Tommy John Surgery


The American Sports Medicine Institute (ASMI) and Auburn University School of Kinesiology have teamed up to provide regular news articles to keep you informed about current findings in the field.

DUCT tape for elbow injuries? … Why not?

In the last few years, there has been an epidemic of elbow injuries in baseball pitchers requiring UCL surgery (“Tommy John Surgery”). In particular, the number and percentage of patients at the youth and high school level has risen dramatically. In fact, of the 200 reconstructions that are carried out a year at the Andrews Sports Medicine and Orthopedic Center, about 60% are collegiate and high school athletes.

elbow dugas

Until recently, the only surgical solution for a major elbow injury was complete reconstruction, which means a yearlong rehabilitation process. However, Dr. Jeff Dugas, a surgeon at Andrews Sports Medicine, is performing a new surgical approach to damaged ulnar collateral ligaments that could potentially cut down the recovery period for pitchers by at least six months. While most of those with full tears of the ligament will need reconstruction surgery, others (particularly those with only partial tears) are benefiting from what is called UCL “repair”.

Dr. Dugas uses a collagen-dipped super-tape, which he sews attached to each side of the damaged ligament, and then anchors it to the bone on each side of the elbow. You can see now why we call it “Dugas Ulna Collateral Tape” (DUCT) tape! In fact, the tape is so strong you could use it to tow a car. Considering the forces that act on the elbow during throwing, that’s an important factor.

Dr. Dugas has performed this kind of surgery over 30 times, and has a 100% record of those patients returning to the same level of competition before their surgery in six months and with full range of motion.

Five interesting facts about Tommy John surgery:
  1. Tommy John surgery is not named after a surgeon! It is named after the first player to have the surgery. The surgeon was Dr. Frank Jobe.
  2. Tommy John stood a 1 in 100 chance of returning to pitching before the surgery. However, after 18 months of rehabilitation he went on to pitch until age 46, notching 288 career victories.
  3. The medical name for the surgery is “ulnar collateral ligament (UCL) reconstruction.”
  4. During the surgery, the UCL is replaced by a tendon from somewhere else in the body (usually from the wrist).
  5. Historically, 15-20 MLB pitchers have undergone Tommy John surgery annually, but over the past three years that number has increased to 25-30.

Dr. Frank Jobe
Dr. Frank Jobe, who first performed Tommy John surgery.

 

 How does the surgery work?
  1. Holes are drilled in the ulna and humerus bones to house the new tendon.
  2. The tendon is most commonly woven into a figure-eight pattern through the drilled holes and then anchored. Sometimes screws are used.
  3. The doctor might also move the ulnar nerve during surgery to prevent pain and the pressures of scar tissue on the nerve.
  4. Watch a movie of the procedure (~12 minutes)

elbow tendon

 

What happens next?
  1. The tendon graft is very weak immediately after the surgery. Transforming a tendon into a functioning ligament requires a very gradual rebuilding process.
    posterior elbow brace
  2. You start with gentle hand grip and shoulder and wrist mobilization exercises immediately after surgery.
  3. Your elbow is immobilized for a week to 10 days, when you then begin some range-of-motion exercises for the elbow.
  4. You might be asked to wear a special hinged brace to protect the elbow.
  5. You then begin strengthening exercises for the entire upper quadrant (shoulder, arm, wrist, and hand).
  6. If you follow the rehab program well, you can get your full range of motion back in six to eight weeks.ucl-brace
  7. The process of rehabilitation to return to the pre-injury level of playing takes about a year for pitchers and about six months for position players.

 

Top 10 tips for youth baseball pitchers
  1. Watch and respond to signs of fatigue (such as decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches).
  2. No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred).dt_141018_little_league_pitcher_800x600
  3. No competitive baseball pitching for at least 4 months per year.
  4. Do not pitch more than 100 innings in games in any calendar year.
  5. Follow limits for pitch counts and days rest.
  6. Avoid pitching on multiple teams with overlapping seasons.
  7. Learn good throwing mechanics as soon as possible. The first steps should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.
  8. Avoid using radar guns.
  9. A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury.
  10. If a pitcher complains of pain in the elbow or shoulder, discontinue pitching until evaluated by a sports medicine physician.

For More information, visit our websites:

http://www.andrewssportsmedicine.com/

http://www.education.auburn.edu/kinesiology

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