Jacob Roy stood on the pitcher’s mound and heard a little pop after he hurled a ball to his catcher. That, he later found out, was the end of his ulnar collateral ligament (UCL).
The UCL runs through the elbow and injuries like this are not uncommon in pitchers. Jacob says it hurt that day and the next, especially when he tried to pitch. He made an appointment with Robert Shalvoy, MD, an orthopedic specialist with Affinity Orthopedics and Sports Medicine, who examined his elbow through x-rays and noticed a debilitating weakness in the UCL. He suggested reconstructive surgery to fix it.
“I wasn’t too nervous,” Jacob admits. “I have seen pro pitchers have this done and they recover to pitch again.”
Known as Tommy John surgery after the 1970s Dodgers pitcher who was the first to have the procedure done so he could return to throwing, UCL reconstruction uses a surgical graft of a tendon from the forearm into the affected elbow. Shalvoy is one of the few surgeons in the region performing the procedure, mainly on high school and collegiate pitchers.
“There’s something about throwing a baseball that is unique, requiring special mechanics of the shoulder, elbow, wrist and hand, and specific ability,” Shalvoy says, adding that pitching increases “the stresses put on the arm, especially the inside part of the elbow, which is the weak link.”
“Throwing the ball approaches the threshold level of the UCL so if the mechanics are wrong, it increases the chance something will go wrong.”
In the past decade, Shalvoy says more and more baseball pitchers have been suffering from UCL strains because they are throwing harder, throwing more often, and throwing for longer in a game.
“Ours is a culture of specialization and these kids are playing nonstop. While we know that kids who take three to four months off each year are dramatically safer, many throw all year round,” he goes on. “The result is that the more you stress your mechanics, the worse your mechanics are, and the more likely you are to get hurt.”
In the 1970s, Tommy John surgery had a 50-percent success rate. Today, because the prevalence of the surgery has increased, patients experience an 80-percent rate. Shalvoy learned the procedure as a fellow and says the key is stabilizing the elbow by grafting the tendon in precisely the right spot in the joint. Patients undergo rigorous rehabilitation after the surgery to help restore motion but also to prevent future injuries.
“The pitcher learns how to take care of the arm, maintain a balance between the shoulder and elbow. They become more in-tuned to the mechanics of their arm,” Shalvoy says. “It’s exciting that this surgery works because it gives people their ability back if they’re willing to do the work.”
For Jacob, the rehabilitation took a year but he is now back on the mound, hurling pitches for St. Raphael Academy’s boy’s baseball team.