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Tommy John surgery. Non operative management may be a better option for some players.

Many observers of baseball think that Tommy John surgery is a miracle operation that returns players to the MLB. In fact, many youth players are under the impression that they will actually throw harder after a Tommy John surgery and that it will improve their performance. 

I always counsel patients that Tommy John reconstruction is not the sure thing that they have been led to believe. By the numbers approximately, 75-80% of professional pitchers and catchers return to their same level of play after surgery. In other words, 20% or one in five don't ever get back to the big leagues after surgery. 

This fact has been shown over and over again by several research studies. For this reason, I encourage patients with partial tears to consider non operative options such as PRP injections and PT prior to opting for surgery. Although this does not work for everyone it has been shown to be effective in nearly 80% of players with partial tears. Interestingly, this is the same percentage of success as the surgery! One of the most publicized examples of this treatment is Masahiro Tanaka. The NY Yankees pitcher had a partial tear of his UCL a few years ago. He opted for non operative management and reportedly had a PRP injection. He has not had any further elbow issues since that time. 

Non operative treatment of a UCL partial tear typically invovles a PRP injection and a period of rest which is typically in the range of 6-12 weeks. The player then resumes a throwing program. If they continue to have pain and do not respond to this treatment, the next step is typically a surgical reconstruction. 


Brad Carofino, MD Dr. Brad Carofino is a board-certified (American Board of Orthopaedic Surgery), fellowship-trained orthopaedic surgeon who specializes in shoulder & upper extremity surgery. Dr. Carofino is an expert in shoulder replacement surgery, minimally invasive arthroscopic rotator cuff repair, and complex reconstructive procedures of the upper extremity.

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I enjoy sharing this story because it is a testament to patient's who are seeking a solution to shoulder arthritis who want to remain highly active. I am grateful for patients like Fred who give me the opportunity to improve their overall quality of life!