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Why Pitchers Have Tommy John Surgery

G. Russell Huffman, MD, MPH
G. Russell Huffman, MD, MPH

When it comes to throwing a ball, most think the magic is in the arm or the shoulder. It’s not.

The secret sauce is body mechanics.

“In reality, about seventy percent of the velocity of say, a fastball pitch, actually comes from the pitcher’s leg and torso,” explains G. Russell Huffman, MD, Director of the Shoulder and Elbow Fellowship Program at the Penn Musculoskeletal Center.

“The shoulder, elbow and hand are really for ball control more so than velocity,” he adds.

When a pitcher develops poor mechanics during prolonged use, Dr. Huffman says, “it can ultimately lead to shoulder or elbow injuries.”

The Surgical Solution

Elbow injuries are a common problem for pitchers, whether they play professionally or at an amateur level.

A common fix is Tommy John surgery.

The surgery, named after the Los Angeles Dodgers player who first had the procedure in 1974, fixes tears in the ulnar collateral ligament (UCL) of the elbow. This ligament connects the forearm bone (ulna) and the upper arm bone (humerus).

Where Pitching Problems Start

At the root of elbow injuries is poor mechanics. But that’s not the only problem.

Dr. Huffman cites overuse as another key factor. And when you’re good at what you do, the problem gets compounded.

Baseball pitcherAlso, younger athletes who participate in multiple leagues may end up pitching year-round. This prevents their bodies from fully resting and recovering.

Ensuring that the body recovers is critical, considering the severe nature of pitching.

“When you release the ball, it’s a pretty violent act,” explains Dr. Huffman. “Just the act of throwing and using all that stored energy in your body to transmit that into a moving object creates some damage that your body can handle.”

But if you don’t take time to rest during and after games, stretch, and let the muscles recuperate, “then the damage keeps building up,” he adds. “You start to lose motion through your shoulder, and then that translates down the arm into the elbow.”

Tommy John: The Repair Job

In Tommy John surgery, a tendon from another part of the body—usually the wrist—is used to reconstruct the damaged UCL in the elbow. The fairly quick procedure takes about 90 minutes.

Traditional Tommy John surgery requires the surgeon to drill a hole in the ulna and humerus bones, and thread the ligament through the bone.

The surgeons at Penn refined their surgical technique, which allows athletes to perform on a higher level.

“We’ve developed a very reliable technique for doing both Tommy John and first-time revision surgery. It’s a little bit of a smaller incision and preserves a little more bone than the traditional fix,” says Dr. Huffman.

Recovery, no matter which technique is used, usually takes up to 18 months.

Why Pitchers Feel They’re Better Than Before

Dr. Huffman says there’s a perception among players that the surgery makes pitchers better.

That’s because it does.

Players understand good mechanics. So, they shift their focus to prevent re-injury.

“The first step is building up leg and core strength,” says Dr. Huffman. "Then, it’s about consistent shoulder stretching and helping athletes become better advocates for themselves by letting coaches know when they need rest.”

When pitchers prepare to go back for their first full season, Dr. Huffman applies the rehab approach for golfers: short, quality outings.

“They have high-quality outings with a lot of strikes, so no one gets discouraged, and they’re not overutilized,” Dr. Huffman says. “I think that’s a smarter way to go back, rather than trying for a complete game the first day out.”

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