Transcript Document

Tommy John Surgery
• Known in medical practice as ulnar collateral ligament
(UCL) reconstruction, is a surgical procedure in which a
ligament in the medial elbow is replaced with a tendon
from elsewhere in the body (often from the forearm,
hamstring, knee, or foot of the patient).
• The procedure is common among collegiate and
professional athletes in several sports,
most notably baseball.
Procedure
• The procedure was first performed in 1974 by
Dr. Frank Jobe, who today serves as a Special
Advisor to the Los Angeles Dodgers, and is
named after former major league pitcher
Tommy John whose 288 career victories ranks
seventh all time among left-handed pitchers.
Procedure
• After the tendon from the forearm of the
same or opposite elbow or below the knee
(or from a cadaver) is harvested, it is then
woven in a figure-eight pattern through
tunnels that have been drilled in the ulna and
humerus bone that are part of the elbow
joint.
Rehabilitation
• 2009, chances of a complete recovery after surgery are
estimated at 85 to 92 percent.[1] At the time of Tommy
John's operation, Jobe put his chances at 1 in 100.
• After his surgery in 1974, John spent 18 months
rehabilitating his arm, returned for the 1976 season, and
went on to pitch in the major leagues until 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.
Throwing Risk
• 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.
Total Number of Pitches Thrown
• 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.
Throwing Volume
• 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.
Type of Pitch
• 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 curve ball
was associated with an
increase in shoulder
pain.
Throwing Mechanics
• 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[5] 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.[6]
Little League Elbow
• 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 Ulnar
Collateral Ligament.
Complications
• There is a risk of
damage to the ulnar
nerve.
In some cases baseball pitchers throw harder after the
procedure than they did beforehand.
•
As a result, orthopedic surgeons have reported that increasing numbers of
parents are coming to them and asking them to perform the procedure on their
un-injured sons in the hope that this will increase their performance.
•
However, many people — including Dr. Frank Jobe, the doctor who invented the
procedure — believe most post-surgical increases in performance are generally
due to two factors. The first is pitchers' increased attention to conditioning.
•
The second is that in many cases it can take several years for the UCL to
deteriorate.
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Over these years the pitcher's velocity will gradually decrease.
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As a result, it is likely that the procedure simply allows the pitcher to throw at
the velocity he could before his UCL started to degrade
List of notable baseball players who
underwent the surgery
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Brett Anderson (pitcher)[9]
Rick Ankiel (pitcher converted to
outfielder)[10]
John Axford (relief pitcher)
Bong Jung-Keun (pitcher)
Bill Bray (pitcher)
Clint Brown (pitcher)
A. J. Burnett (pitcher)[11]
José Canseco (outfielder; injured
while pitching)
Chris Capuano (pitcher, twice)
Chris Carpenter (pitcher)
Joba Chamberlain (pitcher)
Shin-Soo Choo (outfielder)
Manny Corpas (pitcher)[12]
Jorge De La Rosa (pitcher)
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John Dopson (pitcher)
Scott Feldman (pitcher)
John Franco (relief pitcher, holder of
NL record for games pitched)
Éric Gagné (relief pitcher)[12]
Jaime Garcia (pitcher)
Matt Holliday (outfielder)
Tim Hudson (pitcher)
Todd Hundley (catcher)
Tommy John (pitcher)[1]
Josh Johnson (pitcher)
Hong-Chih Kuo (relief pitcher; four)
Francisco Liriano (pitcher)
Shaun Marcum (pitcher)
List of notable baseball players who
underwent the surgery
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Deion Sanders (outfielder)
Scott Schoeneweis (pitcher)
John Smoltz (pitcher)
Stephen Strasburg (pitcher)
Dallas Trahern (pitcher)
Edinson Volquez (pitcher)
Billy Wagner (relief pitcher)
Adam Wainwright (pitcher)
Brian Wilson (relief pitcher)
C.J. Wilson (pitcher)
Kerry Wood (pitcher)
Jordan Zimmermann (pitcher)
Ryan Vogelsong (pitcher)
[edit]List of notable American
football players receiving the surgery
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Daisuke Matsuzaka (pitcher)
Kris Medlen (pitcher)
Sergio Mitre (pitcher)
Paul Molitor (infielder)
Jamie Moyer (pitcher)[13]
Xavier Nady (outfielder; twice)
Joe Nathan (relief pitcher)
Pat Neshek (relief pitcher)
Scott Proctor (relief pitcher)
Jo-Jo Reyes (pitcher)
José Rijo (pitcher)[14]
Kenny Rogers (pitcher)
List of notable American football
players receiving the surgery
• Craig Erickson
• Cameron Heyward (defensive end)
• Sebastian Janikowski (did not affect his career as
a placekicker)
• Rob Johnson
• Deion Sanders (a cornerback, wide receiver, and
return specialist in football; an outfielder in
baseball)
REHABILITATION
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• Though the surgical procedure has been refined, the major
advancements have come in the post-operative rehabilitation,
increasing the success rate from about 60% a decade or so ago.
• The surgery requires a full year of rehabilitation and typically
another year pitching before returning to pre-injury form.
• Essentially, the body must convert a tendon into a ligament, get it
carrying blood again and train it to start working as a ligament.
• It is very weak immediately after the surgery, and the rebuilding
process must be gradual.
Rehabilitation
• The elbow is immobilized in a hard brace for about a
week, then the patient begins exercises to regain limited
range of motion the second week.
• By the second or third week, he can use the arm for
everyday tasks like eating and combing his hair.
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He can start swinging a golf club after three months
and usually begin a light-tossing program at four
moments.
• The throwing program typically starts four months after
surgery, but it can be a month each
Rehabilitation
• The throwing program typically starts four months after surgery, but it
can be a month earlier or two months later.
• They look more like little leaguers in the first days. They start with two
sets of about 15 throws from 45 feet.
• Medically, most pitchers are ready to return to action in 12-15 months.
• Frequently, it’s another year before thy return to form.
• Some pitchers report an increase in velocity afterwards but surgery isn’t
the whole reason.
• Exercises to build the shoulder and forearm make the entire arm
stronger and sometimes the patient simply matures physically