Daily browser, infrequent poster here.
I am in the medical field and have read several threads over the past couple of years on TD that discuss Tommy John surgery and related topics. In these threads, there is often a sentiment that a pitcher should undergo TJ surgery sooner than later, and that non surgical treatment is rarely successful.
Certainly, there is not an abundance of data to argue this either way. However, in the March issue of the American Journal of Sports Medicine (probably the most highly respected sports medicine journal) there is an article which discusses precisely this. I found the results interesting, and I thought others on this site may, too.
It was done in Colorado in the Rockies organization. They looked at all UCL injuries from 2006-2011. In all, they came up with 43 elbows which met their criteria. 8 were complete tears on MRI, and underwent surgery. 35 were incomplete on MRI (which is the much more common finding). Of these, 28 were treated non operatively and 7 were treated operatively.
Of the 28 non operatively treated elbows, 18 were pitchers. They were treated with a program including e-stim, mobilization, massage, ultrasound, laser therapy, cuff and periscapular strengthening. No PRP injections were used, as far as I can tell. They defined success as return to the same level of play for at least 1 season.
Of these 18 pitchers, 94% were able to return to play for at least 1 season at the same or higher level of play. Those with incomplete tears treated operatively had a return to play rate of 86% at the same or higher level. Those with complete tears that had surgery initially had a return to play rate of 63% at the same or higher level.
Overall, I believe this is a well-done study that may answer some questions posters on this site have had in the past. Obviously, those treated non-operatively had less severe injuries, so I don't think you can draw the conclusion that non-surgical treatment is better than surgery in all cases. But this does lend some support to non-surgical treatment in many cases.
I hope some find this helpful. Happy to try to answer any questions folks may have. I'm sure there are other health care professionals or performance specialists on this site that will likely have an opinion as well.
Below is a link to the study abstract: