“Dead Arm” in Baseball Pitchers Tear of the ulnar collateral ligament (UCL): A second degree sprain Proximally attached to the medial epicondyle of the humerus Distally attached to the coronoid process of the ulna, and the medial surface of the olecranon Laterally stabilizes the elbow joint Tear is generally not painful, but significant loss of velocity and control Difficult to diagnose before MRI, and often a career ending injury

“Tommy John” Surgery Surgical technique to replace the UCL was pioneered by Dr. Frank Jobe in 1974 Named for Tommy John, a pitcher for the Los Angeles Dodgers on whom Dr. Jobe operated Tendon from the palmaris longus muscle replaced the ulnar collateral ligament This tendon is not crucial for function, and in fact is missing in ~15% of the population

“Tommy John” Surgery Holes are drilled through the humerus and ulna Tendon is looped through in figure eight fashion and sutured, tendon “ligamentizes” over time Surgery may actually increase velocity above pre-injury, but recovery time is years About cm of tendon are needed Other tendons besides palmaris longus are also used, such as the lateral triceps tendon