Sports Medicine Division In the News

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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.

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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.
 

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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

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Physician News

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Lyle J. Micheli, MD

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Ellen Geminiani, MD

Kathryn Ackerman, MD, MPH

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