Tommy John Surgery, known to surgeons as Ulnar Collateral Ligament Reconstruction, was named after an excellent pitcher named Tommy John, who suffered a tear in his UCL during the 1974 season. He decided to undergo to this then-unknown operation in order to return to pitching. He went on to pitch 26 seasons in the big leagues, 15 of which came after his operation. Fast forward 40 years and this has become one of the most common procedures that baseball players will have, with over 30 pitchers undergoing Tommy John surgery in the past year alone.

The UCL is a tiny strip of tissue that connects the humerus (upper arm) to the ulna (wrist bone). Its job is to protect the elbow against valgus stress, which is the sideways bend in the arm that occurs during the process of throwing a baseball. Repetitive stress on the elbow comes with playing the game of baseball, and this stress can eventually lead to a ligament to become stretched or torn making it impossible to keep the elbow stable.

The surgery itself involves using a harvested tendon and threading it through holes drilled into the humerus and the ulna and repairing the UCL to add strength. To dispel a popular myth, a surgically repaired UCL is not stronger than one that has never been injured and will not improve a pitcher’s ability.

Injury to the UCL may occur acutely with a single event or gradually over time. These injuries are usually associated with a painful pop and constant pain on the inner part of the elbow. Typically, one cannot throw anymore after this injury occurs. Swelling will quickly accompany the pain in this area. Chronic injuries are the most common and most often occur in baseball pitchers.

A medial epicondylar release is performed when a patient has failed conservative treatment for chronic medial epicondylitis (also known as Golfer’s Elbow) and continues to have pain. The pain occurs on the inside of the elbow. Often patients who suffer from medial epicondylitis also have a torn or damaged tendon at the elbow.

A medial epicondylar release is an open procedure, where a small 3 cm incision is made on the inside of the elbow. During the procedure, the tendon that attaches to the inside of the elbow is located and evaluated for any injury or damage. It is commonplace for that tendon to be split during this procedure as to help the surgeon locate all of the loose debris. The debridement of the medial epicondyle occurs, removing any scar tissue or inflammatory tissue that has developed as a result of long term golfer’s elbow. If needed the tendon would be repaired with a strong suture. A patient is placed in a soft cast to immobilize the wrist.

The repair of a damaged tendon can be done by one of two procedures:

• Tendon debridement- This procedure is commonly performed on patients suffering from tendinitis. In this procedure the surgeon will make a small 1 inch incision along the bump on the elbow. The surgeon removes any debris (scar tissue or inflammatory tissue) that has developed as a result of a long term injury to the tendon.
• Tendon release- This is most common procedure done for tendon repair. In this procedure the surgeon locates the root of extensor or flexor tendon on the elbow and splits the damaged tendon while also performing a debridement around the tendon. Sometimes the loose end of the tendon may be sutured to the surrounding connective tissue

The bicep is one of the main muscles in the upper arm that is responsible for bending the elbow and rotating the forearm and wrist. The bicep tendon is the link between the muscle of the biceps and the bones below the elbow. An injury can occur due to repetitive use or due to a sudden force or trauma, resulting in a tearing of the tendon. Such might occur when trying to prevent something heavy from falling or carrying a heavy object.

A tear of the bicep tendon may be partial or complete. Complete tears of the biceps tendon are most prevalent in middle-aged men.

Symptoms of partial tendon tears include pain, swelling, tenderness in the elbow crease or just below the elbow crease, especially during use of the elbow and hand. One might also notice weakness in elbow and forearm strength.  

When a complete tear occurs the patient would feel a snapping noise in the front of the elbow with immediate pain and swelling to follow. Bruising around the elbow may develop not long after the injury. Another sign of a complete tear is the appearance of shortening or retraction of the biceps muscle itself.  Even in complete tears the ability to bend the elbow and rotate the forearm is usually maintained.  This injury requires prompt surgery to repair the torn tendon.

Signs and symptoms of a Bicep Tendon Tear may include:

• Pain and swelling the bicep
• Tenderness just below the crease of the elbow
• Bruising around the elbow
• Shortening or retraction of the bicep muscle

Bicep reconstruction is also referred to as bicep tenodesis. Bicep tenodesis is the surgical repair of an injured or degenerative bicep tendon through the use of a screw or washer and sutures. The repair will be done with a combination of small incisions to look inside the shoulder and a small open incision to repair and reattach the healthy part of the tendon. This is commonly an outpatient procedure.

A triceps tendon rupture occurs when the tendon of the triceps muscle is put under an immense amount of stress and tears usually directly from the elbow joint. Patients suffering from this condition often experience pain and an inability to straighten the elbow with significant swelling of the back of the elbow. While partial tears of the triceps tendon can often be treated non-surgically, patients suffering from a complete tendon rupture will likely require prompt surgery to repair the tendon and resume normal arm function.

Arthroscopy is a procedure that orthopedic surgeons use to inspect, diagnose, and repair problems inside a joint. During elbow arthroscopy, the surgeon will insert a small camera called an arthroscope, into the elbow joint. The camera displays pictures on a screen which the surgeon will use to complete the procedure.

The arthroscope and surgical instruments are small and thin, allowing the surgeon to complete the procedure using very small cuts, rather than an open surgery. This results in less pain for patients, less joint stiffness, and shortens the recovery time for the patient.

Arthroscopic surgery is often the ideal choice for treating certain elbow conditions such as loose bodies, stiffness, osteoarthritis and osteochondritis dessicans. These injuries can damage the ends of the bones and cause bone spurs to develop. These can be painful and make it hard to move the elbow, to the point where this procedure is needed to regain full range of movement in the elbow.