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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. Click here to view the article

Last week, amid concerns that 25-year-old Twins pitching prospect Alex Meyer is too old to still be in the minors, I researched all major league starting pitchers since 1980 who were within an inch of Meyer's towering 6' 9" frame. Turns out their average debut age was 25 years old. I also found something I didn't expect.There weren't a lot of pitchers with high strikeout numbers. That surprised me because when one thinks of tall pitchers, one focuses on the best tall pitcher: Randy Johnson, who ranks second all-time in strikeouts. The pitchers were: Mike Smithson (6’ 8”), who debuted in 1982 as a 27-year-old, Randy Johnson (6’ 10”), who debuted in 1988 as a 24-year-old, Eric Hillman (6’ 10”), who debuted in 1992 as a 26-year-old, Mark Hendrickson (6’ 9”), who debuted in 2002 as a 28-year-old, Chris Young (6' 10"), who debuted in 2004 as a 25-year-old, Chris Volstad (6' 8"), who debuted in 2008 as a 21-year-old, Jeff Niemann (6' 9"), who debuted in 2008 as a 25-year-old and Doug Fister (6' 8"), who debuted in 2014 as a 25-year-old. Looking at their minor league records, Smithson, Hendrickson, Volstad and Hillman all had very mediocre strikeout rates, with the highest at 6.2. Fister’s was only 6.70, though he might end up being the second most valuable starting pitcher on this list. He was fairly effective when he debuted at 25 years old, but it wasn’t until he was traded to Detroit as a 27-year-old that he ratcheted up his control and started posting sub-4.00 ERAs. Meyer, on the other hand, has a 10.4 K/9 in his minor league career. That’s higher than even Randy Johnson had in the minors. The only other pitchers with a rate above mediocre are Chris Young (7.4 K/9) and Jeff Niemann (8.9 K/9). Young debuted as a 25-year-old, was decent as a 26-year-old, and looked like a future star as a 27-year-old. But his career was derailed shortly thereafter by multiple injuries and three surgeries, including facial reconstruction from a hit to the face and two independent shoulder surgeries. He is a great “what if?” (Thanks to Thrylos for helping research this.) But Meyer, who has been shut down each season due to a sore shoulder, reminds me most of Niemann. Niemann was drafted fourth overall and, as the Rays then were apt to do, signed to a major league contract. That’s significant because that meant he was on the 40-man roster and his three option years were needed as he worked his way through the minors. Niemann posted some outstanding numbers in the minors, but also suffered from shoulder and groin injuries, including an offseason shoulder surgery. He made a brief appearance in the majors in 2008 but was promoted to the club for good in 2009 as a 26-year-old, because he was out of options. He had a good rookie year and started well the next year, but faded badly as the season went on due to shoulder and back problems. The next two years were decent, but both were marred by injuries; he made just 31 starts over the two seasons. In his fifth year, he was battling for a job in spring training as a 30-year-old in the Rays rotation when they discovered that he had to undergo shoulder surgery. He hasn’t pitched in the minors or majors since. So to recap, Niemann was "rushed" to The Bigs as a 26-year-old. His career lasted a little over four years. He started less than 100 games. His overall record was 40-26 with a 4.08 ERA. Meyer and the Twins have a luxury that Niemann and the Rays did not; Meyer's demotion this year will only use the first of his three options. He won't need to be promoted for good until he is 28 years old. And as for caring for his shoulder, it's easier to limit and care for a pitcher who is out of he glare of the bright lights of The Show. It could also be, like Johnson, he's going to need some additional time to work through his control issues. Meyer posted a 4.4 BB/9 rate in Rochester last year, which is about 50% worse than average in the majors. At the beginning of this year, that rate is much worse, with a walk rate over 8 per nine innings. And, of course, it's likely to get worse in the majors. But he has three more years to work through those issues in Rochester if he needs them, without starting his service time clock. It may be that delaying his debut in the majors hurts his prospect ranking, but it's not clear that it hurts his long-term development. A look at other tall pitchers reveal that they often need extra time to harness their control and need to be cautious about with their workload to avoid injuries. Those areas should be the focus, not their age. if you would like to know more details about how this list of pitchers was assembled, see Part 1 of this story. Thanks to Thrylos, Hosken Bombo Disco, Jokin, 70charger & Kevin for their assistance in researching this study. Click here to view the article