Tommy john
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The document discusses Tommy John surgery, which involves reconstructing the ulnar collateral ligament (UCL) in the elbow. It provides background on Tommy John, who underwent the surgery in 1974 and returned to pitch successfully after rehabilitation. The anatomy of the elbow and causes of UCL tears are reviewed. The surgery procedure and post-operative rehab process involving 4 phases are then outlined, culminating in a gradual return to throwing.
Tommy john
- 1. Tommy John Emily Silva Elbert Chong
- 2. Understanding the Elbow Bones: Humerus Ulna Muscles: Pronators, Elbow 鍖exors & extensors Ligaments: Ulnar Co!ateral Ligament Anterior Band Intermediate Band Posterior Band Nerves: Ulnar Nerve
- 3. Tommy John MLB debut: 1963, Cleveland Indians 1974, Los Angeles Dodgers Surgeon: Dr. Frank Jobe Sat out 1975 season Pitched again in 1976 164 games wins fo!owing surgery Retired 1989
- 4. Etiology & Pathology Etiology: Overuse, Microtrauma %om a valgus force Side-arm pitching & curve ba! Pathology: Severe stretching or tearing of the UCL
- 6. Rede鍖ning Baseball UCL is extracted Replacement tendon is harvested Palmaris Longus (same arm if possible) A!ogra) Two holes are dri!ed into the Humerus and the Ulna New tendon is then woven in a 鍖gure 8 pattern around anchors
- 9. Patient Background Patient: Lorenzo Johnson 24 years old 62 - 185 lbs. Professional baseba! player (RHP) for 4 years Enjoys pick up games of basketba! Lives with signi鍖cant other and 2 dogs
- 10. Injury History Has been playing baseba! since he was 4 Sustained a suspected RC tear in high school (~2004) Changed his mechanics to a!eviate the pain Began experiencing medial elbow pain ~ 9 months ago Current Diagnosis: Ulnar Co!ateral Ligament rupture MRI results con鍖rmed diagnosis MD su*ests Tommy John surgery
- 11. Phase 1 (weeks 1-4) Pain Management Medications (NSAIDs) Modalities with ice Exercises: PROM elbow 鍖exion & extension AROM wrist/鍖nger 鍖exion & extension Putty squeeze (grip strength) Shoulder isometrics (NO ER) Elbow/wrist isometrics
- 12. Phase 2 (weeks 4-8) Continue pain management and ROM exercises Add elbow AROM @ week 6 Continue isometric exercises Add shoulder theraband exercises (NO ER until week 6) Begin light resistance Elbow & wrist 鍖exion/extension pronation/supination
- 13. Phase 3 (weeks 8-12) Continue pain management (as needed) Continue ROM exercises (fu! ROM by week 12) D/C isometrics and move to %ee weight exercises Begin the fo!owing exercises: Eccentric elbow 鍖exion/extension PNF strengthening Light plyometric exercises Light throwing motion activities (week 11)
- 14. Phase 4 (weeks 12-24) FUNCTIONAL EXERCISES!!! Catch play Long toss Low velocity pitching Steady increase in velocity monthly Beware of early cocking and acceleration
- 15. Other Considerations May fo!ow Tommy John throwing protocol Beginning ~month 5/6
- 16. Throwing Protocol # of Throws Distance 10 20 ft. (warm up) 10 30-40 ft. 30-40 50 ft. 10 20-30 ft. (cool down)
- 17. Back to the grind Fu! ROM pain %ee Fu! strength Ability to throw 90-120 pitches Good cardiovascular 鍖tness
- 18. References Clue%,J.(2010)TommyJohnSurgery.www.about.com Dean,R.(2010)TommyJohnSurgery.h%p://www.uwbadgers.com/genrel/ 062310aab.html Ksander,Y.(2007)TommyJohnSurgery.www.indianapublicmedia.org Longobardi,R.S.F.(2005)TommyJohnSurgery.h%p:// www.universityorthopaedic.com/specialNes/5tommyjohnsurgery.html Lowe,W.TommyJohnSurgery.www.drloweshoulder.com/en/cms/?253 www.carNlagedoc.org/downloads/elbow/TommyJohnRehab.pdf