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Looks like You’re Going to Need Tommy John Surgery

Take Home Points

  1. Pitching places high stress at the UCL ligament
  2. The return rate after initial Tommy John surgery is high.
  3. The return rate decrease with subsequent Tommy John surgeries.
  4. Shoulder and elbow prevention programs are mandatory for pitchers. 

The Ulnar collateral ligament (UCL) is the main stabilizer in the elbow during the pitching motion. When a pitcher brings his arm forward in the acceleration phase of the throwing motion, the hand lags behind the elbow as it rotates over the top. This motion puts a lot of “valgus stress” on the elbow. When you add, warm up throws, bullpen sessions and games a lot of stress is placed on the UCL. Pitchers in their playing careers starting from playing little league to the MLB throw the ball millions of times. This volume without proper injury prevention and rehabilitation results in injuries. Combine these factors plus having bad mechanics or poor arm strength this can lead to weakness and damage in the ligament. “The theory is that these high performance athletes who throw in the upper 80s or 90s accumulate microscopic damage to the ligament over time through the high number of repetition of pitches. At some point, the combined stresses overwhelm the UCL, causing it to rupture (Jiang 2014)”.

UCL tears have ended many baseball pitchers careers. Although, UCL reconstruction, Tommy John Surgery, is an effective surgery for pitchers, it still has inherent risks. Studies have shown that a mid to high percentage of pitchers are able to return to pre-injury levels of performance (Jiang 2014). The question is are they the same pitcher after the surgery or are they going to adapt and change their mechanics to protect the elbow? 
Some pitchers that may rely heavily on the throwing a high 90’s fast ball may have to change their pitching style into more of a finesse pitcher. In a study performed by Jimmy Jiang (2014), data from Major League Baseball was analyzed and found no significant difference in pitch velocity between players who underwent Tommy John surgery after a UCL injury and those who have never had elbow surgery. Looking just at pitch velocity after UCL reconstruction; this suggests that the procedure not only helps pitchers recover their pre-injury performance levels, but also their physical abilities. The data included average pitch velocity for fastballs, changeups, curveballs and sliders. They also studied common performance statistics including total innings pitched ERA, WHIP, batting average against, walks per 9 innings and strikeouts per 9 innings. When you look at the results, there were not enough differences in the pitching velocity or any of the performance traits between players who had surgery and players who did not. 

“UCL reconstruction is a very effective surgery, but it’s also a pure testament to the level of dedication and focus of these athletes that 80 percent of them make it back to the highest level of play,” Leland said. 

“They’re determined that they will get back to playing just as well as before. They work extremely hard, and they’ll be able to get there.” 

Clearly, having any surgery has inherent risks. Tommy John surgery has excellent return to play statistics for the first surgery. Unfortunately, the return rate is much lower after a second tear. This is a big issue as players are getting Tommy John surgery as early as high school. Also, simple velocity measurements does not provide the entire story. Often times, pitching control and psychological issues plague these pitchers. 

Preventing UCL injuries is mandatory for each baseball pitcher. This requires proper education on throwing biomechanics, focusing on power production from the hips and core. It also mandates being smart with young pitching volumes and alertness to shoulder and elbow pain

Our KADP educates children on proper injury prevention and management. These theories are stressed in our sports team training programs, as no athlete performs maximally when injured. 


  1. Jiang JJ, Leland JM. Analysis of Pitching Velocity in Major League Baseball Players Before and After Ulnar Collateral Ligament Reconstruction. Am J Sports Med. 2014 Feb 4
Written by Coach Chris