Tommy John Surgery

1. Tommy John Surgery By: Chuck Weaver ENG W131

2. Table of Contents • Table of Images • Audience • Background • What is the injury? • Anatomy of the Elbow • The Name • Common Injury • Pitching Mechanics • Procedure • Success • Steroids in Rehab • Myth of Tommy John • Prevention • Conclusion • Work Cited

3. Table of Images • Image 1: Chuck Weaver; photo by Lucas Carter • Image 2: UCL; Eorthopod.com • Image 3: YouTube video; youtube.com • Image 4: UCL and LCL; eorhopod.com • Image 5: Elbow Anatomy; health.howstuffworks.com • Image 6: Tommy John; health.howstuffworks.com • Image 6: Force on Elbow; google.com/imghp • Image 7:Stephen Strasburg’s Mechanics flaw; sportsillustrated.cnn.com • Image 8: Tommy John Surgery; google.com/imghp • Image 9: Docking technique; eorthopod.com • Image 10: Figure-of-eight technique; eorthopod.com • Image 11: YouTube video; youtube.com • Image 12: Success; google.com/imghp • Image 13: Steroids in baseball; google.com/imghp • Image 14: Myth; google.com/imghp • Image 15: Saving the Pitcher book; google.com/imghp • Image 16: Tommy John scar; google.com/imghp

4. Audience • This presentation is aimed at anyone that is interested in learning about the Tommy John surgery. The audience is comprised mainly of baseball players and baseball fans. • In that goal of my project was to learn about the Tommy John surgery . Readers can follow along and learn about this injury, as this presentation is for anyone intending to learn about the Tommy John surgery.

5. Background • As a baseball fan and player, I always look at the Detroit Tigers blog looking at the Tigers news. And as I have just recent had knee surgery I decided to look at all the injuries for the Detroit Tigers. While looking at the disabled list, the injury that caught my eye was Tommy John. Tommy John is always a topic in baseball news, but I am sad to say that I do not know much about the injury and the surgery. • With that said, I decided to do research to learn all about this injury and to help other baseball fans like me that were uninformed about this popular baseball injury and to keep away from Tommy John myself. Image 1: Chuck Weaver; photo by Lucas Carter

6. What is the injury? • The first thing I needed to do is figure out what exactly the Tommy John injury was. I used Google to help my search to find what the Tommy John injury was. I came across a site called eorthopod.com. This site is by a group of orthopedic surgeons that made the site to inform people about a number of injuries. On this website I found that Tommy John is an injury to the ulnar collateral ligament (UCL) in the elbow. The ulnar collateral ligamentcan be damaged by overuse and repetitive stress, such as the throwing motion. • The doctors call it a UCLR, ulnar collateral ligament reconstruction. Baseball players and fans call it Tommy John surgery Image 2: UCL; Eorthopod.com

7. What is the injury? (Continued) • This YouTube video gives a brief description of the injury by Dr. Clayton Lane. • Click Image to view video. Image 3: YouTube video; youtube.com

8. Anatomy of the Elbow • Now knowing what the Tommy John injury was, I wanted to know the anatomy of the elbow and see where this ligament was located. On eorthopod.com I learned the anatomy of the elbow relating to the Tommy John injury. There are several important ligaments in the elbow. In the elbow, two of the most important ligaments are the ulnar collateral ligament (UCL) and the lateral collateral ligament. Image 4: UCL and LCL; eorhopod.com

9. Anatomy of the Elbow (continued) • These two ligaments connect the humerus to the ulna and keep it tightly in place as it slides through the groove at the end of the humerus. These ligaments are the main source of stability for the elbow. Image 5: Elbow Anatomy; health.howstuffworks.com

10. The Name • In addition to the web, I also used Allen County Library to help me in my search. I found a great book on the baseball player named Tommy John. • The Tommy John Surgery is named after Tommy John, the Los Angeles Dodger pitcher who was the first to have the surgery in 1974. • The odds of the first surgery recovery were 1 and 100. Image 6: Tommy John; health.howstuffworks.com

11. Why is it common injury for baseball? • While doing a Google search I found that a Discovery Health article about Baseball injuries. • Pitchers sustain more injuries than any other baseball player. The overhand throwing of a baseball by a pitcher is an unnatural motion for the elbow and the shoulder to endure. • The throwing motion substantial amount of force on your elbow. As pitchers continue to throw the repetitious strain can lead to inflammation, microscopic tissue trauma and ultimately a tear in the ulnar collateral ligament (UCL). Image 6: Force on Elbow; google.com/imghp

12. Pitching Mechanics • Sports Illustrated did a story on Stephen Strasburg's struggles with Tommy John pinpointing pitching mechanic flaws. Tommy John is caused by poor pitching mechanics and overuse. The pitching motion is a kinetic chain of events, carefully calibrated and timed. • The ball should be loaded in the late cocking phase precisely when the pitcher's stride foot lands on the ground. • The "late cocking phase," is the process of which the shoulder reaches its maximum external rotation with the baseball raised in the "loaded" position and ready to come forward. • If he's too early or too late he winds up with more force on the shoulder and elbow. Image 7:Stephen Strasburg’s Mechanics flaw; sportsillustrated.cnn.com

