TJ rehab

My son had TJ surgery on 7/20 and all went well. They used his hamstring and he’s doing PT for both. Hes just beginning week 2. I’m asking just purely informational questions for me. I’m sure he has more info from his PT but getting anything other than “everything is fine” from my 21 year old is like pulling teeth.  He has full extension which he said they were happy with but he said he’s having a much harder time bending it up. He said he gets to a certain point and it feels tight hurts and he’s scared to push it because he doesn’t want it to snap (not sure if that’s even possible) He said they’re working on it. I’m sure he has more info from The PT but just for a worried mom is this normal at this point or is this a problem?

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Sounds normal to me.  It is so, so early in his rehab; I'd just be thrilled that he has full extension.  My son had full extension as well before he could bend it all the way (ie, to have forearm pressing against bicep).  I am no doctor, but I'd would guess his doctor's would say it is nearly impossible for the repaired ligament to snap.  I think it is more about getting the blood flow to the new tissue...which is actually a tendon.  That is what is amazing about the human body...with surgeries like TJ and ACL repairs, a tendon (which is like a rope) replaces a ligament (which is more like a rubber band) and with time and proper blood flow, that tissue becomes, in effect, a ligament.  Again, I am no doctor, but I did have my ACL repaired years ago, and it is very similar.  This process of the tendon becoming a ligament is one of the main reasons the rehab and throwing program is so long for TJ.

Relax, be patient and moderate your emotions.  It is a long road back, and there will be ups and downs.  Ours has been a roller coaster ride, and that seems to be the norm.

baseballmomx4 posted:

My son had TJ surgery on 7/20 and all went well. They used his hamstring and he’s doing PT for both. Hes just beginning week 2. I’m asking just purely informational questions for me. I’m sure he has more info from his PT but getting anything other than “everything is fine” from my 21 year old is like pulling teeth.  He has full extension which he said they were happy with but he said he’s having a much harder time bending it up. He said he gets to a certain point and it feels tight hurts and he’s scared to push it because he doesn’t want it to snap (not sure if that’s even possible) He said they’re working on it. I’m sure he has more info from The PT but just for a worried mom is this normal at this point or is this a problem?

Baseballmom, his and your feelings are VERY normal. My son was certain, early in the rehab, that he had re-torn his UCL. Even as far as 12 months post-op, he still felt a lot of “tightness”. His surgeon would tell me when we spoke it was perfectly normal and that son needed to “throw through it”. 

He also said it was almost impossible to have structural damage at that point in the recovery. I’m certain it has happened, but the surgeon would have the best knowledge of the type and strength of tissue that he harvested and placed. 

Bucsfan is exactly right about the conversion of the tendon to a ligament. And it takes TIME. I’ve said on her before, it was at least 20-24 months before son felt like he was back. His velocity was good but he just felt like he couldn’t “turn it loose”. 

As many others have said, it is a marathon, not a sprint. I would say it’s much more difficult mentally than physically. Assure your son he is having very normal feelings. Be patient and follow the script precisely. I know that easy for a stranger on a board to say, but I’ve “been there and done that”. Best of luck. 

Thank you Younggun and Bucsfan. Honestly I didn’t start out concerned. I kept telling him it’s only 2 weeks what are you expecting, but I started to get concerned when he seemed to be worried. I looked online and could only find rehab protocols and nothing really on benchmarks, like you should be able to do x by whatever week. I know everyone’s recovery differs but I guess there is some comfort in knowing you’re on track somewhat. Apparently he was concerned enough to ask at PT today so he has him using his left hand to push up his right to the point that it just starts to hurt or get tight and hold it there to see if he can push further each day.  Oh and he did say it was not snapping just feels uncomfortable.  My son also brought up that he keeps feeling weird things in his arm. Not exactly sure what that means but they did move his nerve so maybe that? Again Thanks for the info, I’m sure I’ll have more questions in the weeks and months ahead. If anything this will teach us all a lesson in patience.😉

Well just so you know, my son had ulnar nerve transposition about 3 months prior to UCL reconstruction. He says his arm doesn’t feel the same to this day, 32 months post-op. My assessment is it may never feel “normal” like it did pre-op. I continue to tell him THIS may be your new “normal”. 

BBMom, I feel your concern as my son (just starting his HS senior year) had his full TJ on 5/8 so we are about 3 months in.  What you are experiencing is normal and glad your son has full extension which is positive returns so far.  I've had to, as they say "trust the process" and just stay right on schedule with what your surgeon provides as a rehab schedule and we provided that to our PT.  I call my PT every few weeks to make sure they are on schedule with the document and to make sure I understand any new things he should be doing at home as well ....like the pitcher's ten exercises he has been doing twice a day.  

Mine has numbness on the top of his left hand and that is also considered normal for the first 3-6 months so it's good to continue to ask questions just to make sure.  Trust your recovery process, be patient (that I've had to really learn) and as said above...it's a marathon.  All my best to you and especially your son as I know it can be frustrating at times, but in the end I just want my son healthy regardless if he can eventually throw what he was, slower or even faster.....just healthy for the long term.

My son is coming up on 2 years post-TJ next week.

Moving the nerve causes weird feelings in just about every patient. What kind of weird varies. My son had numbness in several fingers at the beginning, which eventually reduced to just weakness, which eventually went away. Also had a few numb/tingly spots on his arm and hand that eventually went away.

