Hughes may have low-level thoracic outlet syndrome

Teixeira leaves game with sore shoulder
Maxwell goes deep two more times in SWB win

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.

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Teixeira leaves game with sore shoulder
Maxwell goes deep two more times in SWB win
  • V

    http://en.wikipedia.org/wiki/T.....t_syndrome

    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.

    • http://youcantpredictbaseball.wordpress.com bexarama

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

      • JobaWockeeZ

        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

          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

            Injured or fails and assume the team did something wrong.

            • Gonzo

              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

                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

              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

          “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

          • AndrewYF

            I have it on good authority that the reason the Angels took Jered Weaver over Hughes in the 2004 draft was because they thought Hughes was a prime candidate for thoracic outlet syndrome.

            • Gonzo

              I heard elephantitis.

            • The Big City of Dreams

              How would they know that though? If it was a mechanical issue than I could understand it. Was it something in his delivery?

              • Gonzo

                I am pretty sure it was a joke.

              • The Big City of Dreams

                Or are you just joking if so I missed that one

                *lowers head in shame*

              • AndrewYF

                You just got Sherman’d

                • The Big City of Dreams

                  You should have just said he was fat that would have been a dead give away

        • S

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

          • Gonzo

            False. He was the 23rd pick. The first 15 picks of the 15 worst record teams of the year before are protected.

          • Slugger27

            this was all kinds of fail

    • Marcus

      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?

  • bonestock94

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

    • Ted Nelson

      Kenny Rogers picked up 4 or 5 mph on his FB after being treated…

      • bonestock94

        Wikipedia says he had his surgery in 2007, hardly during his prime. He wasn’t good afterwards, but you can’t really blame a surgery on making a 43 year old pitch poorly. I guess its encouraging if he picked up velocity.

        • Ted Nelson

          Texasleaguers says that he was diagnosed in 2001 and picked up 4 or 5 mph after receiving treatment

          • Gonzo

            Who has Kenny’s #?

            Although wikipedia could have gotten that info from anyone.

          • Gonzo

            MLB has the surgery at both 2001 and 2007.

            He had a freaking rib removed the first time around! WTF?!?!?!?!

            http://mlb.mlb.com/news/articl.....8;c_id=det

            • MannyGeee

              he did the rib thing so he wouldn’t cheat on his wife during east coast roadtrips though…. so there’s that

        • Ted Nelson

          Texasleaguers says that he was diagnosed in 2001 and picked up 4 or 5 mph after receiving treatment.

          • bonestock94

            His numbers improved significantly afterwards, and it seems like he pitched to his career FIP for the rest of his career as an older dude. That’s encouraging.

            • Ted Nelson

              My opinion means nothing, but seems like the proven arms stayed good (Rogers and Cone) while guys who stunk afterwards were unproven and may have failed without toc. Hughes still isn’t proven really but I don’t know if this eliminates the possibility that he could become so

      • AC

        Just not in the 96′ series. Lol

  • Wandering Bear

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

  • Kevin

    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.

  • ledavidisrael

    I want to vomit.

  • Tackaberry

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

  • Slugger27

    im scared

  • B-rando

    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.

  • Poopy Pants

    Where are all the jokes?

    • Light

      It could just be gas…?

      • Gonzo

        I actually laughed.

    • Snake Plissken

      you want jokes, okay.

      How are women and tornadoes alike?

      They both moan like hell when they come, and take the house when they leave.

  • squishy jello person

    Yeeahhh this can’t be good.

    • Chris

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

      Well, that sounds simple, Hughes just needs to stop throwing a baseball.

      • vin

        Maybe he should just stop bowling.

      • MannyGeee

        ummmmm bowling is strenous… but then again i’m fat

  • mike c

    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

  • http://youcantpredictbaseball.wordpress.com bexarama

    Yikes. Be okay, Hughes.

  • Accent Shallow

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

  • http://www.twitter.com/jordansmed JGS

    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.

