Dead Arm in Baseball Pitchers

1
Dead Arm in Baseball Pitchers

• Tear of the ulnar collateral ligament (UCL) A
  second degree sprain
• Proximally attached to the medial epicondyle of
  the humerus
• Distally attached to the coronoid process of the
  ulna, and the medial surface of the olecranon
• Laterally stabilizes the elbow joint
• Tear is generally not painful, but significant
  loss of velocity and control
• Difficult to diagnose before MRI, and often a
  career ending injury

2
Tommy John Surgery

• Surgical technique to replace the UCL was
  pioneered by Dr. Frank Jobe in 1974
• Named for Tommy John, a pitcher for the Los
  Angeles Dodgers on whom Dr. Jobe operated
• Tendon from the palmaris longus muscle replaced
  the ulnar collateral ligament
• This tendon is not crucial for function, and in
  fact is missing in 15 of the population

3
Tommy John Surgery

• About 15 - 18 cm of tendon are needed
• Other tendons besides palmaris longus are also
  used, such as the lateral triceps tendon

• Holes are drilled through the humerus and ulna
• Tendon is looped through in figure eight fashion
  and sutured, tendon ligamentizes over time
• Surgery may actually increase velocity above
  pre-injury, but recovery time is 1 - 2 years