Sports Rehabilitation following Tommy John Surgery

Harvey on Mounnd

Sports Rehabilitation following Tommy John surgery is common today among professional baseball pitchers which allows them to resume their careers.

The procedure was named after Los Angeles Dodgers pitcher Tommy John who was the first pro athlete to have this surgery in 1974. The surgery involves either repairing or replacing the injured or torn ulnar collateral ligament in the elbow.

If the tendon is replaced during the procedure, another tendon is taken from somewhere else in the patient’s body or from a tendon donated by a deceased person. The technical name for the surgery is ulnar collateral ligament reconstruction (UCL). This injury to the elbow is from repetitive stress where the ligament starts to stretch and lengthen thus creates instability of the elbow bones. This ligament connects the upper arm bone (humerus) to the forearm bone (ulna).

Baseball pitchers are prone to this injury due to the forceful twisting of the elbow when throwing the ball to a batter.

In this article we will discuss the symptoms, sports rehabilitation and recovery from Tommy John surgery.

Symptoms

ulnar-collateral-ligamentOn physical examination the patient will exhibit these classic signs (1) pain along the the medial or inside aspect of the elbow (2) patient states there is a feeling of instability within the elbow (3) numbness or tingling in the 4th and 5th digits of involved upper extremity (4) swelling and warmth along the medial aspect of involved elbow and (5) great difficulty in the throwing motion.

The definitive diagnosis is made by x-rays to access the bony structure and MRI with dye to get a clear picture of the damage to the ligament. Most of the time professional athletes start reducing the pain by rest, ice applications and physical therapy.

pre elbowSports rehabilitation at this time will consist of light strengthening to compensate for the weakness in the elbow. If there is no response the professional pitcher will opt for the procedure to pursue their career and get back to strenuous pitching. The majority of professional pitchers decide on surgery right away!

Sports Rehabilitation and Recovery Time

elbow immobilzationRecovery time following Tommy John usually takes approximately one year for full recovery. Immediately following the procedure the patient’s elbow is immobilized in a splint which is worn for approximately 7-10 days. During the period of immobility wrist, hand and shoulder range of motion is performed. The range of motion to these areas can be gentle passive, active assistive or active.

When the elbow does not need to be immobile a specially designed brace is ordered to gradually assist in regaining elbow motion. Light strengthening of shoulder and arm can be started as well as full body conditioning utilizing stationary bikes, hip and knee apparatus etc. In this stage the physical therapist often utilizes electrical stimulation to assist in healing and recruit appropriate muscle fibers to contract.

bracing elbowSix weeks post surgery the patient can now perform light elbow strengthening using a light weight or low resistive band. It is very important during this sports rehabilitation phase to avoid overworking the elbow and to follow the guidance of the sports specialist. For the next 4 months a progressive elbow strengthening program is implemented.

As the patient enters the final stage of sports rehabilitation (4-5 months after surgery) he can start throwing a baseball eliminating the wind up motion. In 6 months post surgery the pitcher can now progress to a modified or easier wind up prior to throwing. In approximately 7-8 months pitchers can start throwing off the mound.

The final step (9-10 months) pitchers can pitch in a competitive game provided they are pain free and have regained normal strength and full elbow range of motion.

Tommy JohnBased on studies of athletes the chances of complete recovery after Tommy John surgery is approximately 85%-90% provided that the patient completed the sports rehabilitation process. When this surgery was first performed in 1974 a tear of the ulnar collateral ligament was considered career ending but as you can see from the statistics the surgery is quite successful giving athletes the chance to excel again.