Tommy John surgery
Encyclopedia
Tommy John surgery, known in medical
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 practice
Medical practice
A medical practice or practice of medicine is the practice of medicine, as performed by a medical practitioner—a physician...

 as ulnar collateral ligament (UCL) reconstruction, is a surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 procedure in which a ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...

 in the medial elbow is replaced with a tendon
Tendon
A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other...

 from elsewhere in the body (often from the forearm
Forearm
-See also:*Forearm flexors*Forearm muscles...

, hamstring
Hamstring
In human anatomy, the hamstring refers to any one of the three posterior thigh muscles, or to the tendons that make up the borders of the space behind the knee. In modern anatomical contexts, however, they usually refer to the posterior thigh muscles, or the tendons of the semitendinosus, the...

, knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...

, or foot of the patient). The procedure is common among collegiate and professional athletes in several sports, most notably baseball
Baseball
Baseball is a bat-and-ball sport played between two teams of nine players each. The aim is to score runs by hitting a thrown ball with a bat and touching a series of four bases arranged at the corners of a ninety-foot diamond...

.

The procedure was first performed in 1974 by Dr. Frank Jobe, who today serves as a Special Advisor to the Los Angeles Dodgers
Los Angeles Dodgers
The Los Angeles Dodgers are a professional baseball team based in Los Angeles, California. The Dodgers are members of Major League Baseball's National League West Division. Established in 1883, the team originated in Brooklyn, New York, where it was known by a number of nicknames before becoming...

, and is named after former major league pitcher Tommy John
Tommy John
Thomas Edward John Jr. is a former left-handed pitcher in Major League Baseball whose 288 career victories rank as the seventh highest total among left-handers in major league history...

 whose 288 career victories ranks seventh all time among left-handed pitchers.

Process

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
Ulna
The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form...

 and humerus
Humerus
The humerus is a long bone in the arm or forelimb that runs from the shoulder to the elbow....

 bone that are part of the elbow joint.

Prognosis

In 2009, chances of a complete recovery after surgery are estimated at 85 to 92 percent. 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
Physical medicine and rehabilitation
Physical medicine and rehabilitation , physiatry or rehabilitation medicine, is a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a...

 takes about one year for pitchers and about six months for position players. Players typically begin throwing about 16 weeks after surgery.

Risk factors

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.

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. 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
Slider
In baseball, a slider is a pitch that breaks laterally and down, with a speed between that of a curveball and that of a fastball....

 was associated with an 86% increased chance of elbow injury, while throwing a curve ball was associated with an increase in shoulder pain. There was only a weak correlation between throwing mechanics perceived as bad and injury. Thus, although there is a large body of other evidence that suggests mistakes in throwing mechanics increase the likelihood of injury 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.

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
Little League elbow
Little League elbow is a condition that is caused by repetitive throwing motions, especially in children who play sports that involve an overhand throw....

" and can be serious but does not require reconstructing the Ulnar Collateral Ligament.

Misconceptions

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. Over these years the pitcher's velocity will gradually decrease. 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

  • Brett Anderson
    Brett Anderson
    Brett Lewis Anderson is an English singer-songwriter, best known as the lead vocalist of the band Suede. After Suede disbanded in 2003, he briefly fronted The Tears, and has released four solo albums...

     (pitcher)
  • Rick Ankiel
    Rick Ankiel
    Richard Alexander Ankiel is a Major League Baseball outfielder who is currently with the Washington Nationals. He bats and throws left-handed....

     (pitcher converted to outfielder)
  • John Axford
    John Axford
    John Berton "The Ax Man" Axford is a Major League Baseball pitcher for the Milwaukee Brewers.-Path to the majors:...

     (relief pitcher)
  • Bong Jung-Keun (pitcher)
  • Bill Bray
    Bill Bray
    William Paul "Bill" Bray , is a Major League Baseball relief pitcher for the Cincinnati Reds. He is a graduate of the College of William and Mary...

     (pitcher)
  • Clint Brown
    Clint Brown
    Clint Brown is a former sports presenter for the TV3 in New Zealand. Considered one of the country's most talented sports broadcasters , Brown was with TV3 for 18 years, reporting and presenting.-Controversy and Resignation:...

     (pitcher)
  • A. J. Burnett
    A. J. Burnett
    Allan James "A. J." Burnett is a right-handed Major League Baseball starting pitcher for the New York Yankees. Previously, he played for the Florida Marlins and the Toronto Blue Jays...

