Hughes may have low-level thoracic outlet syndrome


Joe Girardi said in his post-game press conference that some of the tests run on Phil Hughes show that the right-hander may have a low-level amount (is that the right word? not sure how to phrase it) of thoracic outlet syndrome. Hughes will go to St. Louis to see a specialist who will determine a) if he has it, and b) the necessary treatment. I’m not a doctor (Girardi said it was a circulation problem), so I have no idea what the hell that means. I do know this: Jeremy Bonderman had thoracic outlet syndrome in 2008, and he was never the same again.

Update: Some other players that have had it: Matt Harrison, Noah Lowry, Kenny rogers, and Jarrod Saltalamacchia.

Update Part Deux: Turns out someone I know has TOS, didn’t even know they had it. It’s basically a “cluster of pinched nerves,” and the recovery time depends on the severity. It could have been caused by something like a herniated disc, for example. My buddy had to stop bowling, which is obviously a lot less strenuous than throwing a baseball in the big leagues.

Categories : Asides, Injuries


  1. V says:


    Major League Baseball players Matt Harrison, Hank Blalock, John Rheinecker, Jeremy Bonderman, Kenny Rogers, Jarrod Saltalamacchia, and Noah Lowry[17] have recently been diagnosed with Thoracic outlet syndrome. Kenny Rogers was diagnosed several years earlier with TOS in the other upper extremity. Coincidentally, five of these seven players have played for the Texas Rangers. All-Star pitcher J. R. Richard suffered a career-ending stroke from an undiagnosed case of TOS. Pitcher David Cone had a variant case of TOS, with an arterial aneurysm of the upper aspect of his pitching arm.

    • bexarama says:

      The Texas Rangers don’t know how to develop players without TOS, obviously.

      • JobaWockeeZ says:

        I know you’re joking but seriously the Yankees need to actually develop these guys better. Guys like Hughes won’t fall to 30 something again.

        • Ted Nelson says:

          Seriously? This bs line of reasoning?

          A. Hughes went in the early 20s.
          B. IPK, Joba, Betances, Cole, etc. have fallen to the Yankees since then.

          So factually I haven’t got a clue where you’re coming from there.

          C. You can’t look at every guy who gets injurer

          • Ted Nelson says:

            Injured or fails and assume the team did something wrong.

            • Gonzo says:

              You can’t assume that a team without young pitcher injuries did everything right either. Also, you can’t affirm the Yankees did nothing wrong either.

              I know that’s not what you’re saying. I just wanted to point that out. You can’t affirm to either from where we are sitting.

              • Ted Nelson says:

                Exactly, that’s what I’m saying basically is that we don’t really know what goes on. Over a large enough sample we can start to talk about the results as speaking for the process, and I’m not sure where that point lies. Personnel people change and one stud or big bust can really stilt the results… so that sample is often hard to find. You can be terrible at developing young starters but draft that one stud whose a #1 plus another good starter just through luck, while another team that is great at developing young starters might not have the same success even though their process is actually better.

                As a lot of people have been discussing, it also depends what resources your club commits to acquiring young pitching talent. If you commit high 1st rounders and make trades designed to bring in stud pitching prospects, then you expect better results. Not to say that teams like Tampa (high picks) and Oakland (trades) haven’t done a lot right, but if the Yankees focus has been in signing veteran starters who cost them picks and trading their prospects for veterans… can’t really compare them apples-to-apples with Tampa or Oakland.

            • The Big City of Dreams says:

              You know I’m not too high on how the Yankees have handled things but this isn’t on them unless it has something to do with the huge jump in innings.

        • The Big City of Dreams says:

          “but seriously the Yankees need to actually develop these guys better”

          It may just be bad luck and I’m not one of those everything is luck guys but boy who saw this coming

        • S says:

          Hughes was a #14 overall pick (a parting gift from Andy P.)

    • Marcus says:

      Wait a second, was this comment (http://riveraveblues.com/2011/.....nt-1949435) a joke, or did JR Richard really call Hughes lazy? I wonder what he thinks now?

  2. bonestock94 says:

    Oh man, I guess its safe to go into a full fledged panic over this now.

