Tommy John Surgery

Tommy John surgery is a procedure to fix a torn ulnar collateral ligament (UCL) in your elbow—the ligament that helps keep the joint stable during throwing. Think of the UCL as a sturdy strap on the inner side of your elbow. Repeated high‑speed throws (like pitching) can fray or tear it, causing pain, instability, and loss of power.

During surgery, the doctor usually replaces the damaged ligament with a tendon graft taken from somewhere else (often your forearm, hamstring, or a donor). Small tunnels are drilled in the upper arm bone (humerus) and forearm bone (ulna). The new tendon is threaded through these tunnels and secured so it can act like a new ligament. Sometimes, if the tear is in a good spot, surgeons can repair it directly and reinforce it with an “internal brace.”

Shorter wait times

• For throwing athletes, time matters.
• Private centres can often schedule consultation and surgery sooner, reducing time away from sport, school, and scouting windows.

Choice and control

• Choose a surgeon with high-volume UCL reconstruction experience and strong return-to-play outcomes.
• Select the clinic location (often out-of-province).
• Plan surgery around season timelines, exams, and family schedules.

Peace of mind

• Know who will operate, when it will happen, and the step-by-step plan (graft choice, internal brace, throwing progression).
• Clear timelines reduce anxiety and help coaches, trainers, and families coordinate rehab.

Preventing further decline

• Function and performance: Limits months of elbow instability, pain, and shutdown from throwing; preserves velocity and control potential.
• Joint and tissue health: Ongoing instability can irritate cartilage/ulnar nerve and strain the flexor-pronator mass; earlier stabilization can curb secondary damage.
• Surgical complexity: Repeated partial tears and scarring can complicate later reconstruction.
• Mental load: Shortens time living with uncertainty, lost roster spots, and disrupted training.

1. ‍Confirm your diagnosis. Most patients start with a family doctor or specialist who confirms that surgery is needed.
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2. Research. Explore surgeons who specialize in private Tommy John surgery.
   • You can find surgeons in Vancouver, British Columbia; Calgary, Alberta; Toronto, Ontario; and Montréal, Québec on our app, and review qualifications, as well as pricing.
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3. Schedule an initial consultation. Most surgeons offer in-clinic and online consults.
   
   • Consultations are usually booked within days or a few weeks.
   • Note: expect a consultation fee between $150 - $350.
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4. Consultation. The surgeon will review your condition, symptoms, and any previous treatments or diagnostics, such as x-rays or MRIs.
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5. ‍Post consultation. The surgeon will then review your case and provide surgical options based on your needs; review the risks and expected outcomes; and present pricing and scheduling options.
   
   • Because the procedure is not covered by your provincial health plan when done privately, you’ll need to review the quoted cost and consider payment options (out-of-pocket, private insurance, or financing).
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6. Schedule your surgery date. Once you confirm the procedure and payment, the clinic will schedule your surgery—generally within a few weeks.
   
   • Plan for travel and accommodation, since the surgery will likely take place outside your home province.
   • Expect pre-surgery preparation, and possibly some pre-surgery tests.

Surgery time is about 60–120 minutes (most are ~90 minutes). Plan on several hours for check-in, anesthesia, and wake-up before going home.

Basic steps:

• Check-in and marking
  • You meet the team, review the plan, and the surgeon marks the elbow.
• Anesthesia
  • You get general anesthesia (asleep). Many also get a nerve block to numb the arm after surgery.
• Position and prep
  • You’re positioned safely, the arm is cleaned, and sterile drapes go on.
• Diagnostic look
  • Through small incisions, the surgeon looks inside the joint (arthroscopy or open assessment) to confirm the injury pattern.
• Graft harvest (if using your own tendon)
  • A small tendon (often hamstring or forearm) is taken, cleaned, and prepared. If using donor tissue, it’s prepped instead.
• Bone tunnels
  • Tiny tunnels are drilled in the ulna and humerus at precise spots where the UCL attaches.
• Graft passage and fixation
  • The tendon graft is threaded through the tunnels in a figure-8 or modern fixation pattern and secured with buttons/screws. Tension is set to match normal ligament tightness.
  • Some cases use an “internal brace” (strong tape) to reinforce the repair.
• Check stability and close
  • The surgeon tests elbow motion and stability, then closes the incisions and applies a dressing and brace.
• Recovery instructions
  • You wake up, get instructions for the brace and early movement, and head home the same day.

Everyone's recovery process looks different. This is to give you a general idea of what to potentially expect. Consult your surgical team and take rehab seriously—the more consistent you are, the better your outcome.

Week 1

• Not fun: soreness, swelling, stiff elbow.
• Goals: control pain/swelling, protect the graft, start gentle safe motion.
• Activities: sling/brace as directed, ice/elevate, move fingers/wrist/shoulder, gentle elbow motion if cleared. Wound care.

Weeks 2–4

• Still annoying, slowly improving.
• Goals: increase elbow range of motion (ROM), reduce swelling.
• Activities: regular physio; brace adjustments; forearm rotation and elbow bends/straightens within limits; light daily tasks (typing, eating) if comfortable.

Weeks 5–12

• The grind phase.
• Goals: near-full ROM by ~8–10 weeks; begin light strengthening.
• Activities: progressive exercises for forearm, biceps/triceps, shoulder/scapula; grip work. No throwing.

Months 3–4

• Building a base.
• Goals: stronger arm and shoulder; good mobility and control.
• Activities: more resistance, cardio/conditioning, movement quality drills. Still no throwing unless cleared.

Months 4–5

• Return-to-throw start (if milestones met).
• Goals: pain-free light tosses, clean mechanics.
• Activities: structured interval throwing program—short distance, low effort.