     (pitcher)
  • José Canseco
    José Canseco
    José Canseco Capas, Jr. is a Cuban-American professional baseball manager, outfielder, and designated hitter for the Yuma Scorpions of the North American League and former Major League Baseball player. He is the identical twin brother of former major league player and current teammate Ozzie Canseco...

     (outfielder; injured while pitching)
  • Chris Capuano
    Chris Capuano
    Christopher "Chris" Frank Capuano is an American professional baseball player.-Early life:Capuano graduated from St. Thomas School in West Springfield in 8th grade...

     (pitcher, twice)
  • Chris Carpenter
    Chris Carpenter
    Christopher John Carpenter is a starting pitcher in Major League Baseball who has played for the St. Louis Cardinals since 2003, and is currently signed with the team until the 2011 season, with a club option for 2012.Carpenter was 22 years old and a highly-regarded prospect when he broke into the...

     (pitcher)
  • Joba Chamberlain
    Joba Chamberlain
    Justin Louis "Joba" Chamberlain is a Major League Baseball pitcher for the New York Yankees.-Early life:Chamberlain was born and grew up in Lincoln, Nebraska. Chamberlain's parents, Harlan Chamberlain and Jackie Standley, were never married and split up when Joba was 18 months old...

     (pitcher)
  • Shin-Soo Choo
    Shin-Soo Choo
    Shin-Soo Choo is a South Korean professional baseball outfielder with the Cleveland Indians of Major League Baseball in the United States.Choo was selected as the Most Valuable Player and Best Pitcher of the 2000 World Junior Baseball Championship as South Korea won the event...

     (outfielder)
  • Manny Corpas (pitcher)
  • Jorge De La Rosa
    Jorge de la Rosa
    Jorge Alberto de la Rosa Gonzalez is a starting pitcher for the Colorado Rockies.-Minor leagues:...

     (pitcher)
  • John Dopson
    John Dopson
    John Robert Dopson, Jr. , is a former professional baseball player who pitched in the Major Leagues from 1985 and 1988-1994. Now he is a pitching instructor...

     (pitcher)
  • Scott Feldman
    Scott Feldman
    Scott Feldman was a news anchor for News 12 Long Island for 22 years.-Early life:Feldman was born in St. Louis, Missouri, graduated from the University of Denver in 1971. He served in the U.S. Army Reserves and National Guard....

     (pitcher)
  • John Franco (relief pitcher, holder of NL record for games pitched)
  • Éric Gagné
    Éric Gagné
    Éric Serge Gagné is a former Major League Baseball pitcher.Signing with the Los Angeles Dodgers as a free agent in 1995, Gagné began his career as a starting pitcher...

     (relief pitcher)
  • Jaime Garcia
    Jaime Garcia (baseball)
    Jaime Omar García is a Major League Baseball pitcher for the St. Louis Cardinals.-Early life:Jaime García was born on July 8, 1986 in Reynosa, Tamaulipas, Mexico as the second of three children to civil engineer Jaime García, Sr. and Gloria Rodríguez Flores. García was raised between the border of...

     (pitcher)
  • Matt Holliday
    Matt Holliday
    Matthew Thomas Holliday , nicknamed "Big Daddy", is an American Major League Baseball left fielder for the St. Louis Cardinals. Holliday was originally drafted by the Colorado Rockies in the seventh round of the 1998 Major League Baseball Draft.Holliday is a five-time All-Star and Silver Slugger...

     (outfielder)
  • Tim Hudson
    Tim Hudson
    Timothy Adam Hudson is a starting pitcher in Major League Baseball who plays for the Atlanta Braves. Hudson began his major league career with the Oakland Athletics and played his last two years of college eligibility at Auburn University...

     (pitcher)
  • Todd Hundley
    Todd Hundley
    Todd Randolph Hundley is a former Major League Baseball catcher and outfielder. He is the son of former Chicago Cubs catcher Randy Hundley...

      (catcher)
  • Tommy John
    Tommy John
    Thomas Edward John Jr. is a former left-handed pitcher in Major League Baseball whose 288 career victories rank as the seventh highest total among left-handers in major league history...

     (pitcher)
  • Josh Johnson (pitcher)
  • Hong-Chih Kuo
    Hong-Chih Kuo
    Hong-Chih Kuo is a Major League Baseball pitcher with the Los Angeles Dodgers. When Kuo made his debut in , he became the fourth MLB player from Taiwan ....

     (relief pitcher; four)
  • Francisco Liriano
    Francisco Liriano
    Francisco Liriano y Casillas is a left-handed Major League Baseball starting pitcher for the Minnesota Twins.-Professional career:...

