Tommy John Surgery

Following surgery, patients undergo a comprehensive physical therapy program aimed at restoring flexibility, range of motion, strength, and function, to the elbow. This is done to gradually load the surrounding tissue while protecting the graft while it heals into the bone. This process typically involves a gradual progression of exercises and activities guided by your physical therapist and your physician’s specific post operative protocol. Adhering to the protocol is essential to long-term success while respecting inevitable setbacks and symptomatology. Return to throwing involves gradually loading healing tissue while developing athletic capacity over time.

This is a general outline for rehabilitation protocol. Protocols vary by type of surgery and physician’s orders, and rehabilitation protocol chosen.

Phase 1: Early Healing (0–6 weeks)

• Brace/Immobilization: Bracing and restricted movement is utilized to protect healing tissue.

• Scar Tissue and Soft tissue Management: Preventing scarring is essential in restoring proper mobility. Electrical Stimulation may be used to decrease post operative swelling.

• Gentle Range-of-Motion Exercises: Wrist/gripping, elbow, and shoulder motion are performed within the patient’s tolerance.

• Isometric Exercises: Light muscle contractions without moving the joint (e.g., fist squeezes).

Phase 2: Progressive Strengthening (6–12 weeks)

• Wrist and Forearm Exercises: Wrist curls, pronation/supination (turning the palm up/down).

• Shoulder Stability Exercises: Rotator cuff exercises, exercise bands, scapular retractions, dumbbells, and weight bearing exercises.

• Core and Lower-Body Training: Address relevant hip and ankle mobility issues and core stability to reduce stress on the elbow during throwing.

Phase 3: Sport-Specific Training (3–6 months)

• Plyometric Exercises: Medicine ball throws, explosive rotational movements to improve speed needed for acceleration and deceleration.

• Proprioception Drills: Balance and coordination exercises for joint control.

• Progressive Throwing Work: Gradually increasing volume, distance, and intensity of throwing.

• Arm Action Drills: Designed to improve the arm path and coordination.

Phase 4: Return to Play (6–12+ months)

• Full Intensity Throwing/Pitching with Biomechanical Analysis: Not correcting the previous faults that may have led to the injury in the first place, leads to stress on the new graft and predisposes the injury to re-rupture.

• Regular Mobility and Strength Work

Tommy John Surgery: Success Rates & Return to Play

Tommy John surgery has become a relatively common procedure, especially among athletes, particularly baseball pitchers who frequently place significant stress on their elbows through repetitive throwing motions. While the surgery is not without risks and requires a lengthy rehabilitation process, many patients are able to successfully return to their sport or activity following UCL reconstruction, with good outcomes.

• Success Rate: Around 85–90% of athletes return to their pre-injury level of function.

• Return Time: 12–18 Months, depending on the sport and position played. However, recent research with 129 MLB players suggests only 1.6% returned to play within 1 year while 82% returned by year 3.

• Pitchers vs. Position Players: Pitchers often take longer (closer to 18 months). Position players may return sooner (around 12 months).

• Risks of Surgery: Infection, stiffness-loss of motion, strength deficits, graft failure, re-rupture, or nerve damage.