Torn UCL: Tommy John vs Rehab?

Hello everyone, I’m John and I’m currently a pitcher for Neumann University in Pennsylvania. I am a right handed pitcher, and about a week ago I was informed by an elbow surgeon that I sprained my UCL. On Monday, I got a second opinion and found out I tore my UCL. Up until Monday, I was doing physical therapy for this sprain. Well, yesterday I threw a little bit (not hard just a catch) and was fine with no pain. Today, I threw a little harder and a lot more. Threw a 90% fastball… Still no pain. So I have come to the conclusion that I tore my UCL quite some time ago and have been playing with this tear. My options are at this point is to attempt to rehab for 6-8 weeks and see how much it has grown back after rehab, and then either play or get Tommy John. That would leave me no option but to hang up the cleats for good. I could get Tommy John ASAP and possibly pitch next year and redshirt this year. Or I could just go ahead and rehab and play anyway very carefully, and take much care of my arm until I have unbearable pain. Any opinions?

Most physicians would agree with your plan. If you don’t absolutely need surgery, it’s usually best to play and rehab it until you really need to be cut open. The rehab success rate of UCL replacement surgery is not 100% - it’s far less than a 50/50 shot.

As far as economic timing of the surgery, if you’re a pro prospect, that might play into things, and having the surgery earlier might be better if you can get a medical redshirt.

John,

You should probably be taking guidance from qualified medical people about your situation.

I’m not sure, for example, how Kyle derived his advice that recovery of form after TJ surgery is “far less than a 50/50 shot”. The medical literature doesn’t claim 100% success rates, but it does give reasonable evidence that TJ followed by proper rehab is >80% successful at returning throwing athletes to the same, or even slightly better, performance levels than they achieved pre-surgery. See, for example, the James Andrews article below.

Please note, I am not trying to give you medical advice about your personal situation. The only responsible internet advice for you, in my opinion, is that you should continue to seek the best advice possible from qualified physicians who have had an opportunity to personally evaluate you. No real physician would ever offer a detailed evaluation of your current condition, or suggestions for treatment, based on a paragraph that you wrote on an internet forum.

Am J Sports Med. 2010 Dec;38(12):2426-34.

Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up.

Cain EL Jr, Andrews JR, Dugas JR, Wilk KE, McMichael CS, Walter JC 2nd, Riley RS, Arthur ST.

American Sports Medicine Institute, Birmingham, AL 35205, USA. lylecain@aol.com

BACKGROUND: The anterior bundle of the ulnar collateral ligament (UCL) is the primary anatomical structure providing elbow stability in overhead sports, particularly baseball. Injury to the UCL in overhead athletes often leads to symptomatic valgus instability that requires surgical treatment.

HYPOTHESIS: Ulnar collateral ligament reconstruction with a free tendon graft, known as Tommy John surgery, will allow return to the same competitive level of sports participation in the majority of athletes.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Ulnar collateral reconstruction (1266) or repair (15) was performed in 1281 patients over a 19-year period (1988-2006) using a modification of the Jobe technique. Data were collected prospectively and patients were surveyed retrospectively with a telephone questionnaire to determine outcomes and return to performance at a minimum of 2 years after surgery.

RESULTS: Nine hundred forty-two patients were available for a minimum 2-year follow-up (average, 38.4 months; range, 24-130 months). Seven hundred forty-three patients (79%) were contacted for follow-up evaluation and/or completed a questionnaire at an average of 37 months postoperatively. Six hundred seventeen patients (83%) returned to the previous level of competition or higher, including 610 (83%) after reconstruction. The average time from surgery to the initiation of throwing was 4.4 months (range, 2.8-12 months) and the average time to full competition was 11.6 months (range, 3-72 months) after reconstruction. Complications occurred in 148 patients (20%), including 16% considered minor and 4% considered major.

CONCLUSION: Ulnar collateral ligament reconstruction with subcutaneous ulnar nerve transposition was found to be effective in correcting valgus elbow instability in the overhead athlete and allowed most athletes (83%) to return to previous or higher level of competition in less than 1 year.
PMID:20929932

I agree with flip, talk to the doctors get as much info from them and get them to help you make a qualified decision, theres too many things at risk if you don’t get the help and advice from a trained physician, they ultimately know you better then a message board.