Article: Phil Hughes Surgery Is No Guaranteed Fix

[John Bonnes]

On Tuesday the Twins announced that Phil Hughes will undergo surgery to combat thoracic outlet syndrome. “This isn’t career threatening,” Twins general manager Terry Ryan said. “It’s an injury that I think explains maybe a little bit of his issue. If that is the case, that’s a relief.”

 

But an objective view of pitchers who have undergone the surgery provides less optimism.Thoracic outlet syndrome syndrome isn’t an injury to bones or muscles. It’s an injury to nerves, in which they become compressed which can cause pain and a lack of velocity. The treatment is to remove that which is compressing the nerves, which is presumably why Phil Hughes' surgery involves losing a rib.

 

But nerve injuries are tricky to diagnose and tricky to fix. Looking at high profile pitchers that have undergone the surgery shows some successes, but also some failures. The failures could be due to the surgery not fixing the problem, or to the problem being misdiagnosed. For instance:

 

Cardinals ace pitcher Chris Carpenter underwent surgery for thoracic outlet syndrome (TOS) in 2012 in July, and tried to recover in time to pitch for St. Louis in the postseason. He had a little success, but never pitched again as the symptoms returned the next year. Of course, he would also have been 38 years old in 2013, so was the problem the TOS, or just the game catching up to him?

 

Josh Beckett is a somewhat more optimistic story. He had the surgery in 2013 and bounced back early in 2014 in a big way, posting a 2.88 ERA in 20 starts. But he was then diagnosed with a hip injury and never pitched again. But he was also older – 34 years old – and nearing the end of his career.

 

Similarly pessimistic is Sean Marcum’s story. He had the surgery in July of 2013, but still had shoulder issues after it. He was never an effective pitcher after.

 

More encouraging is current Royals pitcher Chris Young. After years of battling injuries, Young was finally diagnosed with TOS and underwent surgery in 2013. He finally stayed healthy in 2014 and 2015 and posted a 3.40 ERA in those two seasons, albeit with only a 6 K/9 strikeout rate. He’s also hurt this year, but he’s also 37 years old.

 

There are plenty more examples, some good and some bad, but this is by no means a trivial diagnosis. Its built-in nebulous nature, which makes it difficult to diagnose in the first place, also means there is risk in the diagnosis and risk in the cure.

 

Ryan is right – if this explains a little bit of Hughes issue, then this would be a relief. The Twins might still see Hughes return to the form he displayed in 2014 if he regains his velocity, strikeout rate and cuts down on the home runs. But there is no guarantee then can count on him to be his old self next year, or the next three years he is under contract.

 

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[Kwak]

I classify this as buying a lottery ticket and collecting on insurance vs the cost of surgery. It might work, but I'm skeptical.

[troyhobbs]

If Terry Ryan thinks it's a relief then odds are it's not good...

[shs_59]

Disagree entirely with TROY HOBBS

 

this is great news....

 

Good for Phill and i bet by July of 2017 we see 85-95% of the 2014 Phill Hughes dominate ace

 

Phill Hughes holds the ALL-TIME mlb record for K:BB ratio and BB ratio in the '14 season

 

he walked 18 batters whila ammasing around 200 innings!

[jimmer]

Hughes old self wasn't 2014.  It was an outlier.

 

For Hughes, I hope the surgery goes well.  I hope he's able to pitch again if that's what he wants to do.

[CampQ]

How old was Marcum when he had surgery? The other three examples cited were 34 or older. Is this diagnosis usually given to older players?

[Thrylos]

because a picture is worth 1000 words:

 

 

 

TOS is not always due to compression of nerves.  It can be due to the compression of the major blood vessels there .  Nerve compression almost always has tinkling fingers and neck pains as symptoms.  Vascular compression has less pronounced and its symptoms are arm fatigue and shoulder weakness, which are the exact symptoms of a healthy person throwing 100+ pitches at 90+ mph.  Since Hughes pretty much never complained about his grip or had any finger or neck pains (he always had lower back issues,) on paper it might look like the vascular situation here...

 

Another complication of the issue is that one of the major causes of TOS is (guess what?) repeated activity (like throwing 4000+ pitches at 90+ mph over a 5-6 month period).

 

Another problem (which is actually a pretty big one.)  This surgery does not only move part of the first rib.  It cuts open (at best case scenario) or removes part of (at worst case scenario) the scalene muscles (the ones connecting the neck with ribs/shoulder) to relieve the decompression.  And when you cut a muscle, if that muscle helps you throw 90+ mph, it is more than likely that it might take time to be able to throw that 90+ mph again.  

 

Re: Chris Young.  That's an interesting situation because this season his fastball is the fastest it has been since 2007, and his slider is the fastest it has been in his career, so surgery helped him increase his velocity.  On the other hand, an asterisk is needed, because Young's career average velocities are 87.4 for the FB and 78.8 for the SL.  Tommy Milone/Andrew Albers territory...

 

I do not expect him to pitch before the 2017 post-season (she what I did here? )

 

 

 

[alarp33]

Well the 3 year contract he signed before the 2014 season is set to expire at the end of this season, so at least the Twins aren't on the hook for anything.  Oh wait.... 

[nytwinsfan]

Any chance the Twins have insurance on his being able to play and would be compensated for part or all of his salary if he is out an entire year or more or a big chunk of a year?  Or is that just a myth that teams take out insurance on free agent pitcher contracts?

