Throwing elbow pain? Learn about UCL repair and reconstruction (Tommy John surgery) from LA sports medicine surgeon Dr. Shybut. *(141 chars)*
The Throwing Elbow
The Dodgers are chasing a third straight World Series title and every sports fan is excited for playoff baseball this October. Every year we also hear from pitchers whose elbows have quietly been telling them something all season. If your elbow aches on the inside, feels different when you throw, or has started affecting your velocity and control, it's worth understanding what might be going on — and "Tommy John surgery" is usually the first phrase people think of when ulnar collateral ligament (UCL) injuries comes up.
What It Is and What It Feels Like
The UCL is the main ligament stabilizing the inside or "medial" side of the elbow, and it takes on enormous, repetitive stress with every throw — which is exactly why pitchers, catchers, and other overhead throwing athletes are the ones who tear or stretch it most often. UCL injuries usually develop gradually rather than happening all at once: a dull, aching pain on the inside of the elbow during or after throwing, a drop in velocity or command that doesn't have an obvious mechanical explanation, or in more acute cases, a sudden pop with immediate pain during a single pitch.
Because the early symptoms can be subtle — soreness that athletes and coaches sometimes write off as normal "arm fatigue" — UCL injuries are often further along than expected by the time an athlete gets evaluated. Learning to tell the difference between ordinary throwing soreness and a ligament that's actually failing is one of the most important things a throwing athlete (and their parents or coaches) can learn.
When to See a Specialist
Persistent inside-elbow pain with throwing, a noticeable drop in velocity or accuracy, or any sense of instability in the elbow are all reasons to get evaluated by a sports medicine specialist rather than pushing through a season. A thorough exam plus imaging (often MRI) can confirm whether the UCL is partially or fully torn, and whether the injury is a candidate for a non-surgical recovery path or for surgery. Catching a partial tear early sometimes opens up options that aren't available once it progresses to a complete tear.
Treatment Options: Non-Surgical vs. Surgical
Not every UCL injury needs surgery. For some partial tears, a structured program of rest, targeted rehab, and gradual return to throwing can allow the ligament to heal enough to support competitive throwing again — particularly in less severe injuries caught early.
When surgery is needed, there are two general approaches, and which one applies depends on the tear pattern, location, and the athlete's level of competition:
1) UCL repair — for select tear patterns, the native ligament can be repaired directly, typically augmented with an "internal brace," which is a strong suture that works like a seatbelt to protect the healing repaired ligament. For some surgical patients this type of repair offers a faster return to throwing than traditional reconstruction.
2) UCL reconstruction ("Tommy John surgery") — for more extensive or chronic injuries, the ligament is reconstructed using a tendon graft, restoring the elbow's stability for the demands of high-level throwing.
Candidacy for repair versus reconstruction is individualized based on imaging findings, the athlete's age and level of play, and surgical exam findings — there's no single right answer that applies to every throwing elbow.
What Recovery Looks Like
Recovery from UCL surgery is a long process to allow for tissue healing and proper rehabilitation. Early weeks focus on protecting the healing tissue and restoring elbow motion, followed by months of progressive strengthening. The hallmark of UCL rehab is the interval throwing program: a carefully staged, distance-and-intensity progression that gradually rebuilds a pitcher's throwing tolerance. Depending on the procedure and the athlete, return to competitive pitching is typically measured in many months to a year or more — rushing this timeline risks re-injury, so milestone-based and calendar-based progressions matter.
How Dr. Shybut Approaches Throwing Elbow Care
Dr. Shybut's experience with throwing athletes comes directly from the baseball environments he's worked in. During his sports medicine fellowship in Houston, he helped provide care for Major League Baseball's Houston Astros. In practice he previously served as team physician for Texas Southern University athletics. Thus he has firsthand experience across professional and collegiate throwing programs. Today, he continues that work as team orthopedic surgeon for College of the Canyons, where he evaluates and treats throwing athletes at the collegiate level.
That range of experience — from professional pitching staffs to college programs — shapes how he talks through UCL injuries with patients and families: candidly about what repair or reconstruction can and can't promise, and realistic about the rehab timeline it takes to get back on the mound safely.
For referring physicians, Dr. Shybut is glad to discuss UCL repair versus reconstruction candidacy, internal brace augmentation, and return-to-throw progressions directly. Referral lines are available through SCOI.
Dealing With Throwing Elbow Pain?
If you or your athlete is dealing with elbow pain that's affecting throwing — whether you're in Los Angeles, Santa Clarita, the San Fernando Valley, Pasadena, Burbank, Glendale, or La Cañada Flintridge — don't wait out a whole season hoping it resolves on its own. Request a consultation with Dr. Theodore Shybut at SCOI: call (661) 290-5473 or visit shybutmd.com.
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*This article is for general educational purposes and is not a substitute for individualized medical advice. Every throwing elbow is different — a full evaluation is the only way to know what's right for you. Individual results vary.*