UTK Special (Last Updated 10/30/23)

The Tommy John To-Do List

My goal is to regularly update this piece as needed. The last update is in the title.

Occasionally, I’ll get a call from a parent asking questions about their son, who just heard that he has a torn UCL. It’s never good to hear, especially when there’s usually little guidance below the collegiate level. The latest made me think that I should put together a little roadmap to help. Here’s my best advice:

First, remember this is not life threatening or even career threatening. At worst, the time as a baseball player is over but that’s usually not the case. For most, there are multiple options, but all of them involve getting the best care possible. Starting that process quickly is key.

The first step after any elbow injury is to see a good doctor or Athletic Trainer. Many states allow for walk-in access to physical therapy clinics and there are often walk-in orthopedic clinics, usually on Saturday mornings after football Fridays. For collegiate or professional players, it’s key to use the school or team’s medical staff first. Make sure they know and document the injury. Follow their instructions closely.

If a doctor visit is necessary, make sure you see an orthopedic surgeon that specializes in baseball injuries. There are plenty of good orthos out there, but seeing more baseball elbow and arm injuries is a big plus. Collegiate players should see their selected team doctor first, but for lower levels, the team usually doesn’t have a doctor. Call a local college or pro team to ask which doctor they use for pitching arm injuries.

At this visit, take notes. Ask if you can record it on your phone, though many doctors don’t allow that due to either legal or insurance reasons. In many cases, doctors will attempt to deal with the injury conservatively. This can be anything from “wait and see” to a PRP injection. This isn’t bad and certainly isn’t “lost time.” Avoiding surgery is always a positive, though this can feel like a negative up against the timing of the current or even upcoming season. Ask your doctor to “count out” the expected rehab if things don’t go well and surgery is needed, so there’s a date to make a decision on the process.

One of the key things I tell people at any level is that second opinions are common. This is an important decision and unless you’re just absolutely convinced everything is right, getting that second opinion is often a smart move. It is not difficult to find a top surgeon willing to do a consult based on an extant MRI as well as any other records. Yes, you could have Dr. Andrews or ElAttrache check your case. This often comes down to insurance, but don’t think these top doctors are “impossible to reach”, even for a younger player. Perhaps especially for a younger player.

If surgery is recommended, make sure you’re comfortable with both the surgery and surgeon. There are more options available today than ever, so make sure all are considered, which may take more opinions. Things like InternalBrace are changing the game and asking the right questions can help guide things. Doing your research now can help the process later. Again, getting to one of the top surgeons is not as inaccessible as most would think. If you can’t get to them, again, look for a surgeon with lots of baseball specific experience. Asking for success stories they’ve had is very reasonable and many will put you in contact with past patients as a resource.

One overlooked aspect that should be addressed even before surgery is the rehab process. College and pro players will often need to do their rehab with their teams, but even then there can be flexibility. Getting with the best rehab possible and having a good program is as important as the surgery. Your surgeon should make recommendations and just as with a doctor, find one that is both competent and experienced with baseball-specific injuries.

The rehab program itself often isn’t as advanced as the surgery. Most programs are slight variants of the 1984 program from Dr. Kevin Wilk. It’s a fine program, but you can’t tell me that data-driven rehab isn’t possible or that advances have rendered past protocols obsolete. Find a rehab professional willing to work with you on a cutting edge rehab, but at the same time, be willing to listen to someone who is guiding the process.

Return from Tommy John surgery (or variants) is almost assured. The latest study I saw had an 83 percent return rate, but almost all of that is pitchers that chose not to go on with the process. A small number, less than five percent, is one of those quirky things like an equipment failure or a player that overdoes the rehab process against instruction. Even in those cases, a revision (re-do) is possible and a career can be resumed, though later than expected. The rehab process is not fun, or easy, so if you decide to walk away, it’s your choice and the elbow won’t affect anything but your ability to throw overhead in later life.

There are thousands of people who have the curved scar on that elbow, from Tommy John himself to Shohei Ohtani (twice!) Going through the process can get a pitcher back on the field, not better, but losing little but the time. Doing it right, with the right people and right support, can make the process better. I hope this short guide helps parents, coaches, and the pitchers who face the procedure.

As always, if I can help, you can contact me here, or via email. I’m not tough to find and I’m always willing to help with this process.