David-Hernandez

A torn ulnar collateral pigment (UCL) sustained by Diamondbacks relief pitcher David Hernandez required season-ending Tommy John surgery .  He underwent successful reconstruction by Dr. James Andrews. The loss of Hernandez could severely impact the Arizona bullpen.

Tommy John surgery repairs an injured elbow ligament. It’s most commonly done on college and pro athletes, especially baseball pitchers. But it’s sometimes done on younger people as well. The surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type. Tommy John surgery is also called UCL reconstruction. UCL is short for ulnar collateral ligament.

In the operation, the ligament in the elbow is replaced with a tendon. Previously, it used to be taken from a cadaver, but nowadays, the preferred donor tendon is from the patient’s own forearm, typically the one attached to the palmaris longus muscle. This tendon serves no real purpose and, in fact, about 15% of the population don’t have it – alternative sources include plantaris tendon in the ankle or a small part of the hamstring tendon, taken from the back rather than plant foot.

The surgeon will then drill a series of holes in the elbow.  The tendon in question is inserted through the holes in a figure-eight pattern and locked in place. The aim is to provide it with a good supply of blood, to assist it in the healing process.

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For the first week, the arm is kept in a hard brace, completely immobile; the subject can then start very gentle exercises, and by about two weeks after the surgery, it’s usually possible to restart everyday tasks like eating and combing his hair. However, any kind of pitching activity is still a long way off. The average wait is around four months, though it can be anywhere from three to six, depending on the patient’s recovery. It’s crucial not to rush the process. While the arm may feel great, there is a definite risk or re-injury should the new tendon/ligament be over-taxed, especially early on in recovery. As with any arm injury, the distance and velocity of the throwing is gradually increased, up until the pitcher is once again throwing off a mound. Here’s a typical time table.

0-7 Days: Splint is worn, squeeze a soft ball.
1-4 Weeks: Discontinue splint; sling worn for one more week; gradually achieve full range of motion.
1-2 Months: Full range of motion at elbow, wrist, forearm, shoulder; lightweights for forearm exercises.
2-3 Months: Continue lower body conditioning program; continue exercises for upper extremities, including rotator cuff.
3-4 Months: Easy tossing (no wind-up), 25-30 throws building up to 70.
4-5 Months: Continue throwing program with easy wind-up, 20-50 feet, 10-40 throws.
5-6 Months: Throwing program extends to 60 feet at half-speed.
6-7 Months: Gradually increase distance to 150 feet.
7-8 Months: Progress to a mound at half- to three-quarters speed, using proper body mechanics (stay on top of the ball, keep elbow up, throw over the top, follow through with the arm and trunk).
9-10 Months: Simulate game situations.
10-12 Months: Begin normal routine and make appropriate rehab starts.

However, that isn’t the end of the matter. It will often take another year for a pitcher to become completely comfortable with his new arm.  Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery.

Provided by the Primus Sports Medicine Staff- OB