The difficulty in fully bending is likely due to residual inflammation from the surgery, which is part of the normal healing process from having your body cut up with a scalpel. Bending the elbow causes tissue compression on the front/inside and extension on the back/outside, either of which can aggravate areas where there is still some inflammation.

My son also got his graft from the gracilis tendon in his leg. It's much larger and stronger than the palmaris longus tendon. We were told by the doctor WTTE "he ain't ever tearing that one." The main trade-off is that you have to rehab two limbs instead of one.

So to sum up, his physical recovery seems normal to me.

As YoungGun stated above, the mental side of this is much tougher than the physical. I don't mean to alarm you, but you should really monitor his mental state throughout his recovery and return to play. The grind of rehab and recovery, inability to play, not being a contributing part of the team, and fears about whether he would ever be able to pitch the same way again all contributed to my son spiraling into anxiety and depression. (In hind sight, he had other indicators prior to surgery, but the injury/surgery/recovery was definitely the tipping point for him.)

Thanks again for all of the replies. I just feel the more you know the better and maybe then it’s easier not to stress about things if you know they’re normal. 

There still does seem to be a lot of inflammation just looking at his arm. Hopefully that will start to go soon. He’s 3 weeks post op now. 

Mr.Bumstead;  his mental state is what I am worried about.  A local baseball facility hired him when they heard he was hurt and back for the summer. They’ve know him for years. He’s coaching and doing camps etc  so I think that has really helped him not dwell on not playing. The little ones also pump up his ego a little bit 😉. I will watch as school starts up again. He has the added anxiety of going back to a whole new coaching staff and not knowing where he stands after this year. He’s a senior and would have to do a grad year to play next year. One thing at a time I suppose. 

baseballmomx4 posted:

Thanks again for all of the replies. I just feel the more you know the better and maybe then it’s easier not to stress about things if you know they’re normal. 

There still does seem to be a lot of inflammation just looking at his arm. Hopefully that will start to go soon. He’s 3 weeks post op now. 

Mr.Bumstead;  his mental state is what I am worried about.  A local baseball facility hired him when they heard he was hurt and back for the summer. They’ve know him for years. He’s coaching and doing camps etc  so I think that has really helped him not dwell on not playing. The little ones also pump up his ego a little bit 😉. I will watch as school starts up again. He has the added anxiety of going back to a whole new coaching staff and not knowing where he stands after this year. He’s a senior and would have to do a grad year to play next year. One thing at a time I suppose. 

Mine did some coaching this spring and summer as well. It did wonders for him as well.

Another word of caution about the mental side of it, since you have already expressed concern - pitchers, more so than maybe any other athlete, are taught/trained/conditioned to conceal emotions, control body language, or cover up anything that can be construed as weakness. And while I don't know your son, if he's a pitcher at that level there's a good chance that he can and will lie to you, his coaches, and anyone else to cover up his fears and anxieties. If he does lie to you, know that it has nothing to do with his character; he's scared, he's running from it by denying it exists, and he's dealing with it just like he's been taught to deal with it on the mound.

Educate yourself about mental health issues with athletes. The NCAA has actually published several articles about it on their web site.

Be vigilant for behavior trends that veer from his typical behavior. If you know some of his roommates/teammates and their parents, ask them to keep an eye out for signs of trouble (social disengagement, apathy, not going to class, mood swings, changes in appetite or sleeping patterns, etc.) and report them to you if it's outside his normal behavior patterns. You need boots on the ground for this.

Most of all, talk to him about the potential mental health side effects of his injury. Emphasize that it's nothing to be ashamed of. Ask him to read about some of the pro athletes that have recently come out about their mental health issues (Kevin Love, Demar Derozan, Michael Phelps, etc.). We didn't anticipate this happening to our son, so we didn't prepare him for it. So when he started down the hole, his fear of what was happening only drove him deeper into the hole. He got to the point that he didn't leave his bedroom except to eat, use the bathroom, or go to practice. I can't help but think that had he understood what was happening to him, he would have been able to deal with it better.

Thanks Mr. Bumstead. I will definitely keep my eye out. You’ve pretty much described my son. Everything is always “fine”, he’s not much of a talker. He’s very competitive and I think this is going to be a lot harder in him than he may think. He’s been very fortunate. He’s never had an injury to deal with that maybe lasted more than a game.  I even had a talk with his girlfriend to keep an eye and let me know if she thinks anything is up. 

Again thanks for your advice. I hope your son is doing well now.

So my son is one month post op and he had a follow up yesterday. As I was concerned about, they are happy with his extension but not his progress with flexion. He can only get it to barely 90 degrees. He said it’s tight and feels like he hits a wall and it will not bend further. He’s switching PT’s in a week to someone they prefer more than the one he’s at now and is closer to school.  (That was the plan anyway) They don’t want him in the brace anymore except if he’s in a crowd or working with the kids at the baseball facility.  They’ve also prescribed an anti inflammatory. He has to return to the surgeon in 3 weeks, and they want him to be able to touch his wrist to his shoulder by then. They’ve ordered a brace that he will have to wear for 20 minutes at a time throughout the day every few hours that will keep his arm in a bent position at certain degrees. That is getting delivered to the house today or tomorrow. Anyone have a similar experience? Opinions? Advice?Thanks. 

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