Tommy John surgery
306900
226128058
2008-07-16T23:02:11Z
24.148.5.215
/* List of baseball players receiving the surgery */
'''Tommy John surgery,''' known by doctors as '''[[ulnar collateral ligament (elbow) | ulnar collateral ligament]] reconstruction''' (or '''UCL'''), is a surgical procedure in which a [[ligament]] in the medial [[Elbow-joint|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 baseball players.
The surgery is named after [[Tommy John]], a pitcher for the [[Los Angeles Dodgers]] who was the first professional athlete to successfully undergo the operation in 1974. The procedure was performed by Dr. [[Frank Jobe]].
==Process==
After the tendon from the forearm of the opposite elbow or below the knee 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.
There is a risk of damage to the [[ulnar nerve]].<ref name="pmid17279038">{{cite journal |author=Purcell DB, Matava MJ, Wright RW |title=Ulnar collateral ligament reconstruction: a systematic review |journal=Clin. Orthop. Relat. Res. |volume=455 |issue= |pages=72–7 |year=2007 |pmid=17279038 |doi=10.1097/BLO.0b013e31802eb447}}</ref>
==Recovery==
Chances of a complete recovery after surgery are estimated today at 85 to 90 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. Today, the procedure takes about an hour. Full [[Physical medicine and rehabilitation|rehabilitation]] takes about a year for pitchers and about six months for position players. Usually, pitchers who have the surgery can get their full range of motion back after about two months and can start doing weight exercises. For the next four months, they can increase the weight that they use and start doing exercises that emphasize all parts of their arm.
==Risk of injury==
The collateral ligament can become stretched, frayed, or torn through the stress of the throwing motion.
The risk of injury to the throwing athlete's UCL of the elbow is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during each and every hard throw<ref>Fleisig, G.S., The biomechanics of baseball pitching, in Biomechanical Engineering. 1994, University of Alabama: Birmingham. p. 163.</ref>.
In some cases, pitchers will seem to throw harder after the surgery than they did before the injury that caused the surgery to be necessary. However, many people -- including Dr. Frank Jobe, the doctor who invented the procedure -- believe this is 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 degrade. Over these years the pitcher's velocity will gradually decrease. As a result, the surgery simply allows the pitcher to throw at the velocity that he could before his UCL started to degrade<ref>Keri, Jonah, Interview With Frank Jobe. http://espn.go.com/mlb/columns/bp/1431308.html</ref>.
Today, the injury and eventual surgery are becoming more common in children 10-18 years old due to increased season length, the rise of travel teams (and tournament play), and the more frequent use of [[breaking pitch]]es by young pitchers. Children have an additional risk factor because of the open growth plates in young bones. In younger athletes for whom the growth plate (the medial epicondylar physis) is still present, the "opening up" force at the inside of the elbow during throwing is more likely to fail at this region (the growth plate) than at the Ulnar Collateral Ligament. This injury is often termed "[[Little League Elbow]]," and does not require reconstructing the Ulnar Collateral Ligament.
While many authorities suggest that an individual's style of throwing or the type of pitches he throws are the most important aspects of his likelihood to sustain an injury, the results of a 2002 study suggest that the total volume of throwing is the greatest determinant<ref>Lyman, S., et al., Effect of pitch type, [[pitch count]], and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med, 2002. 30(4): p. 463-8.</ref>. The 2002 study followed 426 pitchers aged 9 to 14 for one year, and studied their throwing volume, pitch type, and throwing mechanics. Compared to pitchers who threw 200 or fewer pitches in a season, players 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]] 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<ref>Whiteley, R., Baseball throwing mechanics as they relate to pathology and performance - a review. Journal of Sports Science & Medicine, 2007. 6(1): p. 1-20.</ref> 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<ref>Lyman, S., et al., Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc, 2001. 33(11): p. 1803-10.</ref>.
==List of baseball players receiving the surgery==
All are [[pitcher|pitchers]] unless otherwise noted.
