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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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