Tommy John

Ulnar Collateral Ligament (UCL) reconstruction, also known as Tommy John surgery has become common among baseball pitchers and other throwing athletes. Due to the repetitive motions of overhead throwing athletes, like major league pitchers, overuse and improper wear can lead to microscopic trauma. This, over time can contribute to weakness and laxity causing injury in the ulnar collateral ligament.

Causes of UCL injury

The ulnar collateral ligament provides the primary resistance to valgus (lateral displacement away form midline) stress that occur during the late cocking and early acceleration phases of throwing, during a forehand stroke in tennis, or in a trailing arm during an improper golf swing (1). It is commonly injured due to repetitive trauma of a valgus force.

How Tommy John surgery works

Even though Tommy John surgery is very common these days among athletes it is still a surgery that requires an extensive and lengthy rehabilitation process. For surgery, surgeons drill holes into the ulna and humerus bones so the new tendon can be weaved like a figure eight. Tendons are commonly taken from the palmaris longus tendon in the forearm, hamstring tendon, or the big toe extensor tendon.

Implications of Tommy John Surgery

Just like any surgery, changing the structure of the body can have lasting implications and is a major stressor on the system. Athletes typically return to full level activity within a year, however surgery includes moving major muscle in order to get the bones for re-attachment of tendons. This process can have potential issues including nerve or blood damage, which can lead to permanent numbness and/or weakness. Additionally, the ulnar nerve which passes around the elbow joint may need to be moved to prevent future exasperation in the elbow region.

Tommy John surgery should not be taken lightly and is not a substitute for improper mechanics, poor strengthening program, and lack of proper recovery protocols and/ or rest. For instance, it is not uncommon for individuals to seek Tommy John surgery regardless of the injury because it is believed to improve overhead activities. However, this is not the case and getting this type of surgery does not imply increases in athletic performance. It is important to prevent UCL reconstruction by following a proper exercise routine, taking adequate rest and adhering to a good nutritional program to promote recovery and ligament health.


  1. Prentice, W. E., & Arnheim, D. D. (2011). Arnheims principles of athletic training: A competency-based approach. New York: McGraw-Hill Higher Education.

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