13. Procedure • In addition to my Google searches, I used Academic Search Premier to help me in my search. • The reconstruction is performed through an incision on the medial (inside) side of the elbow joint. • The damaged ulnar collateral ligament along the medial side of the elbow is replaced with a tendon harvested from somewhere else in the body. The tendon graft can come from the patient's own forearm, hamstring, knee, or foot. Image 8: Tommy John Surgery; google.com/imghp

14. Procedure (continued 1) • One common technique used to replace the damaged ulnar collateral ligament is called the docking technique. The surgeon drills two holes in the ulna and three in the medial epicondyle (the small bump of bone on the inside of the elbow at the end of the humerus). The two holes in the ulna form a tunnel that the tendon graft will be looped through. • Another common technique to reconstruct the ulnar collateral ligament is the figure of eight technique. In this technique, the tendon graft is threaded through two pairs of holes - two drilled in the medial epicondye and two in the ulna. The graft is looped through the holes in a figure of eight fashion. The two ends of the tendon are sutured to the tendon itself. Image 9: Docking technique; eorthopod.com Image 10: Figure-of-eight technique; eorthopod.com

15. Procedure (continued 2) • This YouTube video shows a skeleton diagram of the procedure. • Please click image to view video. Image 11: YouTube video; youtube.com

16. Success • In 1974 this injury would be career ending without this surgery. • Today, around 83 percent of the operations go as planned . • While using Academic Search Premier I found a study that observed how successful these surgeries are studying the average time to full competition and throwing. • 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. 83% Image 12: Success; google.com/imghp

17. Steroids in Rehab • I continued to use Academic Search Premier to continue my search. I found an academic journal that discussed the use of steroids in the rehabilitation of Tommy John Surgery. • This journal discussed that with steroid use these athletes have the potential to enhance their performance. • Although the steroids are helping build back up the elbow to make it stronger, athletes are also making their legs stronger and building a stronger core with the use of steroids. There is controversy over steroids should be used in these athletes rehabilitation. Image 13: Steroids in baseball; google.com/imghp

18. Myth of Tommy John • The myth of Tommy John is that some Tommy John recipients returned from rehab with claims that the surgery made them pitch better than they were before. • Some pitchers throw harder post-surgery, but that is often due to the time developing their legs, core and shoulder more than it is the rebuilt elbow ligament. • As it stands, however, there's little or no truth to the myth. Image 14: Myth; google.com/imghp

19. Prevention • To prevent from pitching injuries I used the help from a book from the Allen County Public Library called Saving the Pitcher: Preventing Pitching Injuries in Modern Baseball. • In this book I learned that it is important to take care of your arm. • Some of these preventions included: • Stretching before you throw • Perfect ones pitching mechanics. • Don’t overuse the arm. • Ice after each use to calm down inflammation. • And many more tips… Image 15: Saving the Pitcher book; google.com/imghp

20. Conclusion • With all the research I have learned a lot about the Tommy John surgery. I have educated myself on this common baseball injury. Now when watching SportsCenter or reading the news I will be educated when they are discussing the Tommy John injury. • In this presentation I have underlined what the injury is, the anatomy of the elbow, why Tommy John is a common injury, pitching mechanics, the procedure, success of Tommy John surgery, steroids in rehab, the myth, and prevention of the Tommy John injury. Image 16: Tommy John scar; google.com/imghp

21. Work Cited • Alortho. "Tommy John Surgery." YouTube. YouTube, 25 Mar. 2009. Web. 15 June 2012. <http://www.youtube.com/watch?v=p5O8-htSCxc>. • Burchard, S. H. Tommy John. New York: Harcourt Brace Jovanovich, 1981. Print. • Carroll, Will. Saving the Pitcher: Preventing Pitching Injuries in Modern Baseball. Chicago: Ivan R. Dee, 2004. Print. • Lamb, Robert. Discovery Health. Discovery, n.d. Web. 15 June 2012. <http://health.howstuffworks.com/medicine/surgeries-procedures/surgery-change-baseball2.htm>. • Scott T. Arthur, et al. "Outcome of Ulnar Collateral Ligament Reconstruction Of The Elbow In 1281 Athletes." American Journal of Sports Medicine 38.12 (2010): 2426-2434. Academic Search Premier. Web. 15 June 2012. • "Steroids, Tommy John, and Cataracts." Nine: A Journal of Baseball History & Culture 19.2 (2011): 141-143. Academic Search Premier. Web. 15 June 2012. • "Ulnar Collateral Ligament Reconstruction (Tommy John Surgery)." Eorthopod.com. Medical MultiMEDIA Group, n.d. Web. 15 June 2012. <http://www.eorthopod.com/content/ulnar-collateral-ligament-reconstruction-tommy-john-surgery>. • Verducci, Tom. "Mechanical Flaw Will Be Red Flag for Strasburg Even after Return." Mechanical Flaw Will Be Red Flag for Nationals' Stephen Strasburg. Sports Illustrated, 8 Mar. 2011. Web. 15 June 2012. <http://sportsillustrated.cnn.com/2011/writers/tom_verducci/03/08/stephen.strasburg.mechanics/index.html>. • Washingtontimes. "What Is Tommy John Surgery?" YouTube. YouTube, 05 Sept. 2011. Web. 15 June 2012. <http://www.youtube.com/watch?v=sN7gr2wMRWk>. • "Www.wonderweight.com." Baseball. WonderWeight, 2012. Web. 15 June 2012. <http://www.wonderweight.com/category_s/24.htm>.