Marlins pitcher Jose Fernandez was diagnosed with a tear of his ulnar collateral ligament earlier this week, and underwent “Tommy John” surgery this morning.  Although this is considered a season-ending injury, sources say that Fernandez’s elbow is “pristine,” making it more likely that he will return to the same level. Dr. Neal ElAttrache performed his surgery. untitled

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.

Here’s what Fernandez has to look forward to following surgery, and throughout the 12-18 month recovery.

For the first week, the arm is kept in a hard brace, completely immobile. The athlete 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.  The average wait is around four months for any kind of pitching activity, though it can be anywhere from three to six, depending on the patient’s recovery. It is 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.

After 10-12 months the recovery is not fully complete. 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 Primus Sports Medicine Staff