A Beginner’s Guide to Achilles Injury and Tommy John Surgery
By: Rebecca Webb, PA-C
Opening day in Baltimore is here and fans are excited to cheer "dem O’s" into the 2018 season. While everyone hopes that their team is in tip-top shape, professional players can experience injuries. I am sure most of you have heard about the Orioles’ all star closer Zach Britton’s injury during an off-season workout; a ruptured Achilles tendon. But, do you know what that exactly means and how it’s treated? How about the eponymous Tommy John surgery? It’s okay, I didn’t either until my medical training! So I am here to give you the explanation behind some of those crazy medical words you hear thrown around all the time.
Let’s start with Zach Britton’s ruptured Achilles tendon. The first thing we should talk about is determining what exactly a tendon is. A tendon is a strong band of tissue that attaches a muscle to a bone. Specifically, the Achilles tendon attaches the calf muscles to the calcaneus, also known as the heel bone. The calf muscles are responsible for planting motions of the foot, and the Achilles tendon is used in almost any activity that involves movement of your legs.
The most common injury to the Achilles tendon is related to chronic overuse, but the most devastating injury is when the tendon actually ruptures, or becomes unattached. This typically occurs when an acute, or sudden, force is placed on the tendon during an activity involving sudden starts and stops or pivoting. In Zach Britton’s case he was running and in his own words it “felt like something punched me in the leg.” Other people have described it as a “pop” with severe, immediate pain in the back of the calf. When the tendon completely tears, most often a surgery is required to repair the tendon. We wish Britton a continued speedy recovery!
Okay, let’s move onto another common medical phrase you might hear surrounding baseball: Tommy John surgery. The medical field has a habit of naming ailments and procedures after specific doctors or public figures and it can be terribly frustrating as the name gives no indication on its own as to what’s really going on! Tommy John surgery was, of course, named after Tommy John, a Major League Baseball pitcher who underwent the first successful “ulnar collateral ligament repair surgery” wayyyy back in 1974. OK that’s a lot, I can see why they named it the Tommy John surgery. But what exactly is it and why do us fans seem to hear about it all the time?
A ligament is a band of tissue that connects two bones, providing support and stability to a joint. The ulnar collateral ligament (UCL) connects a bone in the forearm called the ulna, to the the humerus in the upper arm, and supports the inside portion of the elbow joint. With baseball players, it is most often the repetitive throwing that slowly damages this ligament over time. The player will complain of pain at the inside of the elbow, especially with throwing. When the injury gets to the point where there is a lot of instability or pain, a surgical procedure is often necessary to get the pitcher throwing 90+ MPH again. When it is decided that surgery is necessary to repair a player’s UCL, generally the area is ensured to be clear of foreign bodies and bone spurs. Then the player’s damaged ligament is removed and completely replaced by harvesting tissue from another ligament or tendon in their body.
Tommy John surgery is considered a major advancement in sports medicine and players have a fairly high rate of success returning to their former level of competition. You might remember Orioles catcher Matt Wieters had this surgery in 2014. Other famous Orioles players that have had this surgery include Dylan Bundy, Hunter Harvey, and Orioles new player Alex Cobb. According to Major League Baseball’s official website, approximately 30 pitchers per year require this surgery and they also report 25% of pitchers in the major and minor leagues have needed the surgery at one point in their career.
I hope you’ve enjoyed learning a little more about common injuries that occur in baseball. For more information regarding the topics discussed above, visit OrthoInfo.org from the American Academy of Orthopedic Surgery. See you next time!
- O’Connor FG. Evaluation of elbow pain in adults. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2018. www.uptodate.com. Accessed March 19, 2018.
- Maughan KL. Achilles tendinopathy and tendon rupture. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2018. www.uptodate.com. Accessed March 19, 2018.
- Young C. Throwing injuries of the upper extremity: Clinical presentation and diagnostic approach. In: Post T, ed. UpToDate. Waltham, Mass.: UpToDate; 2018. www.uptodate.com. Accessed March 19, 2018.
- Ghiroli B. (2017 December 22) Britton has surgery to repair right Achilles. Retrieved from https://www.mlb.com/news/orioles-zach-britton-has-achilles-injury/c-263808464
- Andrews. (2014) Tommy John FAQ. Retrieved from http://m.mlb.com/pitchsmart/tommy-john-faq/
Rebecca Webb, PA-C is a Physician Assistant at The Centers for Advanced Orthopaedics, OrthoMaryland Care Center. Rebecca is a member of our Joint Team, working closely with Dr. Peter Jay and Dr. Barry Waldman, treating hip and knee conditions, sports injuries and basic fractures.