Across America a majority of Tommy John elbow surgeries – also known as ulnar collateral ligament (UCL) reconstruction procedures – are being performed on teenagers.
According to an American Orthopaedic Society for Sports Medicine report (2007 to 2011), nearly 57 percent of these surgeries to correct a torn elbow ligament involve 15- to 19-year-olds, mostly baseball players.
This increasingly younger patient is reflected in the office of Preston Wolin, MD, director of sports medicine at the Chicago Center for Orthopedics at Weiss Memorial Hospital. The orthopedic surgeon says the number of patients in need of this procedure usually spikes in early August, following summer travel baseball season. “This is a disturbing surgical trend among high school pitchers and one that’s in large part preventable,” says Dr. Wolin, who is among the sports medicine team at Weiss that oversees the medical care of St. Rita of Cascia High School’s baseball team in Chicago. He’s also a baseball pitching coach for another Chicago area high school.
Top 3 Elbow Overuse Injury Prevention Measures
“Overuse of the arm is the main reason these kids need the Tommy John surgery,” Dr. Wolin notes. “If players, parents and coaches monitor three areas, we’ll see the number of these surgeries go down.”
- Players limit the number of pitches they throw in a game and accommodate an appropriate number of days of rest.
- Players take more time off in between seasons, limiting the number of teams in which they participate, instead of making baseball a year-round sport.
- Players participate in multiple sports so they are using different muscles throughout the year.
A Story from the Mound
St. Rita High School Senior Tyler Woynerowski, 18, of Burbank, Ill. agrees with those preventive measures, although he cannot imagine playing another sport other than baseball. He’s been playing the game since age 5 and quickly rose among the youth leagues as a star pitcher. He first noticed his elbow hurting at age 12 or 13, but played through the pain hoping physical therapy would be enough to correct his soreness. Following his freshman year at St. Rita in 2014, he joined a travel league for the summer.
“During that first game, on my first pitch, I felt something snap and a pop sound in my elbow, and my hand was numb for a bit,” Tyler explains. He played through the pain – again – but at first base. “I love the game of baseball!”
Despite the position switch, Tyler describes his elbow pain that summer becoming “unbearable.” He says, “I was underhanding the ball in between innings from first base and wondering if I would ever be able to pitch again.”
Tyler and his parents consulted with Dr. Wolin. At the end of July, it was determined Tyler would likely need Tommy John (TJ) surgery, named after the first pitcher to have it.
“We went in with a scope to clean up some of the scar tissue, but we quickly realized Tyler had to undergo TJ surgery,” Dr. Wolin says.
Ulnar collateral ligament (UCL) reconstruction/Tommy John surgery
The outpatient procedure takes about 90 minutes and has a 90 percent success rate.
It involves replacing the damaged elbow ligament (UCL) with a healthy tendon taken from the forearm or other part of the body, such as the hamstring. That healthy tendon is negotiated through holes drilled in the bone surrounding the elbow. The tendon eventually grafts to the bone.
Some players and parents are under the false impression that the procedures could be performed in the absence of injury to improve performance.
“That’s a myth,” Dr. Wolin says. “This surgery should be avoided, if at all possible, especially at such an early age. Despite the surgical success rate, it comes with risks and a long road to full recovery.”
Since surgery, Tyler says his pain has subsided and he feels great but he had to undergo almost 13 months of intense rehabilitation to get there.
Tracy Woynerowski, Tyler’s mother, noted, “It was hard enough to hear he needed surgery, but then to watch what he had to go through to rebuild his strength…it was difficult.”
Knowing what they know now, both said they would have approached some situations differently to avoid this injury and surgery.
Tyler is playing for the St. Rita team this spring as a first baseman with the hopes of returning to the mound as a pitcher someday soon with a comeback goal in mind: “I want to pitch a complete game and have it be a shutout.”
Dr. Wolin looks forward to seeing that day come for Tyler. He also hopes fewer teenagers will have to undergo what Tyler did to reach similar goals.
“If the baseball community works together and takes a few preventive measures, it will make the game of baseball safer and more fun for generations to come.”