Tommy John surgery is often necessary for a pitcher with an ulnar collateral ligament (UCL) injury. Is it needed for a partial UCL injury?

Derek writes:

I am a 40 year old male right handed pitcher. I play men’s amateur baseball and have pitched since college.  I recently felt pain in my pitching elbow, and after a visit to an orthopedic surgeon and MRI, I was told I have a partially torn MCL. I plan to continue to pitch for many years and want to know if I should accept the injury, understand that it will continue to be a problem if I continue pitching after resting it, and have surgery now?  I can accept missing this season if I can predict that I can possible return next season. Suggestions?

Before I address partial injuries, I think it would be worthwhile to explain Tommy John injuries in general.

UCL injuries of the elbow

Ulnar collateral ligament injuries of the elbow (some surgeons call that ligament the MCL of the elbow) are unfortunately common injuries in throwing and overhead athletes, like baseball pitchers. In almost all cases in these athletes, the ligament gradually frays over time until it finally ruptures. Complete ruptures do not heal on their own. If an athlete wants to continue to pitch and cannot at the level he desires after the injury, surgical reconstruction is often performed.

Also read:
Ask Dr. Geier – Preventing youth pitching injuries
The misperceptions of Tommy John surgery

Teenage high school pitcher on the mound during a game

Partial UCL injury

Partial UCL injuries are exactly what the name implies. The ligament is partially torn. Some athletes can compete with that injury, especially if they play a position that doesn’t involve much throwing. Throwing athletes often have trouble playing due to pain, loss of velocity, or difficulty locating their pitches.

While a period of rest and physical therapy might not actually get the ligament to heal, it is often worth trying. If a period of rest and rehab allows a pitcher to return to pitching without symptoms, then he could avoid surgery. Unfortunately studies on nonoperative treatment have shown mixed results.

Treatment of a partial UCL injury of the elbow

A recent study suggested that platelet-rich plasma might help athletes with partial ulnar collateral ligament tears return to sports. While considerable debate about the use and effectiveness of PRP exists generally, it might be worth trying. Potentially it could help a pitcher avoid surgery and a year-long (or more) recovery.

Lastly, surgical reconstruction of the UCL (Tommy John surgery) is an option if nonoperative treatments aren’t working and the pitcher cannot compete as well as he would like. We don’t have much data on the success of these operations among older pitchers, but studies on pitchers at the Major League level show return to pitching rates between 83% and 92%. Again, if a pitcher doesn’t mind missing an entire season and undergoing surgery and extensive physical therapy, then it can be a good option. Every pitcher has to weigh the pros and cons for himself.

Tommy John surgery common among baseball pitchers

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