Ulnar Collateral Ligament Injury / Tommy John Procedure

The elbow joint is stabilized by ligaments on the inside (medial) and outside (lateral) aspects of the elbow. The ligament on the inner aspect of the elbow is known as the ulnar collateral ligament. In overhead athletes, particularly pitchers, the throwing motion puts high levels of repetitive stress on this ligament. Over time, this ligament can become stretched or torn. When this occurs, athletes may notice pain on the medial aspect of the elbow with throwing. This may be associated with a drop in velocity or problems with accuracy. Occasionally, the repetitive stress may also can injury to the nearby ulnar nerve, which may result in pain, numbness, or tingling radiating into the hand.

In most cases, initial treatment for ulnar collateral ligament injuries involves rest from overhead sports and a therapy program to focus on elbow strengthening and body mechanics. Patients who have persistent discomfort after non-operative treatment, or those who have a complete rupture of the ligament and wish to resume throwing high-level throwing may opt for surgery.

The procedure to reconstruct the ulnar collateral ligament has commonly been known as Tommy John surgery. It as an outpatient surgery in which an incision is made over the medial aspect of the elbow, and a tendon from the patient or a donor is used to recreate the damaged ligament. Therapy begins after surgery to help restore strength and stability to the arm, followed a specialized sport-specific program to return athletes to overhead activity.

Further information on this injury can be found in this handout, or on the AAOS OrthoInfo website, an orthopaedic resource center providing expert information.