*[[Brian Anderson (pitcher)|Brian Anderson]]
*[[Rick Ankiel]] (converted to [[outfielder]])
*[[Andy Ashby]]
*[[Luis Ayala]]
*[[Brandon Backe]]
*[[Danys Baez]] (out for 2008 season)
*[[Rocco Baldelli]] ([[outfielder]])
*[[Rod Beck]] (deceased)
*[[Erik Bedard]]
*[[Francis Beltran]]
*[[Jeff Bennett (baseball)|Jeff Bennett]]
*[[Kris Benson]]
*[[Adam Bernero]]
*[[Brent Billingsley]]
*[[Joe Borchard]] ([[outfielder]])
*[[Dewon Brazelton]]
*[[Ambiorix Burgos]]
*[[A. J. Burnett]]
*[[Paul Byrd]]
*[[Jorge Campillo]]
*[[José Canseco]] (former outfielder; injured while pitching)
*[[Chris Capuano]] (currently rehabbing; twice)
*[[Chris Carpenter]]
*[[Rocky Cherry]]
*[[Shin-Soo Choo]] ([[outfielder]])
*[[Todd Coffey]]
*[[Manny Delcarmen]]
*[[Ryan Dempster]]
*[[Chris Denorfia]] ([[outfielder]])
*[[Jorge DePaula]]
*[[Brendan Donnelly]] (currently rehabbing)
*[[Octavio Dotel]]
*[[Adam Eaton]]
*[[Dave Eiland]] (twice)
*[[Willie Eyre]] (currently rehabbing)
*[[Jesse Foppert]]
*[[Chad Fox]] (three times)
*[[Frank Francisco]]
*[[Eric Gagné]]
*[[Rusty Greer]] (former outfielder)
*[[Luis Gonzalez (outfielder)|Luis Gonzalez]] ([[outfielder]])
*[[Mike Gonzalez (baseball)| Mike Gonzalez]]
*[[Angel Guzman]] (currently rehabbing)
*[[Mike Hampton]]
*[[Pat Hentgen]]
*[[Runelvys Hernández]]
*[[Shawn Hill]]
*[[Matt Holliday]] ([[outfielder]])
*[[Norris Hopper]] ([[outfielder]])
*[[Philip Humber]]
*[[César Izturis]] ([[infielder]])
*[[Jason Isringhausen]]
*[[Tommy John]]
*[[Kelly Johnson (baseball)|Kelly Johnson]] (converted from [[outfielder]] to [[infielder]])
*[[Steve Karsay]]
*[[Jimmy Key]]
*[[Josh Kinney]]
*[[Hong-Chih Kuo]] (twice)
*[[Cory Lidle]]
*[[Jon Lieber]]
*[[Francisco Liriano]]
*[[Matt Mantei]]
*[[Scott Mathieson]] (twice; out for 2008 season)
*[[Joe Mays]]
*[[Seth McClung]]
*[[Dustin McGowan]]
*[[Forman Mills]]
*[[Matt Morris]]
*[[Peter Moylan]]
*[[Xavier Nady]] (outfielder)
*[[Russ Ortiz]]
*[[Juan Padilla]]
*[[John Parrish]]
*[[Carl Pavano]] (currently rehabbing)
*[[Chris Ray]] (currently rehabbing)
*[[Carlos Quentin]]
*[[Britt Reames]]
*[[Arthur Rhodes]]
*[[Matt Riley]] (three times)
*[[Ricardo Rincón]]
*[[Mariano Rivera]]
*[[Fernando Rodney]]
*[[Kenny Rogers (baseball)|Kenny Rogers]]
*[[Francisco Rosario]]
*[[B. J. Ryan]]
*[[Aníbal Sánchez]]
*[[Jose Rijo]] (three times)
*[[Humberto Sánchez]]
*[[Scott Schoeneweis]]
*[[Jae Seo]]
*[[John Smoltz]]
*[[Kyle Snyder]]
*[[Rafael Soriano]]
*[[Tim Spooneybarger]]
*[[Merkin Valdez]]
*[[Tyler Walker]]
*[[Travis Webb]]
*[[Jake Westbrook]]
*[[Scott Williamson]]
*[[Brian Wilson]]
*[[Vance Wilson]] (catcher)
*[[Mark Wohlers]]
*[[Randy Wolf]]
*[[Kerry Wood]]
*[[Jaret Wright]]
*[[Tyler Yates]]
*[[Matt Young]]
*[[Mike Zagurski]]
*[[Víctor Zambrano]] (twice)
*[[Jeff Zimmerman]] (twice)
== List of football players receiving the surgery ==
*[[Jake Delhomme]] (currently rehabbing)
*[[Craig Erickson]]
*[[Chris Hunter]]
*[[Sebastian Janikowski]]
*[[Rob Johnson (football player)|Rob Johnson]]
==References==
<references/>
==External links==
*[http://www.usatoday.com/sports/baseball/2003-07-28-cover-tommy-john_x.htm USA Today article]
*[http://www.ocfamily.com/archives/ocfamily_2005/ocfamily0205/game_0205.html OC Family Magazine article on avoiding Tommy John injury in young pitchers]
*[http://www.asmi.org/asmiweb/usabaseball.htm Research-based pitch limit suggestions according to the age of the pitcher]
[[Category:Surgery]]
[[Category:Sports medicine]]
[[de:Tommy John Surgery]]
[[nl:Tommy John-operatie]]
[[ja:トミー・ジョン手術]]
[[zh:尺骨附屬韌帶重建術]]