  3. Wandering Bear says:

    This don’t sound good at all. Hopefully it’s a similar case to Cone and he can recover. That poor kid.

  4. Kevin says:

    So very sad :( Hopefully he does not need surgery because it sounds like his career would be over if it does indeed come to that. Poor guy.

  5. ledavidisrael says:

    I want to vomit.

  6. Tackaberry says:

    This is just awful news. Get rid of it, Mike!

  7. Slugger27 says:

    im scared

  8. B-rando says:

    According to the Wikipedia it says pain is almost always present and usually is sharp. The fact that Hughes hasn’t experienced that pain is someone optimistic, maybe.

  9. Poopy Pants says:

    Where are all the jokes?

  10. squishy jello person says:

    Yeeahhh this can’t be good.

  11. mike c says:

    you know if colon wasn’t pitchng so incredibly, I’d feel a lot worse about hughes than I do. hopefully they are catching this early and can treat him with medication and not surgery

  12. bexarama says:

    Yikes. Be okay, Hughes.

  13. Accent Shallow says:

    Well . . . low level is better than high level, right?

  14. JGS says:

    I figure this is probably more reliable than wikipedia (not sure about whether you need a subscription or not).

    Operative sentence: All nine patients were initially able to resume their careers in collegiate or professional baseball, returning to a level of performance at least equivalent to that achieved previously.

    My take: serious, but fixable. Get well soon, Phil.

  15. RRRRRRandy says:

    “My buddy had to stop bowling, which is obviously a lot less strenuous than throwing a baseball in the big leagues.”

    I laughed at this.

    Get well, Philip. Get well. You’re only 24.

  16. RollingWave says:


    That’s not a pretty list of players.

  17. Gonzo says:

    Well, nothing is confirmed. Let’s have a firmer prognosis before anything.

    Good luck Phil, but in the words of Cash, drive on.

  18. Steve H says:

    Is there any idea when this may have started affecting him?

  19. Angryankee says:

    I feel so cold…

  20. wilcymoore27 says:

    Bad, bad news for the Yankees …

    Right now, of the Yanks’ former “Big 3″ pitching prospects – Hughes, Chamberlain, Kennedy – the one who’s looking best is the one we traded away. Hughes is now a big question mark. Joba is the “seventh-inning guy” (TM), while 26-year-old Ian Kennedy is 3-1 for the Diamonbacks, with a 1.09 WHIP and 26-8 K-walk ratio, in 31 innings pitched. And Kennedy had a pretty fair season for Arizona last year.

    The morale here? You can never have enough (young) pitching …

    • Poopy Pants says:

      Kennedy’s stats don’t count because he’s in the NL.
      - RAB

      • Steve H says:

        Would you trade Joba straight up for Kennedy?

        • The Big City of Dreams says:

          I’d trade the new job for the old one.

        • Clint Holzner says:

          No. Ian Kennedy just is not that good, sure he would be nice to have. But just because he pitched a complete game against a Phillies lineup that is literally a shell of what it used to be (considering it has lost Utley, Werth and Raul Ibanez currently has a -1.1 WAR) does not make him a good pitcher.

          I will make that Granderson traded 100 out of 100 times.

        • bonestock94 says:

          I would. I’d rather have a starter with league average FIP (with our rotation) than a great 7th inning pitcher (with our pen). Am I crazy, maybe, I haven’t slept much and its been a rough day.

          • Steve H says:

            If Kennedy could give a league average FIP in the AL East I’d do the trade too. I just don’t see it happening here. His stuff simply wouldn’t (and didn’t) play well in the big boy league.

            • bonestock94 says:

              60 innings as a 22 and 23 year old in the AL East. Crappy attitude to boot. Yea he looked shitty in ’08 but I don’t know, I’m not as bearish as everyone else is on him. Would I take him over our toolsy CF? No. Joba, I think so.

        • MannyGeee says:

          depends on how his stuff plays out of the ‘pen….


    • Light says:

      I bet if they traded Joba away he would put up good numbers as a starter.

