Ulnar Collateral Ligament – Elbow Surgery (Tommy John)

Learn about UCL Elbow Surgery elbow surgery Ulnar Collateral Ligament - Elbow Surgery (Tommy John) Baseball PitcherElbow Surgery (Tommy John) – Ulnar Collateral Ligament

Contributed by Stephanie Thomas, COF

To coincide with 2017 Opening Day, we decided to shed some light on a procedure we see quite often that is related to baseball and more specifically pitchers. In fact, a professional pitcher was the first person to have this elbow surgery about 40 years ago.

Who is Tommy John?

In 1974 Los Angeles Dodgers’ pitcher Tommy John was having a great 11th season in the Majors, starting 13-3. Many believed he would eventually be a Cy Young Award winner, but he damaged his ulnar collateral ligament (UCL), which is a ligament of the elbow. He was adamant about returning to baseball. John went to the team physician, Dr. Frank Jobe and asked him to develop an elbow surgery that would fix his UCL and allow him to pitch again. Dr. Jobe developed a technique that allowed John to return to pitching in 1976. Since then there have been different techniques developed to help repair the UCL.


Original Procedure – During Dr. Jobe’s procedure, he would harvest the patient’s palmaris longus in the wrist. It is important to note that not everyone has a palmaris longus; if the patient doesn’t have this ligament the surgeon may opt to harvest a different autograft (from patient’s body) such as the gracilis, plantaris, or a strip of the Achilles to complete the elbow surgery.[1] You can test yourself by touching your thumb to your ring finger and twisting your wrist. The ligament will pop out (like the photo) if you have it.

Ligament used for Elbow Surgery elbow surgery Ulnar Collateral Ligament - Elbow Surgery (Tommy John) ligament in arm for elbow surgeryDr. Jobe utilizes the Figure 8 technique where he would drill two holes in the medial epicondyle and two holes into the ulna and feed the palmaris longus through. Then he would suture the tendon to itself. He also had to detach the flexor-pronator musculature at its origin which would cause the ulnar nerve to transpose.[2]

Docking Technique – This technique, developed by Dr. David Altchek, it is different from the original technique in many ways. First it does not detach the muscle group, instead, it uses a muscle splitting technique. This procedure also does not drill as many holes, and the tendon is shaped into an “elongated D” instead of a figure-8. The tendon graft enters the humerus but never exits and is sutured to the bone.[3]

What are the Signs and Symptoms of Ulnar Collateral Ligament Injury?

You may feel a “pop” on the inside of the elbow that is accompanied with pain and possible swelling. You could also notice that you are weaker when throwing. Always make sure you have your injury evaluated by a healthcare professional; an MRI may be ordered to determine if there is a tear in the ligament that requires elbow surgery.

Who should have “Tommy John” elbow surgery?

Surgical intervention should be discussed with your physician. There are conflicting ideas on how early is too early to for an athlete to have this procedure. Many believe that high school athletes should not have the surgery due to some athletes still growing, where others believe it is ok. You should also ask the doctor what type of technique he/she will be performing.

Treatment and Rehabilitation

If you decide to have “Tommy John’s” elbow surgery, you will be placed in an elbow range of motion orthosis, after the procedure, (we use the Breg T-chek, seen below) to help protect the elbow and to eliminate movement. The orthosis is also adjustable to allow for a controlled range of motion. When the time comes, you will begin physical therapy and rehabilitation to get back to throwing again. This whole process can take over a year. Discuss the timeline with your doctor.

 

Our specialists can answer questions about the The T-chek Brace

Just call us or complete our contact form and we’ll get back with you within 24 hours.

References

[1] Ellattrache N; Harne C; Mirzayan R; Sekiya J. Surgical Techniques in Sports Medicine. Lippincott Williams and Wilkins. 2007.

[2] Vitale M. Ahmad C. The Outcome of Elbow Ulnar Collateral Ligament Reconstruction in Overhead Athletes: A Systematic Review. Am J Sports Med. 2008;36:1193-1205.

[3] Borak T. Ulnar Collateral Ligament Reconstruction: A Look Inside Tommy John Surgery. The Surgical Technologist.2009;41:163-172.

3 Tests to find the Best Shoes

3 Tests to find the Best Shoes

When you can’t get orthotic shoes from a specialist, you can use these tests and choose the best shoes to support your feet and provide the best support for your knees, your back, and your posture.

Tammy Daulton, Our Licensed Pedorthist has simplified this process with 3 easy tests to select the best shoes:

  1. Get the Best Shoes best shoes 3 Tests to find the Best Shoes best shoe test collageHeel Test – Hold the shoe in both hands; place one hand on the bottom of the front of the shoe.
    Push the heel of the shoe toward the inside of the shoe with the other hand. If the heel is easy to push down it won’t provide good support for your heel. The best shoes have a sturdy heel to support the entire foot and ankle.
  2. Toe Test – Hold the shoe in both hands; place one hand at the toe of the shoe and one and on the heel of the shoe. Push the toe of the shoe up to try to bend the front of the shoe up. If the shoe is easy to bend anywhere but where the toes meet the foot, it will not provide good support. The best shoe will have very little bend anywhere but right where the toes connect to the rest of the foot.
  3. Twist Test – Hold the shoe in both hands with one hand gripping the heel and one hand gripping the bottom of the front of the shoe. Twist the heel to the right while twisting the front of the shoe to the left. The best shoe will be difficult to twist. If the shoe is easy to twist it will not provide good support.

The next time you go shoe shopping, take these tests with you to choose the best shoes. These tests will help you find shoes that will reduce foot and knee pain caused by wearing non-supportive shoes.

If you have any questions about choosing the best shoes you can send an email to contact@gobioworks.com.

 

Understand Health Insurance and Durable Medical Equipment

Understand Your Health Insurance  health insurance Understand Health Insurance and Durable Medical Equipment Save money by understanding your health insurance e1481556849589Bioworks is eager to help you save time and money and make optimal use of your health insurance. However, with the complexity of health insurance policies today, and the constant changes made by insurers and employers, keeping up-to-date on every policy is difficult for us. When possible, we do let you know what we know about certain carriers or policies, even when a certain product or services is not covered.

So we are encouraging you to understand the limits and requirements of your health insurance. This is critically important when you are or a family member is referred to a durable medical equipment (DME) supplier.

How Health Insurance Deals with DME

Many DME referrals require prior authorization by your insurance company, which means that your insurance company may reject the cost of the merchandise provided to you, unless they have been notified and provide approval in advance. Many carriers no longer allow you to obtain the DME before notifying them and get authorization later. Many insurances are denying “retroactive” authorizations.

Not only do virtually all insurance companies differ in their requirements and coverage, but their policies and procedures are constantly changing. While we try our best to keep current with developments in health insurance, you are the only person who can know everything about your particular policy at any given time and with particular treatments are equipment.

How You can Avoid Health Insurance Issues

Please review your policy and become familiar with all its requirements. Call your insurance carrier whenever you are going to the doctor or you are anticipating needing to make a DME claim. Our insurance and billing staff will be available to you as you need services and DME from Bioworks.

If you have any questions, call us at 513-793-7335. Thank you!

The BIoworks Staff

photo credit: www.freeimages.com, photographer Marcelo Moura

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