Tommy John surgery and teen pitchers: what you need to know
Donald Bae, MD, a Boston Children’s Hospital orthopedic surgeon whose specialties include sports injuries of the upper limb and elbow injuries, answers parents’ questions about Tommy John surgery and ulnar collateral ligament (UCL) tears.
What is Tommy John surgery?
Tommy John surgery refers to reconstruction of the ulnar collateral ligament (UCL) of the elbow. This ligament is one of the main stabilizers of the elbow during the throwing motion, and may tear with repetitive overuse. Young athletes with UCL tears may complain of elbow pain, swelling and the inability to throw with the same velocity or force as before the tear.
Often, athletes can recall a specific throw or injury when they felt a pop on the inner aspect of the elbow. In athletes with persistent functional limitations, Tommy John surgery may be considered to help return them to their prior level of throwing.
When should an orthopedist or sports medicine specialist be consulted? How is a UCL tear diagnosed?
Any persistent elbow pain in the young throwing or overhead athlete should be evaluated by an orthopedist or sports medicine specialist.
An ulnar collateral ligament tear is usually diagnosed by a careful medical history, specific physical examination and x-rays or MRI.
How can parents and coaches prevent UCL injuries in teen athletes?
Prevention is worth a pound of cure, and this is certainly true of UCL injuries in young throwers.
Following USA Baseball's guidelines regarding pitch counts and types of pitches thrown is important. Attention to throwing mechanics and conditioning of the lower body, core, shoulder and elbow is also important. In addition, year-round baseball participation on multiple teams increases the risk of elbow injuries like UCL tears. Finally, athletes should not throw in pain to avoid potential UCL tears.
What factors go into the decision about surgery?
The decision to have Tommy John surgery is complex and individualized for each patient-athlete. Surgery has risks, and the recovery from Tommy John surgery is long. The athlete's age, level of baseball participation, athletic goals, and any associated conditions must also be considered.
What is the surgical recovery process like?
Following Tommy John surgery, athletes are typically immobilized in a splint or brace for 6 weeks, followed by months of physical therapy and rehabilitation. In general, athletes may not be ready to throw or pitch competitively for nine to 12 months after surgery. With current surgical techniques, the success rate of Tommy John surgery is 80 to 90 percent.
Are there any other relevant factors for parents to consider?
Children are not small adults, and the types of injuries sustained by young, growing athletes are different as well. Tommy John surgery is not typically performed in younger patients with open growth plates, though there are many ways in which orthopedic surgeons and sports medicine doctors can help younger, growing throwers with elbow pain and problems.
To learn more about preventing common baseball injuries, download Boston Children’s Injury Prevention guide. To read a Sports Illustrated feature about Boston Children's approach to Tommy John surgery click here.
Patient Stories from Thriving
FIFA’s sports concussion policy sends wrong message to soccer players
Don’t let Little League Shoulder keep your All-Star out of the game
Keeping twin dancers on their toes
Developing the sports physical of the future
Can sports make kids smarter?
Mo’ne Davis: A Woman Among Boys at the Little League World Series
Even Mild Concussion Can Cause Thinking, Memory Problems: Study
Pediatric overuse injuries increase due to year round, one sport training
Pediatricians recommend training to prevent ACL tears
Just One Season of Hits in High School Football May Alter Brain: Study
Marathon Medical Tent Doctors Reflect On Bombing Response
Doc: They Can't Scare Me Away
Should you let your child play football?
For Young Athletes, Injuries Need Special Care
Evidence shows cognitive rest aids concussion recovery
Skip the homework if you've got a concussion
The Wall Street Journal reports that the rehabilitation needs of children and teens are different than those of adults. More sports medicine programs are working exclusively with young athletes, using surgical techniques and physical therapy protocols that don't interfere with growing bones and cartilage. Boston Children’s Lyle Micheli, MD, explains that doctors must very systematically rehabilitate young athletes for strength and basic function and determine when it is safe for them to return to play.
Mininder Kocher, MD was interviewed by the Chicago Tribune about the rising rate of ACL tears in kids and adolescents.
On August 8, 2013, Michael O'Brien, MD, was interviewed on NECN's BroadSide with Jim Braude. Dr. O'Brien weighs in on the consequences of performance enhancing drug use in teens.
Young endurance runners draw cheers and concerns
Texas sisters, Kaytlynn Welsch, 12, and Heather Welsch, 10, compete in races with elite athletes more than double their age. Placing in more races than not, the Welsch sisters continue to shock fellow runners, but is this too much on them? Mininder Kocher, MD, talks about young endurance runners.
