Ulnar Collateral Ligament Reconstruction, abbreviated UCLR but more commonly known as Tommy John surgery, is a surgical procedure which repairs the ulnar collateral ligament. The ulnar collateral ligament is located in the elbow. When the ulnar collateral ligament is damaged, the elbow can feel unstable. When this sensation first arises, physical therapy is recommended. If the injury doesn’t respond to physical therapy, Tommy John surgery is considered.
The ulnar collateral ligament is a thick band of tissue, similar to a rubber band. It connects the humerus, in the upper arm, to the ulna in the forearm It’s vital in stabilizing and strengthening the elbow. The ligament can either be torn, stretched out, or dislocated, most commonly by overuse.
This injury is usually seen in athletes whose sport requires them to throw a lot, as throwing places unusual amounts of stress on the elbow. Baseball pitchers are prime candidates for Tommy John surgery. UCL injuries are also seen in tennis players, softball players, and javelin throwers, amongst others.
Symptoms of a UCL injury include pain on the inside of the elbow or a sense of looseness in the elbow. Other sensations include tingling or numbness or in the ring finger or decreased ability to throw. The injury is officially diagnosed with tests such as X-rays or an MRI.
During Tommy John surgery, a tendon is extracted from an arm, occasionally the leg, to replace the torn ulnar collateral ligament. The procedure is minimally invasive and performed using a laparoscope. Once the patient is placed under general anesthesia, an orthopedic surgeon begins the procedure with a small incision on the inside of the elbow. The damaged ligament is removed through this incision.
An additional incision is made to recover a tendon from an uninjured area of the body. The forearm is the most common choice, but a tendon can also be extracted from the upper and lower area of the leg. In rare incidences, a donor tendon can be used as well.
Once the tendon graft is obtained, it is sewn in where the ulnar collateral ligament was removed. If a patient was experiencing numbness and tingling of the hand in addition to pain, then the ulnar nerve is slightly moved. This helps full sensation in the hand to return.
Patients recovering from Tommy John surgery typically stay overnight in the hospital for observation. For the first few weeks following surgery, the elbow is kept in an immobilizer. This keeps the elbow stationary and supported. Patients may be provided pain medication by their doctor. Heat and ice are also recommended to minimize pain.
After the immobilizer is no longer needed, physical therapy begins. Physical therapy allows the elbow to regain strength and range of motion. Typically, therapy lasts about 6-8 weeks. For professional athletes though, extensive rehabilitation may last over a year to allow full performance to return.
If you’re experiencing severe elbow pain or tingling sensation in your hand, reach out to Arlington Orthopedic Associations. We have a number of board-certified physicians who specialize in the elbow. Contact us today and schedule a consultation to find out if Tommy John surgery is the best route for you.