     (pitcher)
  • Shaun Marcum
    Shaun Marcum
    Shaun Michael Marcum is an American professional baseball starting pitcher for the Milwaukee Brewers of Major League Baseball.-Early life:...

     (pitcher)
  • Daisuke Matsuzaka
    Daisuke Matsuzaka
    is a Japanese professional baseball pitcher with the Boston Red Sox of Major League Baseball in the United States. He previously played for the Seibu Lions in Japan's Pacific League. He was selected the MVP of the inaugural and the second World Baseball Classic, and is an Olympic bronze...

     (pitcher)
  • Kris Medlen
    Kris Medlen
    Kristopher Allen Medlen is a Major League Baseball pitcher for the Atlanta Braves.-Professional career:Medlen was drafted by the Braves in the 10th round of the 2006 Major League Baseball Draft....

     (pitcher)
  • Sergio Mitre
    Sergio Mitre
    Sergio Armando Mitre is a American professional baseball pitcher.-Background:Mitre is of Mexican American descent. He grew up in Tijuana, Mexico, where he trained in the arts of kenpo, boxing and wrestling due to frequent street fights.Mitre graduated from Montgomery High School in San Diego,...

     (pitcher)
  • Paul Molitor
    Paul Molitor
    Paul Leo Molitor , nicknamed "Molly" and "The Ignitor", is an American former Major League Baseball designated hitter and infielder. During his 21-year baseball career, he played for the Milwaukee Brewers , Toronto Blue Jays , and Minnesota Twins...

      (infielder)
  • Jamie Moyer
    Jamie Moyer
    Jamie Moyer is an American professional left handed baseball pitcher who is currently a free agent. At the time of his last game to date , he was the oldest player in the major leagues and had the most wins, losses, and strikeouts of any active Major League pitcher...

     (pitcher)
  • Xavier Nady
    Xavier Nady
    Xavier Clifford Nady VI is a Major League Baseball outfielder and first baseman, who is a free agent.-Amateur career:The St. Louis Cardinals originally drafted Nady in the 4th round of the 1997 Major League Baseball Draft after he was named Northern California Player of the Year in his senior...

     (outfielder; twice)
  • Joe Nathan
    Joe Nathan
    Joseph Michael Nathan is an American professional baseball pitcher for the Texas Rangers of Major League Baseball . Nathan started out his baseball career as a shortstop in high school but converted to a pitcher after being drafted by the San Francisco Giants...

     (relief pitcher)
  • Pat Neshek
    Pat Neshek
    Patrick J. Neshek is an American professional baseball pitcher who is a free agent. Neshek is a graduate of Park Center Senior High School in Minnesota and of Butler University.-Early career:...

     (relief pitcher)
  • Scott Proctor
    Scott Proctor
    Scott Christopher Proctor is an American professional baseball pitcher who is currently a Free Agent.-Minor leagues:Proctor was drafted in the 17th round of the 1995 Major League Baseball Draft by the New York Mets out of Martin County High School, but decided to attend Florida State University,...

     (relief pitcher)
  • Jo-Jo Reyes
    Jo-Jo Reyes
    Joseph Albert "Jo-Jo" Reyes is an American professional baseball pitcher for the Baltimore Orioles of Major League Baseball...

     (pitcher)
  • José Rijo
    José Rijo
    José Antonio Rijo Abreu is a former right-handed pitcher in Major League Baseball who spent the majority of his career with the Cincinnati Reds .-Playing career:...

     (pitcher)
  • Kenny Rogers (pitcher)
  • Deion Sanders
    Deion Sanders
    Deion Luwynn Sanders , nicknamed "Prime Time" and "Neon Deion", is a former National Football League cornerback and Major League Baseball outfielder who currently works as an NFL Network analyst...

     (outfielder)
  • Scott Schoeneweis
    Scott Schoeneweis
    Scott David Schoeneweis is an American Major League Baseball left-handed relief pitcher who is currently a free agent.In the five seasons from 2003–07, Schoeneweis allowed only one home run to left-handed batters...

     (pitcher)
  • John Smoltz
    John Smoltz
    John Andrew Smoltz is an American former Major League Baseball pitcher and active sportscaster. He is best known for his prolific career of more than two decades with the Atlanta Braves, in which he garnered eight All-Star selections and received the Cy Young Award in 1996...

     (pitcher)
  • Stephen Strasburg
    Stephen Strasburg
    Stephen James Strasburg is a right-handed pitcher for the Washington Nationals, who selected him with the first pick in the 2009 Major League Baseball Draft...

