12 things you probably didn’t know about Tommy John surgery
Last Tuesday, Orioles catcher Matt Wieters went under the knife for Tommy John surgery on his right elbow, becoming the 23rd major leaguer to lose his 2014 season for elbow reconstruction.
That roster consists almost entirely of pitchers, but Wieters’ misfortune shows that position players can blow their ulnar collateral ligaments, too. It’s not all terrible, though: the success rate for TJ surgeries nowadays is about 90 percent. Plus, have you ever worn surgical booties? They’re fantastic.
Owing to the skyrocketing number of players joining the Tommy John fraternity and Matt Harvey’s middle finger, even casual baseball fans have an idea what the surgery entails.
Now we’ve dug a bit deeper into Tommy John surgery mythology for some facts you probably didn’t know. Much of the information comes from Christopher S. Ahmad M.D., the New York Yankees’ head team physician and associate professor of clinical orthopedic surgery at the Columbia University College of Physicians and Surgeons; and Bradley Raphael M.D., an assistant team Physician for Syracuse University who trained at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles, a facility named (in part) for the late orthopedic surgeon Frank Jobe who performed the first ever "Tommy John surgery."
1. The Godfather of Tommy John surgery, Dr. Frank Jobe, was first exposed to medicine at age 18 when he served as medical supply sergeant in World War II in the 101st Airborne Division during the Battle of the Bulge.
"These guys would be operating in tents with bullets and shrapnel flying around," Dr. Jobe said of surgeons working under combat conditions. "There was tremendous noise from the shells going off. There was blood everywhere. These guys became my real heroes."
Dr. Jobe passed away this March at 88. Last year in a question-and-answer session on Reddit, Jobe explained why he ultimately pursued medicine after the war.
2. Some athletes think that surgery should be performed in the absence of an injury to improve performance.
In 2011, researchers led by Dr. Ahmad surveyed 189 baseball players ages 10-to-23 and found that 50 percent of high school athletes believed that Tommy John surgery should be performed in the absence of injury for the purpose of improving performance.
"Some kids will come in with their uniforms on, with their parents, going to play that night, wanting a consultation to be considered for Tommy John operation," Ahmad told Buzzer. "I’ve asked ‘When did you get hurt’ and I’ve heard, ‘Well he’s not hurt, but he’s not developing as quick as the other kids.’"
Some of those players and parents wanting a gratuitous Tommy John surgery are some of the same people who would like to get robot legs to enhance their abilities, but they don’t account for the entirety of the people who are misperceiving what the surgery is about.
3. The surgery doesn’t last very long.
All the magic happens in roughly 60-to-90 minutes of which only a portion is the actual reconstruction of the ulnar collateral ligament.
"That general timeframe is from skin to skin and includes the harvesting of the palmaris longus — the forearm tendon you need to weave through the tunnels drilled into the ulna and humerus bones," Dr. Brad Raphael told Buzzer.
Put another way, the whole thing lasts only about three innings of a Yankees-Red Sox game.
4. A lot of people think Tommy John is a doctor, not a pitcher.
Mostly younger people. "They don’t even know I pitched," John told Sports Illustrated. "The kids say ‘Tommy John, the doctor.’ I hear that often. I can’t change that. My name is in all the medical journals. Tommy John Surgery. That’s what it’s called and I’m proud to be associated with the surgery and the late Dr. Frank Jobe."
When Jobe was asked if he was annoyed that the surgery is named for John not himself, he said, "Not at all. I like it."
5. You’re not hearing much about the players who get Tommy John and fail.
In other words, you’re almost always reading in the news about the star major leaguers (for example, Stephen Strasburg and Adam Wainwright) who have bounced back from the surgery and performed well.
"It’s selection bias. People who cover games see the top pitchers, but they’re not in office helping kids struggling who were cut from the team," Dr. Ahmad said. "We celebrate the guys who do really well, but we don’t get to learn about those kids — those young professionals never progressed from the minors to the majors."
