“Dead Arm” in Baseball Pitchers
• Tear of the ulnar collateral ligament (UCL): A second degree sprain
• Proximally attached to the medial epicondyle of the humerus
• Distally attached to the coronoid process of the ulna, and the medial surface of the
olecranon
• Laterally stabilizes the elbow joint
• Tear is generally not painful, but significant loss of velocity and control
• Difficult to diagnose before MRI, and often a career ending injury
“Tommy John” Surgery
• Surgical technique to replace the
UCL was pioneered by Dr. Frank
Jobe in 1974
• Named for Tommy John, a
pitcher for the Los Angeles
Dodgers on whom Dr. Jobe
operated
• Tendon from the palmaris longus
muscle replaced the ulnar
collateral ligament
• This tendon is not crucial for
function, and in fact is missing in
~15% of the population
“Tommy John” Surgery
• About 15 - 18 cm of
tendon are needed
• Other tendons besides
palmaris longus are also
used, such as the lateral
triceps tendon
• Holes are drilled through the humerus and ulna
• Tendon is looped through in figure eight
fashion and sutured, tendon “ligamentizes”
over time
• Surgery may actually increase velocity above
pre-injury, but recovery time is 1 - 2 years