UCL Injuries and Tommy John Surgery: Fact or Fiction


The prevalence of ulnar collateral ligament (UCL) injuries in throwing athletes has grown substantially over the past several years, especially in the adolescent patient population. As more and more professional athletes successfully return to high levels of play after Tommy John surgery (or ulnar collateral ligament reconstruction), many young athletes, parents, and coaches have come to recognize that elbow injuries in throwing athletes are not necessarily career ending. As public awareness about Tommy John surgery and its success stories have grown, so too have some myths and misunderstandings about the surgery. Here are some common misconceptions about UCL injuries and Tommy John surgery:

I can tear my ulnar collateral ligament with one “bad throw.”

Although many athletes report hearing or feeling a “pop” on one specific pitch or throw, the vast majority of athletes have had symptoms on the inside portion of the elbow for quite some time before the ligament finally tears. It is less common for an athlete to tear the ligament with one single throw without prior symptoms. For this reason, it is imperative that parents and coaches pay attention to the symptoms that young athletes report. Always take any elbow pain very seriously—it could be an early sign of overuse and possible ligament injury.

Pitch counts and innings counts are separate in different leagues and don’t cross over or add up.

The ulnar collateral ligament is typically injured as a result of cumulative damage over time and it does not discriminate based on which league an athlete is pitching in! Staying just under the limit in two leagues in the same week will add up and exceed the overall limit. If an athlete is simultaneously participating in multiple leagues and playing on multiple teams, it is the collective responsibility of the player, parents, and coaches to ensure that the TOTAL pitch or inning count does not exceed the recommended limit.

Tommy John surgery will make me a better pitcher.

A common myth about Tommy John surgery is that having surgery when the ligament is not torn will add speed/strength to a player’s pitches. Many players will begin to lose accuracy and speed because of pain, muscle fatigue, and ligament damage before their ligament ruptures completely. Having surgery on a healthy ligament will not improve a player’s performance

If I have surgery, I’m out for the year.

Recovery from ulnar collateral ligament reconstruction usually takes approximately 12–16 months.

Having Tommy John surgery means my career is over.

When undergoing UCL reconstruction for a complete or high-grade partial tear, success rates are close to 90 percent in professional athletes and about 75–80 percent for high school athletes

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