Medial collateral ligament tear
(Tommy John injury)
What is it?
The ligaments in the elbow connect bone to bone. They basically hold the humerus, the ulna and the radius together. They can be seen on the anatomy page. The 2 most important ones are the medial collateral ligament, and the radial collateral ligament. It is the medial collateral that is the Tommy John ligament, and is the main cause of problems in the thrower's elbow. This ligament can tear
if a thrower throws too often, too hard, or incorrectly.
What does it feel like?
This problem comes in 2 varieties:
One is when everything is fine and then all of the sudden, the ligament just pops during one throw. This usually occurs during the late cocking phase of throwing. It is a sudden pain on the inner side of the elbow, and there is a sudden and complete inability to throw.
The other type is when the elbow aches on the inner side for a long time, and is worse and worse when you throw as time goes by. It finally gets so bad that you just can't throw hard or accurately any longer, because it just hurts too much. There is no pop in this type of "chronic attritional" injury.
How is it treated?
Nonoperative treatment is sometimes successful for the chronic attritional type, and it requires several months of rest and throwing retraining. SafeThrow facilities are very good at this type of retraining therapy.
Operative treatment is required if there is no improvement with nonoperative treatment of a chronic attritional injury, or if there is a sudden complete tear accompanied by a pop. This is Tommy John surgery, and the technique for this surgery continues to evolve and improve.
How long will I be out of throwing?
If nonoperative treatment is successful, about 3 months.
If surgery is required, about 14-16 months. This long time is required since the tendon that is used for graft material has to turn into ligament before it can take the stress of throwing again.
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