     (pitcher)
  • Dallas Trahern
    Dallas Trahern
    Dallas Neal Trahern is a professional baseball pitcher.Trahern was drafted by the Detroit Tigers in the 34th round of the 2004 Major League Baseball Draft...

     (pitcher)
  • Edinson Volquez
    Edinson Volquez
    Edinson Volquez [VOL-kez] , is a starting pitcher in Major League Baseball for the Cincinnati Reds. He bats and throws right-handed....

     (pitcher)
  • Billy Wagner
    Billy Wagner
    William Edward Wagner , nicknamed "Billy the Kid", is a retired Major League Baseball relief pitcher. He pitched for the Houston Astros , the Philadelphia Phillies , the New York Mets , the Boston Red Sox , and the Atlanta Braves...

     (relief pitcher)
  • Adam Wainwright
    Adam Wainwright
    Adam Parrish Wainwright is a right-handed starting pitcher in Major League Baseball for the St. Louis Cardinals. He was drafted 29th overall by the Atlanta Braves in the 2000 amateur draft. He made his major league debut for the St...

     (pitcher)
  • Brian Wilson (relief pitcher)
  • C.J. Wilson (pitcher)
  • Kerry Wood
    Kerry Wood
    Kerry Lee Wood is a National Major League Baseball relief pitcher. Wood recorded over 200 strikeouts in four out of his first five seasons, with a high of 266 in 2003....

     (pitcher)
  • Jordan Zimmermann
    Jordan Zimmermann
    Jordan Zimmermann is a pitcher for the Washington Nationals. He was the Nationals' best prospect going into the 2009 MLB season, according to Baseball America.-Professional career:...

     (pitcher)
  • Ryan Vogelsong
    Ryan Vogelsong
    Ryan Andrew Vogelsong is a Major League Baseball pitcher for the San Francisco Giants. In addition to an earlier stint with the Giants , he has played for the Pittsburgh Pirates , and for Nippon Professional Baseball's Hanshin Tigers and Orix Buffaloes .-Amateur career:He graduated from Octorara...

     (pitcher)


List of notable American football players receiving the surgery

All players listed are quarterback
Quarterback
Quarterback is a position in American and Canadian football. Quarterbacks are members of the offensive team and line up directly behind the offensive line...

s unless noted otherwise.
  • Jake Delhomme
    Jake Delhomme
    Jake Christopher Delhomme is an American football quarterback for the Houston Texans of the National Football League. Delhomme played college football at Louisiana-Lafayette before being signed by the New Orleans Saints as an undrafted free agent in 1997...

  • Craig Erickson
    Craig Erickson
    Craig Neil Erickson is a former professional quarterback who was selected by the Philadelphia Eagles in the 5th round of the 1991 NFL Draft and also by the Tampa Bay Buccaneers in the 4th round of the 1992 NFL Draft. He is one of the few NFL players to be drafted twice, most famously Bo...

  • Cameron Heyward
    Cameron Heyward
    -Pittsburgh Steelers:Heyward was drafted in the first round of the 2011 NFL Draft by the Pittsburgh Steelers.On July 29, 2011, Heyward signed a four-year deal with an option of a fifth year contract with the Pittsburgh Steelers...

     (defensive end)
  • Sebastian Janikowski
    Sebastian Janikowski
    Sebastian Janikowski is a left-footed Polish placekicker who plays for the National Football League's Oakland Raiders. He is nicknamed The Polish Cannon because he is considered to have one of the strongest kicking legs in the league, and leads the NFL in kickoffs for touchbacks. He lives in...

     (did not affect his career as a placekicker
    Placekicker
    Placekicker, or simply kicker , is the title of the player in American and Canadian football who is responsible for the kicking duties of field goals, extra points...

    )
  • Rob Johnson
    Rob Johnson (football player)
    Rob Garland Johnson is a former professional American football quarterback who played for 10 seasons in the National Football League .-College career:...

  • Deion Sanders
    Deion Sanders
    Deion Luwynn Sanders , nicknamed "Prime Time" and "Neon Deion", is a former National Football League cornerback and Major League Baseball outfielder who currently works as an NFL Network analyst...

     (a cornerback
    Cornerback
    A cornerback is a member of the defensive backfield or secondary in American and Canadian football. Cornerbacks cover receivers, to defend against pass offenses and make tackles. Other members of the defensive backfield include the safeties and occasionally linebackers. The cornerback position...

    , wide receiver, and return specialist in football; an outfielder in baseball)

External links

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