Tommy John injuries an epidemic in Little League

The injury that St. Louis Cardinals star pitcher Adam Wainwright suffered in the bullpen during spring training isn't just a big league problem. As baseball season approaches, Little Leaguers and other school-age players should be aware that they can damage their elbows. Dr. Anand M. Murthi, attending orthopedic surgeon and chief of shoulder and elbow surgery at Union Memorial Orthopedics and Sports Medicine, explains the surgery that is sometimes necessary for repairs. It's called ulnar collateral ligament (UCL) reconstruction, better known as Tommy John surgery, named after the former pitcher who was one of the first professional athletes to successfully undergo the procedure.

Question: What is the anatomy of the elbow, and what can go wrong?

Answer: The elbow is held together by muscles, ligaments and the bony architecture. The elbow flexor and extensor muscles provide dynamic stability to the elbow, while the surrounding ligaments provide stability of the bones themselves forearm to arm. The bones of the elbow (humerus, radius, and ulna) are inherently stable unless a ligamentous injury occurs or fracture. The medial collateral ligament of the elbow (Tommy John injury/ligament), holds and supports the inside part of the arm (humerus) to the forearm (ulna). It is the main stabilizer for the elbow when throwing.

Q: Are there steps to take to prevent injury to the ligaments?

A: For pitchers or throwing sports, making sure to keep the shoulder and wrist strong and flexible will take the stress off the elbow. Also making sure the core muscles (legs, back, abdomen etc) are strong and will assist in keeping the elbow stable and provide strength during the throwing motion.

For pitchers especially and in younger athletes, making sure to have the appropriate amount of rest in between pitching days is crucial. Also, an appropriate pitch count per game has proven to be necessary to prevent these injuries in our throwing athletes.

This has become an epidemic in youth leagues. Overuse and pitching on too many days and excessive pitch counts has led to a higher incidence of medial collateral ligament injuries.

Q: If you do have a ligament injury, what are the symptoms?

A: Symptoms are usually only when throwing, and are an aching, sharp pain on the medial (inside part) of the elbow.

Throwers will notice a decrease in pitch velocity and accuracy.

Infrequently, pitchers will actually notice a "pop," which is an actual sensation of the ligament rupturing with an acute episode of pain and inability to throw any more pitches (sounds like this is what happened to Adam Wainwright).

Q: What is Tommy John surgery and who can benefit?

A: Tommy John surgery or medial collateral ligament reconstruction is named after Tommy John who was a pitcher with the Los Angeles Dodgers. In 1974 he injured his elbow/medial collateral ligament and was unable to pitch and almost had to retire, when Dr. Frank Jobe performed the revolutionary surgery that bears his name. John was able to return and be a productive pitcher for many more years.

The surgery entails taking a tissue graft (either from the patient or allograft-cadaver graft) and weaving it through holes/tunnels in the arm bone (humerus) and forearm bone (ulna) and tensioning it to reconstruct the damaged medial collateral ligament. The patients then undergo a period of rehabilitation.

Q: Will patients be able to return to sports, specifically throwing, and when?

A: In the largest series of patients in the literature, approximately 80 percent of patients returned to their previous level of competition or higher. The average time to full competition was about 11 months. It often takes 12-18 months to return to their previous level of sports participation.