MLB: Is Thoracic Outlet Syndrome Becoming a Major Worry?
With the announcement that San Diego Padres right-hander Tyson Ross will undergo surgery for Thoracic Outlet Syndrome, that brings the surgery again to the forefront with another MLB pitcher having the procedure. What is TOS, and how big of an issue is it?
Thoracic Outlet Syndrome Background
So, to get this out of the way, I’m not a doctor. I don’t even play one on TV (trust me, I’ve tried – something about “Who would put that ugly mug on prime time?”). I’m using a number of sources in this spot, but an easy-to-read and review in-depth overview on thoracic outlet syndrome is on the Mayo Clinic website.
There are multiple causes that initiate thoracic outlet syndrome, but for baseball the cause that is most relevant is repetitive injury due to overexertion from repetitive movement. What happens is that tissue grows in the area of injury (the shoulder/upper chest area for pitchers, primarily) and begins to cut off circulation and cause clots in some considerations that can become dangerous.
Surgery can sometimes be effective, but only after other treatments have not been effective. The primary treatments of thoracic outlet syndrome are physical therapy and pain relief measures to allow for work to be able to continue. In the case of vascular outlet syndrome (when veins and/or arteries are compressed by swelling and abnormal muscle growth), treatment may include blood thinners to dissolve clots.
Why is this suddenly an issue?
Here’s a list of MLB pitchers have been publicly diagnosed with TOS recently: Tyson Ross, Matt Harvey, Mike Foltynewicz, Luke Hochevar, Phil Hughes, Josh Beckett, Jaime Garcia, Kyle Zimmer, Chris Carpenter, Matt Harrison, Chris Young, Clayton Richard, Noah Lowry and Shaun Marcum. Marcum and Beckett were prompted to retirement due to TOS as the recovery was not working without surgery, and they chose not to pursue surgery, which is truly a risky procedure for TOS.
It does seem like this is a whole new issue that we’ve never heard of before the last few seasons, but in all seriousness, it’s been around for well over 30 years in the game. One of the game’s brightest stars, in fact, had his career tragically derailed due to the results of vascular thoracic outlet syndrome, J.R. Richard.
Richard was an incredibly talented pitcher who really debuted before the advent of an accurate radar gun, but was teammates with Nolan Ryan and had many Astros teammates who would swear that Richard was the harder thrower of the two by far. He was a guy who went through the typical control struggles of a big fastball pitcher before breaking through in 1979, and he was on his way to an incredible season in 1980, even being selected to start the All-Star Game. Then, on July 30, Richard suffered a stroke that ended his major league career.
The stroke was eventually tied to vascular TOS as a blood clot had traveled to Richard’s brain.
So what is causing this?
Much like the increase in Tommy John surgeries, the reasoning for increased TOS issues in Major League Baseball is pretty simple at its base – velocity. The overexertion of attempting to throw at max velocity over and over and trying for even more velocity has led to this damage of the upper body of young pitchers that is not just a general injury, but life-threatening, as Richard found out.
At some point, it begs the question of whether it is safe to allow your child to become a pitcher as a parent. Certainly, we saw a guy like Clayton Kershaw come out on Thursday evening for an inning of postseason relief to help his team, and guys will do that as competitors, but coaches at all levels are not doing what Dave Roberts very publicly stated that he did – checking with multiple medical sources before giving the go-ahead for such possible wear and tear on an arm.
What can be done?
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ESPN’s Keith Law is notorious on Twitter for attacking coaches for abusing their pitchers’ arms, and TOS is absolutely a result of that abuse. Sure, we see the pitchers in the major leagues that end up losing time or even ending their career due to TOS, but how many pitchers in the minor leagues end their careers due to thoracic outlet syndrome that we never hear about? How about at the college level? How about those that never made college ball, but did enough damage at the high school level that they have TOS symptoms later in life without the medical support that a professional player has?
Really, the big thing that needs to be done is to re-evaluate how we view pitching. Watching a guy like Madison Bumgarner should give an idea of the misconception of what a great pitcher can be. Bumgarner averaged 90.9 MPH with his fastball in 2016, yet he’s one of the best pitchers in the league. Rich Hill has had an incredible run the last two seasons averaging 90.2 MPH. Rick Porcello and Johnny Cueto finished in the top 5 of Fangraphs WAR in 2016 averaging 90.2 and 91.5 MPH, respectively. A guy with that 95-98 MPH average is impressive, for sure, but pushing so many guys toward that is ignoring how short the shelf life of those pitchers typically is, and how many pitchers that are in the truly elite category are not lighting up a radar gun.
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For your enjoyment, here’s a bit of video of J.R. Richard…