Tommy John surgery, also called ulnar collateral ligament reconstruction (UCLR), occurs following injury to the ulnar collateral ligament (UCL) in the elbow. Tommy John surgery is a surgical procedure in which the UCL is reconstructed using a tendon from another part of the body.

The procedure was named after Tommy John, a baseball player who was the first to have the surgery in 1974.

What causes an ulnar collateral ligament injury?

Throwing and racquet athletes (baseball and tennis players, for example) are the most common patients for this surgery. Occupations that place excessive force on the elbow, especially when this stress is repeated, can cause injury. The UCL connects the bones of the elbow, which stabilizes the joint. If this ligament is injured and left untreated, chronic problems can occur.

What does UCL injury feel like?

Athletes with this condition have pain in the elbow during and after throwing or similar overhead activities. They may also develop numbness and tingling in the hand due to stretching of the ulnar nerve at the elbow. The pain is often chronic and reoccurring, leading to erosion of the athlete's ability to throw or hit overhead.

How do I know that I need Tommy John surgery?

A UCL injury is diagnosed with a thorough medical evaluation. Diagnostic tests such as x-ray and MRI are often used. X-rays may be taken to look for any fractures or bone abnormalities, while an MRI may evaluate the soft tissues of the elbow. The decision to move forward with surgery is made jointly by you and your surgeon.

How is Tommy John surgery performed?

An incision is made on the medial (inside) portion of the elbow joint. The damaged UCL is replaced with a tendon from some other area of the patient's body. Typically, a tendon from the patient's own forearm, knee, foot, or hamstring is used. However, if necessary, donor tissue may be used.

Duke Orthopaedics performs Tommy John surgery at locations throughout North Carolina, including Raleigh, Durham, and Chapel Hill. Learn more about elbow ligament reconstruction at Duke.

Treatment Videos

At Duke Orthopaedics, our doctors repair ulnar collateral ligament injury with Tommy John surgery. The following video demonstrates this procedure.