    • The Big City of Dreams says:

      It’s crazy how things work huh. No one would have imagined this happening to the big 3 but look where they are today. Hughes goes from 18 games to this.

  21. Fred Phelps says:

    To the bullpen! They need a fifth inning guy.

  22. Paul says:

    Guys, fear not! I actually have TOS right now and it’s not THAT bad!

    Thoracic Outlet Syndrome is essentially a compression of a major bundle of nerves and blood vessels that lead from our upper shoulder/chest cavity into our arms. Accordingly, blood flow and nerve signals are restricted leading into those extremities. This compression results from a postural deficiency often acquired from a repetitive motion (like throwing a baseball, or in my case, typing at work all day) that can be corrected by stretching and strengthening the shoulder/chest area. Though I’ve been granted Worker’s Comp for it and I truly can’t work right now, physical therapy 3x a week is my simple treatment plan. Everything I’ve read says ~80% of patients clear up fine with this approach to treatment.

    If Hughes indeed has a “low-level amount” of it, as Girardi says, then he certainly has no more than I do. If that’s the case, and that’s the only thing he has, he’ll be back in a month or two.

  23. dryankeegirl23 says:

    This kid’s head must be spinning right now. There are a series of nerves, blood vessels, etc in your neck that lay in a space between the collar bone and your first rib. When that space is too narrow it pinchees the nerves and limits bloodflow. Depending how narrow that space is and how badly the nerves and vessels are being pinched will determine what his future may be. The only treatment is pain management, streatching and avoiding repetative motion (ie: pitching). As stated above there have been other pitchers that have were diagnosed with this. Once diagnosed the person must be careful not to make it worse b/c this could lead to a stroke. The only surgery involves removing the first rib but is not often done b/c of the proximity to the person’s neck. This is research and medical trials involving BOTOX (of all things) for pain management.

    He is saying he doesn’t have pain but let’s not forget this kid had a cracked rib last year and tried to play through it. THis all has the possiblity of being serious. For his sake (and the Yankees) I hope it isn’t. Prayers and wishes are with Phil Hughes…..

  24. Andrew says:

    Seems like the big question is whether his case of TOS, or whatever it is, requires surgery or not. If he goes under the knife forget about him for quite a while, but it seems like a best-case diagnosis at this point would be him getting put on a therapy/medication/rehab program to hopefully eliminate the symptoms. So that might happen, maybe.

  25. Tony S says:

    The objectives of treatment of Thoracic Outlet Syndrome include:

    * Reduce the compression of the nerves and blood vessels in the thoracic outlet region.
    * Relieve the symptoms of numbness and weakness.
    * Restore function to the arm and hand.

    Conservative treatment is usually the first-line approach for the management of patients with TOS. This usually includes Chiropractic adjustments of the spine, shoulder and bones of the arm to open up the constriction within the thoracic outlet and relieve pressure on the nerves and blood vessels. Postural training and muscle strengthening exercises may be used to fortify the area and reduce the likelihood of symptoms returning. Most patients with TOS will improve with conservative treatment and only a small number of patients require surgery.

    We usually see results in as little as 1-2 weeks and often sooner. The recovery time is much shorter than surgery, far less painful and the cost is substantially lower. Often times however there are other areas of constriction in the arm, shoulder or neck that lead to similar symptoms which can also be detected and corrected by a chiropractor who is trained in neurology and orthopedics. Recently the FDA has approved the use of low-level laser therapy for the reduction of pain that has also shown great promise in this area.

    • Will says:

      That sounds optimistic at least.

      • dryankeegirl23 says:

        Hopefully he will return soon. However, his first priority (obviously) is his heath. If not treated properly this can become very serious. Yes, this is a very managable condition for most people. But most people do not throw a baseball at 90 mph 100 times every 5 days. Luckily he is going to see a great doctor who will put him on the best path to a quick recovery.

        • Midland TX says:

          But why go through the hassle of traveling to St. Louis when there is all this great anonymous and often emotionally wrought medical advice on a baseball blog.