[jorgenswest]

Good work John and Thrylos. Thanks.

[HitInAPinch]

Hmm..  If it were me, I'd get the surgery and get outta baseball. 

 

On the "ALL-TIME mlb record for K:BB ratio and BB ratio in the '14 season" thingy:

all that tells me is Hughes is throwing a lot of balls in the strike zone.  And in 2015, hitters took advantage.  This is the common theme in Hughes' career.

[Dantes929]

 

Hughes old self wasn't 2014.  It was an outlier.

 

For Hughes, I hope the surgery goes well.  I hope he's able to pitch again if that's what he wants to do.

Of course its an outflier.  He set an all time major league record.    However his control history before 2014 was just ok and 2015 was still really good so a good chance he simply figure it out..    The SO/9  dipped substantially which relates to velocity which might very well relate to his health.     So I guess 2014 was an outflier but if his velocity had remained it might have been the new norm.    Never one of my favorite guys to watch pitch because all his pitches looked the same.   I enjoyed watching him pitch toward the end of last year more because he started throwing more breaking balls.   I thought it might serve him well if he got his velocity back and it still might but I am not really counting on it either.

[nicksaviking]

Good luck Phil. I don't find this good news simply because I don't wish an extensive surgery and rehabilitation on anyone.

[jimmer]

 

Good luck Phil. I don't find this good news simply because I don't wish an extensive surgery and rehabilitation on anyone.

I completely tore my ACL in my knee this year.  I opted for rehab and to build up my hammy and quad just to avoid having to have the surgery that comes with so much pain and such a long re-hab.  So yeah,  I agree with your sentiment wholeheartedly.

Edited June 30, 2016 by jimmer

[Mike Sixel]

 

Good luck Phil. I don't find this good news simply because I don't wish an extensive surgery and rehabilitation on anyone.

 

Agree with this. And, I'll add, I am always amazed when a guy this age comes back from this kind of thing. Hoping he turns out to be able to use his arm fully in the many coming years....

[Thrylos]

 

Agree with this. And, I'll add, I am always amazed when a guy this age comes back from this kind of thing. Hoping he turns out to be able to use his arm fully in the many coming years....

 

it might sound funny because of the level ball players are compensated, but if someone is planning to play 4-5 more years so they can have enough $ to do what they want to do when they retire, and they don't want to either compromise what they want to do or find another job or something, then, well, they gotta play.

 

Not that much different than someone who is doing any other job really.  Just the compensation level and retirement ages change... 

[Mike Sixel]

 

it might sound funny because of the level ball players are compensated, but if someone is planning to play 4-5 more years so they can have enough $ to do what they want to do when they retire, and they don't want to either compromise what they want to do or find another job or something, then, well, they gotta play.

 

Not that much different than someone who is doing any other job really.  Just the compensation level and retirement ages change... 

 

Except he has that money....and I'd want to golf in my 50s.......I agree on guys that don't have that money (sort of), but I think, like most of us, they don't think about the long term consequences and impact on their happiness/health enough.

[Rick Niedermann]

If I remember right, Mark Guthrie had this surgery and came back for about 8 or 9 years to an up and down relief career.

[glunn]

 

Any chance the Twins have insurance on his being able to play and would be compensated for part or all of his salary if he is out an entire year or more or a big chunk of a year?  Or is that just a myth that teams take out insurance on free agent pitcher contracts?

I wish that we could know what insurance the Twins have in place, and how this stacks up with other teams.

 

For example, some real estate owners don't carry earthquake insurance because of the expense, some carry it because they are conservative, and some carry it but with a very high deductible to reduce the expense.  Insurance companies probably make a big profit on this, so it might make sense to "self-insure", i.e. eat the losses when they occur.  Unlike earthquake losses, the loss of a highly paid player can be covered with a replacement player who is paid the MLB minimum.

 

I wish Hughes the best and hope that there is some insurance.

[DocBauer]

I wish Hughes all the best! You never want to see someone injured and require surgery, especially if it could be career threatening.

 

Strictly from the practical, baseball side of things, this goes to show the Twins can't go in to next season with ANY notion of Hughes being healthy, recovered and ready. (Perkins the same, for that matter) Which again scrambles the ideas for the 2017 rotation.

 

Not to conjoin threads, but it makes it all the more imperative, in my opinion, for May to start. I still believe the Nolasco experiment should end for both parties sake. And I'm not opposed to moving Santana, if the rumors we hear about his potential trade value are accurate. Berrios, Duffey, May, Gibson and maybe Wheeler at least offer youth and potential. (It's also possible Dean and Meyer may yet be part of this equation) But if Santana is indeed moved, the Twins may still have to sigo a veteran SP...possibly on a 1 year make good deal...or trade for someone.

 

But it is imperative they don't count on Hughes.

[TheLeviathan]

It's crazy to think we may not see Hughes or Perkins throw until 2018, if they do at all for the Twins ever again.

 

Hope he can at least leg out a few more years and his arm gets healthy enough for his career and the rest of his life.  

[Badsmerf]

Good luck Hughes, sounds like you'll need it. Baseball is only a small part of life. Injuries suck , and coming back from them sucks even worse.

[CampQ]

Looks like Matt Harvey is going to have the same surgery for the same diagnosis