UCL tear

How big is the tear?  I'm no doctor, but I think if it's 1%-5% (maybe?) you may be able to rehab it for a while.  Ask an expert doc about their experiences.  One of son's docs said small tear, and another said >50% and rehab would have wasted an extra year.  So get a 2nd opinion.

Chef, first off, let me say I am sorry for your son's injury.  I'm not a orthopeadic doc, but I will tell you where I stand, having the ability to look back on my son's situation.  My son felt a "pop" during a throw from the outfield when he was 15.  We had x-rays, MRI and examination which all revealed a UCL tear.   Son had no pain, even during docs exams.  Our local ortho referred us to Dr. James Andrews.  Son saw Dr. Andrews about a month after the injury.  During his examination, I could see the look of confusion on doc's face as he was expecting son to exhibit some pain, but to his surprise, my son complained of zero pain on all the movements.  Dr. Andrews was great!  He took a LOT of time talking to us and explaining his findings and recommendations.  He suggested that we proceed with rehab, but he warned me that surgery may still be required in the future if he didn't respond favorably to the rehab.

Son did the prescribed rehab and followed up with Dr. Andrews 6-8 weeks later.  A second MRI was taken and showed his UCL scared over and healing.  Dr. Andrews was certain he would make a full recovery and released him to normal playing about 4 months later. 

Fast forward 3 years.  Son feels a "sensation" in his elbow the morning following a complete game in which he threw only 89 pitches over 7 innings.  The team trainer felt like it was just soreness and nothing structurally wrong.  After 2 weeks of rest, the issue was still present, so we saw the ortho doc once again.  This was a different doctor from our first visit.  On examination, he felt certain there was no structural damage.  The doc didn't want to do a MRI.  I basically demanded it as son was getting a lot of pro interest leading into the 2015 MLB draft.  The MRI showed no structural damage, and the ortho told me his ligament looked better than it did on the MRI from 3 years prior.  We talked with his HS coach and college pitching coach and all agreed to shut him down as a precaution until he got to campus for summer.  Son went through the summer throwing program with no issues while throwing long toss or flat ground.  When he threw his first bullpen from the mound, he felt the "sensation" again.  The trainer immediately diagnosed it as an ulnar nerve issue and he was referred to the team ortho.  On his examination a few days later, he confirmed the trainer's diagnosis and set son up to have a nerve conduction test.  The test confirmed the clinical diagnosis, and son had ulnar nerve transposition surgery in August.  He rehabbed from the surgery and everything progressed seemingly flawless.  Son was again able to throw long toss and flat ground with no pain or issues.  His first bullpen from the mound, he felt a "pop" on his 4th pitch.  A UCL tear was feared and that was confirmed by MRI a couple days later.  Son had UCL reconstruction December 16.

I know this has been a very long post, but I'm trying to lay the groundwork for my opinion.  With all the information I have now, I still do not know if I would have done anything different.  You can really only go by what the experts recommend.  I do think the original tear of son's UCL never completely healed.  He does have a slight mechanical flaw where he throws from a slightly closed position.  Other than that, I have never had anyone tell me that son had mechanical issues.  He has never had a pitching lesson, but he has thrown in front of many, many scouts.  I would think that if a major flaw was present, someone would have said something by now.

I think your son is a freshman or sophomore in college, right?  My opinion would be to lean toward the more aggressive surgical option at this point I think.  Maybe being conservative is the right call for a young teenager, but at this point in your son's career, I would rather have the issue solved rather than putting a band aid on it, per se.  Again, I'm not an ortho doc, but I am in the medical field and have a fair amount of knowledge and understanding of anatomy.  Everyone is different and each has his own opinion.  I'm just giving you my opinion as my son is 2 months post-op. I'm not saying we or he would have done anything different.  It is very difficult and I really feel for you and your son.

Things happen for a reason and I fully believe that God is in control.  My faith is the one thing that I can hold on to.  I can tell you it is very difficult to see my son sitting in the dugout watching his teammates perform and knowing he can't.  This is the first time he has missed any sport due to injury.  I have to believe God is teaching him something.  Hopefully we are able to look back in a few years and see the lessons. 

Sorry to hear that, Chef.  My advice would be to go to ASMI site (asmi.org) and ask Dr. Fleisig for a referral to an Andrews-trained doctor in your area, but after Googling Dr. Kremchek, it looks like he fits that bill.  Still, couldn't hurt to ask.

Good luck to your boy!  Hoping for the best. 

Kremchek is absolutely a great choice.  There is a poster here whose son had TJ surgery performed by Kremchek in the last 4 months.  Maybe he will read this post and chime in.

Thanks Younggun (and everyone else). I agree with you about being aggressive in treatment. He did hear a pop, but said his arm got really hot at end of third inning, then we had a long at bat. he said his forearm was tight when eh went back out, felt something on first pitch but tried to work thru it. threw about 10-15 more pitches, got worse and coaches kept asking if he was ok and he said yes. They came out and out immediately after he buried a fastball 10 feet in front of plate and he was done.