Or major leaguers who just hope to make it back after surgery, like Mets right-hander Jeremy Hefner. According to the Wall Street Journal, after Hefner threw fastballs from the mound at full speed on June 22 for the first since since his surgery last August, "Not too many people noticed. The whole thing lasted about 10 minutes. No reporters posted updates to their Twitter accounts."
Dr. Ahmad and other researchers are actually putting media members to the test. They’re currently in the midst of repeating the 2011 study that captured player, parent and coach misperceptions about Tommy John surgery, this time asking beat writers, columnists and others in the media similar questions about the surgery.
"A lot of the perceptions kids get are by watching TV, reading the newspapers and online," Ahmad said. "I think that many writers believe that [Tommy John surgery] is an outstanding operation where people come back and throw harder. The data is coming in right now and we don’t know what to expect."
6. A lot of young players have become more reckless because they figure they can always get Tommy John surgery.
"They’re playing recklessly — throwing too much, not following rules about pitch counts, and sometimes they’ll have pain but don’t tell anybody," Dr. Ahmad explained, calling it a cavalier attitude.
"One of the ways that we’re trying to get control of this is to let people understand that it’s a tough operation, a difficult recovery, and you’d like to avoid it if you can."
In other words, kids, do not aspire to get your arm cut open, even by the most talented physicians.
7. Fifteen percent of people lack the tendon that’s most commonly used to repair the damaged ligament.
That tendon is the palmaris longus, an "accessory tendon" in the forearm. Dr. Raphael said the tendon does help with wrist flexion but it’s not necessary for arm functioning and considered vestigial.
"It’s a strong tissue and usually the first option because the surgeon doesn’t have to expose another body part to harvest it," Dr. Raphael said. "It’s right there on the same side as the operation, so you don’t have to expose a leg to get tissue from the hamstring, for example."
Want to test to see if you have a Palmaris longus?
8. Jose Rijo had Tommy John surgery three times with two additional arm operations, and is basically a bionic man.
After 12 years in the bigs, Rijo missed five full seasons from 1996 to 2000, undergoing three Tommy John surgeries (the third by the famed Dr. James Andrews) and two additional arm surgeries in that time. Rijo persevered and managed to come back briefly in 2001, and picked up five wins in 2002 in nine starts.
During his recovery (or recoveries) arthritis formed in the elbow joint, helping to stabilize it. Said Reds medical director Tim Kremchek:
That was about 12 years ago, so Rijo’s elbow is now nearly an antique.
9. When Dr. Jobe performed the operation on Tommy John, he gave him a one in 100 chance to ever pitch again.
"He looked around my office very seriously," Jobe recalled. "He looked me in the eye and said, ‘Let’s do it.’ And those are three words that changed baseball."
John pitched for 13 years after recovering, earning 164 of his 288 career wins in that span. And he missed only one start after the elbow reconstruction, due to the flu.
Not bad for a one in 100 shot.
10. You can see exactly how the procedure works, if you like.
It’s not for those of you who get queasy easily. After Jose Rijo’s third surgery, Dr. Andrews suggested that he watch another patient undergo the procedure.
"I almost got sick to my stomach" Rijo said. "It was after my third surgery. Dr. Andrews wanted me to see exactly what Tommy John surgery was. But it was more than I could take."
Modern medicine is impressive, if you can stomach it.
11. There’s a New York City-based undergarments company named Tommy John.
Indeed, Tommy John the pitcher and the surgery do not have a monopoly on the name — a particularly desirable one because it’s actually two first names.
12. Dr. James Andrews helped design an app "Throw Like a Pro" to enable young players to prevent elbow overuse
— Tom Patterson (@tompattersonnyc) August 22, 2013
"For the first time kids and parents everywhere will have access to the information and routines that we hope will put an end to this epidemic," Andrews said off the iOS mobile app.
Dr. Kevin Wilk and Abracadabra Health assisted Andrews in the project. The app includes a pre-season preparation guide for players, information on warming up, pitch counts, proper throwing mechanics and much more.
Andrews will have fewer potential patients but it’s the right thing to do.