Tommy John surgery & UCL repair

The ulnar collateral ligament resists the valgus force generated on the inside of the elbow during the throwing motion. Injury can be acute — a pop during a throw, with immediate loss of velocity and control — or cumulative, with medial elbow pain that appears late in outings and takes progressively longer to settle.

Loss of command and velocity, pain during the late cocking and acceleration phases, and occasionally ulnar nerve symptoms in the ring and small fingers are the common complaints.

Throwers often describe the elbow feeling different before it becomes painful, and command tends to suffer before velocity does.

Medial elbow pain that recurs with throwing, a pop during a throw, or persistent loss of velocity and command should be evaluated rather than pitched through. Early assessment often preserves non-operative options, and it prevents a partial injury becoming a complete one mid-season.

Assessment covers the elbow directly with valgus stress testing and palpation of the ligament, and also the shoulder, hip and trunk, because deficits elsewhere in the kinetic chain often load the elbow. X-rays assess bone and any loose bodies or spurring; MRI, often with contrast, defines whether the tear is partial or complete and where it sits along the ligament.

Throwing history matters as much as imaging: volume, rest, recent changes in program, and the level and timing of the athlete's season.

Selected partial injuries are managed without surgery. That means a defined period without throwing, rehabilitation targeting the forearm flexor-pronator mass, the rotator cuff and scapula, and hip and core mechanics, then a graduated interval throwing program with objective checkpoints.

The plan is built around the athlete's calendar and level, with a realistic assessment of what is achievable in the time available.

UCL repair reattaches the athlete's own ligament to bone, in some cases augmented with an internal brace, and is appropriate for acute tears at the ligament's attachment where tissue quality is good — most often in younger athletes.

UCL reconstruction, known as Tommy John surgery, replaces the ligament with a tendon graft passed through bone tunnels at the native attachment sites. It is the option for mid-substance tears, chronically degenerated ligaments, and revision situations. The ulnar nerve is protected and, when symptomatic, addressed.

Both procedures are outpatient. Early recovery protects the repair or graft while restoring motion; strengthening follows, first in the forearm and shoulder, then across the whole kinetic chain.

Return to throwing follows an interval program with defined stages — flat ground, distance progression, mound work, then competitive throwing. Progression is earned at each stage rather than scheduled, and mechanics and workload are addressed so the athlete returns to a program that the elbow can tolerate.

Dr. Horner is a board-certified orthopedic surgeon with fellowship training in sports medicine and shoulder surgery at Rush University Medical Center, and he has cared for professional athletes in Chicago. Throwing athletes are managed with the season, position and workload in view, not the imaging alone.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.