I am with you on Gods plan. He said to me this morning that he has been praying about it a lot since last night and whatever God decides for him he is ok with. that he is at peace with whatever happens. Makes me proud of who he is as a man  

sultan, that is the question and Dr did not say. I saw MRI (I had to ask, he wasn't going to show it to us), but really didn't know what I was looking at. He just said a tear. Said there were long strands still connected from bone to bone. Coaches were asking grade1,2,3. Not sure they ever got an answer from Dr. I think that is why they were pushing for a 2nd opinion. They did not have to push much for me to agree

chefmike - really sorry to read this.  Your son will be in my thoughts and prayers.

Couple of things from our older son's UCL experience:

• He heard no pop, but instead felt something like a 'funny bone' sensation in his elbow after throwing a changeup in basically a bullpen session.  Both he and his MLB club thought (hoped?) it was probably an over-pronation.
• The MRI conducted by the team's doctor did not show a tear and so they tried rehab - didn't work.  Same 'funny bone' sensation 4-6 weeks later after rest.  He was then given the choice to decide - he went for the surgery after which the doctor told him there was indeed 'extensive damage' that hadn't been seen on the MRI
• Our younger son's college PC told him (once he heard about older son) that these things don't turn out w/ no surgery very often - no idea what that means?  But in our older son's case, he was correct.
• Since his MLB team would fly him anywhere for the surgery, our son did a lot of research and picked his own doctor based on a number of factors including a) reputation, b) success rate, c) repeat surgery rate and d) number of holes drilled.  There were probably other factors, but those were some.  Dr. Andrews was indeed 1 of 3 finalists in our son's analysis, but he chose a different doctor based on his own criteria.  My point is that it would be hard to go wrong with the doctor everyone mentions first, but there may be another one that fits your son's situation better?  Think about it, thats all.

All the best - let us know how it goes.  Hopefully just rehab, but others have given you good experiences and advice on that scenario - that I've heard from many others too.

The ASMI sports medicine forum is good.  Lots of physician and trainer responses.  Also ask about platelet rich plasma therapy.

I had my surgery done in August 2014 by Dr. Kremchek. He was the third doctor I saw and the only one who was able to fully diagnose the tear (mine was a partial tear). Before Dr. K, I had done two stints of rehab (each 5 weeks long). I did not find improvement and ended up having the surgery which could have been done 8 months prior, in reality. 

With that said, if your son ends up opting for surgery, I would absolutely go with Kremchek. He is one of the best there is. Also keep in mind that the road back from TJ is not the end of the world. Stick to the process and it will heal as it is supposed to. I wish your son the best! Feel free to give me a PM if you have any questions. 

Chef, So sorry to hear, while I have no answers for you, you and your son willbe in my thoughts and prayers.

Got final news about son. Tommy John surgery with Dr Kremchek this Friday. Said original MRI was "terrible". Did X-ray, ultrasound, and a contrast MRI with fluid. Showed a significant tear across the middle of muscle. Holding on a one end by a couple threads. 

The difference in the whole process of diagnosis was like mid day at the equator on the longest day of year vs midnight in anartica on shortest day of year. 

He is ok with outcome. He has been saying surgery since it happened. thanks everyone for the information. It was very helpful in asking questions and then understanding what the Doc and everyone was talking about.

I'll keep you posted

Good luck to your son. Let us know if there is anything we can do?

Thanks Bishop. At this point just like what I will be doing for next few days. Hitting my knees and asking for him to be ok to the man I charge of it all 

Unless we want to have the donate for yearly out of pocket money. Like I have $4000 laying around . That's what payment plans are made for. It does frost my buns a bit that because we got such bad advice by college docs we felt the need to go outside, which means instead of college picking up all the costs after our insurance pays, I have to. Will and would do it in a second for any of my kids but is a bit frustrating. The 4K would be the same whether I went thru school docs (not specifically affiliated with school but an agreement of some sort) or where he ended up. The politics of insurance- ugh! 

I will be praying for your son.  A kid I know had TJ and came back the end of last spring, played through the summer.  Pitched a perfect game to start off his spring season!

I'm not an expert but it seems every time I hear that an MLB pitcher gets treated conservatively he needs surgery anyway a couple months later. 

But I would trust the doctor, maybe a very small tear can heal itself.

Dominik85 posted:

I'm not an expert but it seems every time I hear that an MLB pitcher gets treated conservatively he needs surgery anyway a couple months later. 

But I would trust the doctor, maybe a very small tear can heal itself.

got second opinion from an expert in this surgery yesterday. Surgery it is. On Friday

Good luck. Son is 18 months post TJ with Kremchek and doing well.  Have him follow the program religiously and all will work out.  Oddly I believe the adversity my son has experienced and the dedication to coming back has made him both mentally and physically stronger.  Rooting for a very healthy future for your son!  

Fairly new to this forum but as a parent of a student-athlete my heart goes out to your son. Best wishes to him on a full and speedy recovery.