Martha Murray appointed to NIAMS
Martha Murray, MD, has recently been appointed to serve on the NIAMS (National Institute of Arthritis Musculoskeletal and Skin Diseases) Advisory Council of the NIH. She takes the place of Dr. Regis O'Keefe who was the sole orthopaedic surgeon on the committee. The four year term was effective on October 1, 2012. The mission of the NIAMS, a part of the U.S. Department of Health and Human Services' National Institutes of Health (NIH), is to support research into the causes, treatment and prevention of arthritis, musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. The Advisory Council provides advice to the NIH on broad policy issues and makes recommendations on research proposals in a second tier of review after analysis by a study section.
ISG 2012 Besterman/McColivin Print Award
The Encyclopedia of Sports Medicine won the ISG 2012 Besterman/McColivin Print Award, a major award given annually by the Information Services Group (ISG) of CILIP, the Chartered Institute of Library and Information Professionals. The Encyclopedia of Sports Medicine was edited by Lyle J. Micheli, MD.
Schools in Mass. report nearly 3,000 concussions
A new law passed in 2010 requires schools to report head injuries in Massachusetts and the numbers are astonishing. With nearly 3,000 concussions reported from schools throughout Massachusetts, Michael O’Brien, MD, was asked to review the reported data. Learn more.
Doc offers tips to prevent school sports injuries
Benton Heyworth, MD, discusses the importance of pre-season workout regimens, proper warm-ups and making sure the athlete knows and understands their sport and assignment. Find out more.
Dover junior returns to soccer after surgery
WMUR-TV New Hampshire profiles Boston Children’s Hospital patient Aimee Hartwell, featuring her as the weekly “Hometown Hero.” Hartwell seriously injured her knee playing soccer and had it successfully repaired by Boston Children’s Mininder Kocher, MD, MPH. Watch the video.
Lyle J. Micheli, MD
- Top Docs Q&A: Lyle Micheli - Boston Magazine, 2014
- Experts discuss the high cost of youth sports - Fox 25 Boston, 2014
- For Young Athletes, Injuries Need Special Care - The Wall Street Journal, 2014
- Physician Profile - eClinic
- Caution: Dangerous curves - Boston.com, 2012
- Finish line scenes at the Boston Marathon - Boston.com, 2012
- Sports are great for kids, but too much comes with risks - MomsTEAM, 2012
- Details may predict kids' soccer-injury recovery - Reuters, 2012
- 10 sports medicine specialists receiving recognition - Beckers Orthopedic Review, 2011
- Are kids old enough to be playing adult games? - Boston.com, 2010
- Sports training has begun for babies and toddlers - The New York Times, 2010
- Dr. Lyle J. Micheli: Orthopedic care for young athletes - knee1.com, 2009
Mininder S. Kocher, MD
- Exercises Aim to Reduce ACL Tears in Kids - ABC World News, 2014
- Female soccer players may face health problems - U.S. News & World Report, 2012
- Sharp rise in serious sports injuries in children - ABC News, 2011
- From the operating room to the winners podium - Thriving, 2011
- Teens trainging too hard, too often - Boston.com, 2010
- Can a gene test tell you your toddlers sports? - U.S. News & World Report, 2008
- An ironman who's not yet a man - The Washington Post, 2008
- How was Tiger able to play golf for a year with a badly injured knee? - Scienftic American, 2008
- Torn ACL's, other big injuries hit little athletes - USA Today, 2008
- The rise in diagnosis of ACL injuries in children - ReachMD, 2008
Martha M. Murray, MD
Benton E. Heyworth, MD
Michael J. O'Brien, MD
Ellen Geminiani, MD
Kathryn Ackerman, MD, MPH
Thomas Vorderer, DPM
Brian Fitzgerald, BSN, ATC, LAT
Gianmichel Corrado, MD
Sports Concussion Clinic
William P. Meehan, MD
- Should You Let Your Child Play Football? - The Boston Globe Magazine, 2014
- The Pressure To Win And New Concussion Research -WGBH.com, 2014
- Cognitive Activity Could Hinder Concussion Recovery, Study Suggests - Huffington Post, 2014
- Teen athletes with concussions shouldn't do homework, study says - Los Angeles Times, 2014
- Skip the homework if you've got a concussion - NBC News, 2014
- Study: Students need time off from school, sports to recover from concussions - WHEC-TV, 2014
- Concussion recovery delayed by mental activity, study shows - CBC, 2014
- Children’s concussions and brain rest - The Boston Globe, 2014
- Preventing concussions in high school sports - Fox 25 News, 2012
- Study proves multiple mild concussions have a cumulative, lasting effect - WCVB.com, 2012
- New state concussion law puts players, schools on alert - Patriot Ledger, 2011
- Meehan: Coaches, parents: Take concussions seriously - Metrowest Daily News, 2009