug Brocail

Jon Lieber

Jeff Zimmerman

Danny Patterson

Brian Tollberg

Jason Christiansen

John Franco

Pete Harnisch

Will Ohman

Jason Grilli

Ryan Vogelsong

Kevin Jarvis

Dave Eiland

Lance Painter

Adam Eaton

Pat Hentgen

Kevin Walker

Kris Benson

Doug Brocail

Matt Mantei

Rod Beck

Darren Dreifort

Garrett Stephenson

Dave Eiland

Scott Downs

Bill Simas

Scott Erickson

Scott Radinsky

Michael Tejera

Randy Williams

John Smoltz

Juan Pena

Scott Williamson

Orber Moreno

Rocky Coppinger

Sterling Hitchcock

Ken Cloude

Joe Roa

Dan Kolb

Tom Gordon

Matt Beech

Kerry Wood

Kerry Ligtenberg

Seth Greisinger

Matt Morris

Matt Beech

Billy Brewer

Jason Isringhausen

Rheal Cormier

Jason Bere

Pedro Bordon

Steve Ontiveros

Chad Fox

Steve Sparks

Bill Pulispher

Steve Karsay

Paul Wagner

Jose Rijo

Al Reyes

Darren Dreifort

Cal Eldred

Tim Worrell

Jose Canseco*

Mike Bielecki

John Farrell

Steve Ontiveros

Matt Young

Jimmy Key

Ken Dayley

Steve Christmas*

Paul Molitor*

Brent Strom

Tommy John

*Nonpitcher

Template:/Div col

References[edit]

  1. ^ Grantland staff (July 23, 2013). "30 for 30 Shorts: Tommy and Frank". Grantland. Retrieved August 17, 2013. 
  2. ^ a b Carroll, Will. "Dr. Frank Jobe, Tommy John and the Surgery That Changed Baseball Forever". Bleacher Report. Turner Broadcasting System, Inc. Retrieved July 17, 2013. 
  3. ^ Rosenhek, Eric (July 1, 2009). "The gory details of Tommy John surgery". The Good Point. Retrieved April 6, 2014. 
  4. ^ Dodd, Mike (July 29, 2003). "A year of rehab for Tommy John patients". USA Today. 
  5. ^ Fleisig, G.S., The biomechanics of baseball pitching, in Biomechanical Engineering. 1994, University of Alabama: Birmingham. p. 163.
  6. ^ Schwarz, Alan (February 27, 2008). "New Twist Keeps Dickey's Career Afloat". The New York Times. 
  7. ^ Lyman, Stephen; Fleisig, Glenn S.; Andrews, James R.; Osinski, E. David (2002). "Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers". The American Journal of Sports Medicine 30 (4): 463–8. PMID 12130397. 
  8. ^ Whiteley, Rod (2007). "Baseball throwing mechanics as they relate to pathology and performance – A review". Journal of Sports Science and Medicine 6 (1): 1–20. doi:10.1111/j.1600-0838.1996.tb00062.x. 
  9. ^ Lyman, Stephen; Fleisig, Glenn S.; Waterbor, John W.; Funkhouser, Ellen M.; Pulley, Leavonne; Andrews, James R.; Osinski, E. David; Roseman, Jeffrey M. (2001). "Longitudinal study of elbow and shoulder pain in youth baseball pitchers". Medicine and Science in Sports and Exercise 33 (11): 1803–10. doi:10.1097/00005768-200111000-00002. PMID 11689728. 
  10. ^ Purcell, Derek B; Matava, Matthew J; Wright, Rick W (2007). "Ulnar Collateral Ligament Reconstruction". Clinical Orthopaedics and Related Research 455: 72–7. doi:10.1097/BLO.0b013e31802eb447. PMID 17279038. 
  11. ^ Longman, Jere (July 20, 2007). "Fit Young Pitchers See Elbow Repair as Cure-All". nytimes.com. Retrieved October 23, 2013. 
  12. ^ Keri, Jonah (September 13, 2007). "Interview With Dr. Frank Jobe". ESPN.com. Retrieved October 13, 2008. 
  13. ^ all players listed referenced to https://docs.google.com/spreadsheet/ccc?key=0ApDc5PGsBzgVdFpGbk84WnhNZlZ4VlFEY3pDVkFzNnc#gid=3* which was in turn sourced to http://www.baseballheatmaps.com/disabled-list-data/ retrieved April 18, 2014. Those authors examined all of the disabled list transactions, and have listed players more than once if they have had the surgery more than once. These are listed in reverse chronological order.

External links[edit]