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Get answers to your Shoulder and Elbow questions.
In September 2010, Washington Nationals pitcher Stephen Strasburg underwent a special type of reconstructive elbow surgery known as Tommy John surgery. Dr. James Dreese, assistant professor of orthopaedics and team physician for the University of Maryland Terrapins, answers some frequently asked questions about this procedure below.
The motion involved in throwing a baseball, or any other type of object, places stress on the medial (inner) side of the elbow. The ulnar collateral ligament is the ligament most responsible for resisting this stress, and, as a result, can often be injured. Tommy John surgery is used to correct the injury caused to the ligament.
Injury is most common in baseball pitchers because the baseball is relatively small, and throwing it at a high speed generates very high angular velocity in the arm, which places a high degree of stress on the elbow. Those baseball pitchers who throw at high speeds are particularly at risk for injury to the ulnar collateral ligament.
The first 12 weeks after surgery are spent working on restoring range of motion. Four months following surgery, a light throwing program is instituted. Progression of the throwing program occurs over several months. Throwing from the pitchers mound is not permitted until six or seven months following surgery. Return to competition typically occurs at nine to twelve months following surgery.
Outcome studies show that 70-90 percent of throwers are able to return to the same level of competition.
In general, the factors that place pitchers most at risk for injury are high throwing velocity and high repetition of throws. Maintaining pitch counts can certainly be helpful. Some throwers may also be at an increased risk as a result of their throwing mechanics. Study of these factors is complicated, but arm position, trunk rotation, and core mechanics also likely play a role.
Experience is important with any surgery, but it is particularly important with Tommy John surgery. The operation requires precision and outcomes can be negatively affected if not performed well. In addition, the post-operative recovery phase can have setbacks that require early recognition and appropriate adjustment in the rehabilitation protocol.
I do perform ulnar collateral ligament reconstruction surgery in throwing athletes who fail non-operative treatment. The results are very good, but the rehabilitation process can take up to one year before there can be a return to competitive throwing.
This page was last updated on: September 30, 2010.