  26. fire levine says:

    maybe they’re gonna put joba in the rotation


  27. Bpdelia says:

    This is good news to me. It’s.diagnosed treatable and his is mild enough that he isn’T in pain, just weak. Time to move hughes to the pen and joba to the rotation.:)

  28. Joltin' Joe says:

    Hopefully he doesn’t get the yips like Mr. Saltalamacchia did… oh wait.

  29. Uke says:

    I know it’s off topic, but does anyone know if ManBan is back on the DL?

  30. adeelmd says:

    TOS is an easy diagnosis to make. You need to identify the cause of the obstruction. If it is muscular, you can think of physical therapy to treat it, but that would require altering your physiology. It could also be due to something osseous like a cervical rib in which surgery would be indicated. Since I no longer have any faith in the Yankee medical team, it could be a huge fungating lung cancer for all we know.

    Either way, healthwise he will be fine, but fastball and curveball wise is a big question mark.

  31. EndlessMikeJr says:

    How can the Yankees be at fault. They took the time not to overruse the pitchers. Joba had a shoulder injury in 2008 thats why he hasn’t been the same.

    These low MLB draft pitchers are not that great normally. Some pitchers bodies can’t hold up in the long run of a baseball season. The Yankees have done a great job but these picthers are overrated and good not great.`

    • adeelmd says:

      As a radiologist, I am responsible for reading images (like MRI and CT and Xray). Because of these things, my area of expertise is centered on diagnosis of disease. The yankees are at fault because TOS is a relatively easy diagnosis to make (a reasonable Dr. should think about it in anyone with shoulder pain). TOS is most common in young atheletic males, especially pitchers. It has nothing to do with pitch count, relief appearances and what not. It should have been diagnosed in spring training camp.

      • The Big City of Dreams says:

        “It should have been diagnosed in spring training camp.”

        I might catch heat for this but did the Yankees drop the ball? It would be hard to say yes because during camp he didn’t have any symptoms or least didn’t report any to my knowledge.

      • S says:

        They wouldn’t have known to look this doesn’t exactly sound like a common condition besides in ST experiencing lower velocity is not new for any pitcher and Hughes might have assumed he just had normal fatigue and his arm wasn’t strong.

        Now they should have sent him to get checked out after putting him on the DL.

  32. jackstrawelf says:

    Yanks blew it with these three, starter to relieving n back again that’s just common sense not good for anyone, imagine they did that to mo when he was a starter, yanks have poor development n probably worst scouts in all of baseball when random guys like humber can shut that lineup down, let em play forget these wimpy winy pitch counts

    • The Big City of Dreams says:

      At the same time though you can’t ride them into the ground….I guess you’re point of view is they are doing everything to protect these arms but they are still getting injured so why not change the philosophy.

  33. Drew says:

    Update Part Deux: Turns out someone I know has TOS, didn’t even know they had it. It’s basically a “cluster of pinched nerves,” and the recovery time depends on the severity. It could have been caused by something like a herniated disc, for example. My buddy had to stop bowling, which is obviously a lot less strenuous than throwing a baseball in the big leagues.

    A little dramatic don’t you think Mike?

  34. The Big City of Dreams says:

    Got this from a blogger on lohud

    # Tom in N.J. April 27th, 2011 at 11:54 pm

    Ledger_Yankees According to a 2008 story in the St. Louis Post-Dispatch, most guys who undergo TOS surgery are back in four months.

  35. MannyGeee says:

    1. don’t know if this was covered, but…. genetic disorder or damage from pitching??? I assume the former since its not as common as say… TJS

    2. at least his obliques are OK

  36. Snake Plissken says:

    This can be solved via group prayer.

  37. lion says:

    is he going to live?

  38. Yankee fan says:

    As a long time sufferer of both the neurogenic and vascular form of TOS, I can assure you that TOS IS NOT CURABLE. I have had three surgeries (two ribs and scalene muscle removed and my pec minor divided)and am under care of one of the leading TOS care givers in the world. At best, you can treat the symptoms, but you cannot continue to abuse your arm with any repetitve activity. I was once an active athlete, but TOS has turned me into an avid walker.

    I truly hope that he does not have TOS, but only time will tell.

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