Tag: tommy john surgery

Good News for Stem Cell Treatment on Elbows

One of the perennial questions faced by professional baseball pitchers is how long they will be able to do what they do. Pitching is extremely traumatic on the joints and ligaments of the shoulder and elbow, a fact which has led to many calls for limiting the pitch count of younger players.

But once a player is in the big leagues, he doesn’t have the luxury of sitting a few games out when he’s tired. Pros face all the same health issues as younger athletes, and the consequences can be punishing. When joints give out entirely, pitchers have traditionally been faced with two prospects: Tommy John surgery, or retirement.

But platelet rich plasma (PRP) may represent a Third Way, one which extends careers without extending time in recovery. As the Los Angeles Angels’ Garrett Richards recently discovered, the bounce-back can be astoundingly swift:

Instead of electing to undergo standard Tommy John surgery, Richards decided to try to heal his injury by getting an injection of stem cells directly into his elbow. . . . Gross, but it apparently worked. Passan reports Richards is feeling great and throwing 98 mph at spring training. Richards is clearly pleased with the tentatively positive outcome: “Science, bro. I’m a believer now,” Richards told Passan.

This isn’t the same response that everyone will have, of course. But it is an encouraging sign for this still-novel procedure, one that could soon be a common treatment for elbow pain that helps athletes young and old heal faster and play longer.

Understanding Elbow Surgery

As a San Diego orthopedic surgeon who treats kids alongside adults, I spend a lot of time talking to athletes about how to extend their active careers.

Baseball is an evergreen topic when it comes to sports medicine, especially the various burdens that pitchers place on their shoulders and elbows. Many of these conversations focus on the pros and cons of a common elbow surgery procedure known as Tommy John surgery. At one end of the spectrum I see rising pitchers who wonder when they might require a Tommy John procedure, while at the other I field questions from seasoned pitchers who have had the procedure and wonder what to expect as they ease out of their competitive years.

The answers to such questions typically depend on each patient’s individual history, genetics and lifestyle, but they all start with an understanding of the process. This article covers the basics of Tommy John surgery in simple language, including this key passage about a wrist tendon known as the palmaris:

Once the tendon is harvested, the doctor will have the tendon cleaned and cut to size while he goes back into the elbow. Holes are drilled through the bones of the upper and lower arm, angled to allow the tendon to loop through and be placed in as near an identical position as the damaged ligament. In some cases the doctor will leave the damaged tendon in place, but most dissect it away.

The donor tendon is then looped through two or three times and locked into place. The doctor will then check that the ulnar nerve (“funny bone”), which runs through the same area, is not entrapped. Some doctors will move (transpose) the nerve as a matter of course, while others leave it in place. Nerve entrapment is one of the most common complications of the surgery. Tommy John himself suffered from the issue.

Recovery is often rapid, and research shows that this kind of elbow surgery is surprisingly durable and resilient. It’s not a magic bullet, however, and pitchers should be disabused of the notion that it will result in superhuman improvement. Like anything else, the mechanics of Tommy John surgery don’t hold up forever, and revision or followup appointments may be required.

Bottom line: if you’re experiencing elbow pain already, it’s wise to speak with an orthopedic surgeon about your options for surgery, recovery, and aftercare. To learn more, contact the San Diego elbow surgery experts here today.