Months 6–9

• Progress throwing.
• Goals: increase distance/effort; add position-specific work.
• Activities: bullpen-style progressions for pitchers; field drills for position players.

Months 9–12+

• Return to competition (timing varies).
• Goals: full strength, endurance, and command.
• Activities: game-speed throwing once cleared by surgeon and physio.

Red flags anytime

• Fever, wound redness/drainage, calf pain/swelling, chest pain/shortness of breath, new numbness/weakness—contact your care team.

In Canada, private clinics in charge between $10,000 to $25,000.

In the U.S., you can expect to pay CA$13,500 to CA$34,000.

Costs vary so much because of location, surgeon experience, facility type, scope of potential treatments, complexity of the issue, and included services (some clinics offer all-inclusive, while others charge separately for anesthesia, followup care, etc.).

For more information on cost, see here.

What’s included

Most quotes for private Tommy John cover:

• Surgeon fee (and assistant if used) and anesthesiologist/general anesthesia.
• Facility fees (OR time, nursing, supplies, arthroscopy equipment).
• Immediate post‑op recovery care and routine early follow‑ups (wound check, suture removal).
• Basic sling and initial rehab instructions (varies by clinic).

What’s usually not included:

• Pre‑op consults and advanced imaging beyond basics (MRI, MRI‑arthrogram).
• Braces/splints or special implants beyond standard supplies.
• Unexpected overnight admission or ER visits; additional imaging for complications.
• Formal physiotherapy/occupational therapy beyond initial guidance.
• Post‑discharge medications (pain meds, anti‑nausea).
• Travel and accommodation if out‑of‑province.
• Fees for complication management or re‑operations beyond the routine global period (policy dependent).

Insurance and financing options

• Private health insurance: Some plans may cover part of the costs, such as hospital fees. It’s important to check your policy directly.
• Financing plans: Many clinics offer monthly payment options to help spread out the cost. Learn more about your financing options here.‍
• Medical Expense Tax Credit (METC): This is a non-refundable credit that reduces your taxes when you pay out-of-pocket for eligible medical expenses. Learn more about how to claim METC for private surgeries.

Choosing your surgeon is one of the benefits of going the private route. Here’s what to consider and the key questions to bring to your Tommy John consultation.

What to look for

• Experience and volume
  • Ask how many UCL reconstructions (and UCL repairs with internal brace) they perform per year, primary vs revision, and for throwers vs non-throwers.
• Credentials and training
  • Confirm licensure with the provincial college (e.g., CPSO in Ontario, CPSBC in BC, CPSA in Alberta).
  • Look for FRCSC-certified orthopaedic surgeons with fellowship training in sports medicine/upper‑extremity or shoulder & elbow, and experience with overhead athletes.
• Safety
  • Ask about infection rates, unplanned returns, stiffness rates, return‑to‑sport timelines.
• Technique and anesthesia
  
  • Reconstruction vs repair with internal brace—why for you?
  • Graft choice: autograft (palmaris longus, gracilis) vs allograft; pros/cons, expected strength, donor‑site morbidity, and cost implications.
  • Tunnel/anchor technique and fixation method; how they protect the graft during early rehab.
  • For throwers: evaluation of kinetic chain (shoulder, scapula, trunk, hips) and how that factors into rehab.
• Facility accreditation‍
  
  • Make sure the clinic is accredited by national bodies such as Accreditation Canada or the Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF).‍
• Rehab integration‍
  
  • Access to elbow‑savvy physiotherapy, clear phased protocol, and communication with your local physiotherapist if you’re traveling.

Questions to ask during your Tommy John consultation

Surgeon and surgery plan

• How many UCL reconstructions/repairs do you perform yearly?
• What are your return-to-play (RTP) rates and average time to RTP by competition level?
• What are your last 12–24 month rates for infection, nerve issues (ulnar neuropraxia), stiffness, graft failure, and unplanned re-operations?
• Do you recommend reconstruction or repair with internal brace for me—and why?
• Which graft (palmaris, gracilis, or allograft) do you prefer in my case? How does graft choice affect recovery and cost?
• Will you perform elbow arthroscopy or ulnar nerve procedures if needed? How would that change risks, rehab, and price?
• Anesthesia plan (regional block + sedation vs general) and pain-control strategy (nerve block duration, multimodal meds).
• Is this outpatient same-day? Any chance of overnight stay? What criteria decide that?
• Do you have a transfer agreement with a hospital if an emergency occurs?

Recovery and aftercare

• What’s my timeline to: brace weaning, full elbow ROM, start strengthening, start interval throwing, flat-ground work, bullpens, and live competition?
• What are the specific criteria to progress between phases (ROM, strength ratios, pain-free milestones, biomechanics)?
• Do you provide a written return-to-throw program? How will you coordinate with my local physio/athletic trainer and coach?
• What red flags should prompt a call or ER visit (fever, wound drainage, calf pain/swelling, shortness of breath, new numbness/weakness)?
• Who is my post-op contact (direct phone/email)? Typical response time? How many follow-ups are included and when?

Costs and logistics

• What exactly is included in my quote (surgeon, anesthesiologist, facility fees, graft/implants, nerve block, imaging review, immediate post-op care, scheduled follow-ups)?
• What could add cost (allograft upcharge, additional arthroscopy time/procedures, ulnar nerve decompression, brace, extra imaging, complications/re-operations)?
• If intra-op findings require added procedures, how do you handle consent and pricing in the moment?
• If I’m traveling from another province, which follow-ups can be virtual? Will I receive the operative note, graft/fixation details, and the full rehab plan for my local team?