    • The Big City of Dreams

      Panic level now downgraded

    • http://twitter.com/steveh_mandaura Steve H

      Did you stay at a Holiday Inn Express last night?

    • http://www.twitter.com/jordansmed JGS

      That said, the average recovery time for people who had the surgery that paper is talking about was 11 weeks until resumption of unrestricted throwing, which means that’s probably it for the season, if that’s what this is and it’s serious enough to warrant surgery.

    • Gonzo

      “…initially able,” sounds worse than just saying “able.”

      Why couldn’t they just say able! Damn this site!

      • http://www.twitter.com/jordansmed JGS

        Because two of them wound up having secondary operations a couple of years later.

        • Gonzo

          Well that’s a dikfir.

          • http://www.twitter.com/jordansmed JGS

            Yea, that would suck, but everything in this paper is basically the worst case scenario for what Hughes has, which is still fixable. Hopefully it won’t come to any of that.

    • Kit

      The link just gave me flashbacks to those 20 page lab reports I had to do…screamed a little. But yeah, sounds like it’s pretty treatable, especially if its as low-grade as Joe emphasized.

      • http://www.twitter.com/jordansmed JGS

        Heh. Sorry about that. Here’s hoping it’s not even remotely as serious as the patients in that paper.

  • RRRRRRandy

    “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.

  • RollingWave

    shiiiiiiiiiiiiiiiiiiiiiiiiit.

    That’s not a pretty list of players.

    • Accent Shallow

      Well, most of those guys sucked prior to diagnosis.

      Phil Hughes already has the advantage.

      • Fred Phelps

        Um, he sucks too. A career 5 ERA as a starter says so.

        • MannyGeee

          counterpoint, he didn’t get traded for Johan OR Halladay.

  • Gonzo

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

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

  • http://twitter.com/steveh_mandaura Steve H

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

  • Angryankee

    I feel so cold…

  • wilcymoore27

    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

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

      • http://twitter.com/steveh_mandaura Steve H

        Would you trade Joba straight up for Kennedy?

        • The Big City of Dreams

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

          • The Big City of Dreams

            Joba*

        • Clint Holzner

          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

          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.

          • http://twitter.com/steveh_mandaura Steve H

            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

              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

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

          ZING

    • Light

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

      • The Big City of Dreams

        He might get the chance if he’s in a package for a starter.

    • The Big City of Dreams

      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.

      • Ted Nelson

        It’s what tends to happen with prospects

        • The Big City of Dreams

          It does but it sucks that it’s happening here lol.

  • Fred Phelps

    To the bullpen! They need a fifth inning guy.

    • The Big City of Dreams

      not with the way Colon is pitching

  • Paul

    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.

    • http://twitter.com/steveh_mandaura Steve H

      Get well man.

    • Gonzo

      What were your symptoms? This sounds like something I would think I have.

      • Paul

        They increased gradually over a few weeks time (because I was stupid enough to not stop working when I first felt pain. Let that be a lesson to you, you’re job isn’t worth your quality of life. I digress). First I had a steady, dull pain in my wrists and elbows, then I became to experience numbness and tingling in my hands and fingers. Finally, muscle fatigue set in in the shoulder and forearms.

        • Gonzo

          Thanks. Get well.

    • Nedro

      Kids get it from lugging their backpacks around school, stuffed with textbooks. It’s a big problem.

      • Gonzo

        For the kids!!!

  • dryankeegirl23

    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…..

    • Monteroisdinero

      Dryankeegirl23? Very nice handle. I like all 4 components of it.

  • http://twitter.com/AndrewLeighNYC Andrew

    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.

  • Tony S

    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

      That sounds optimistic at least.

      • dryankeegirl23

        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

          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.

  • http://twitter.com/kschmidt2 Kiersten

    Shit shit shit.

    • Daniel

      Um…….thanks for contributing?

  • fire levine

    maybe they’re gonna put joba in the rotation

    /silverlining

    • bonestock94

      Yea right, Carlos Silva and Kevin Millwood say hello.

    • The Big City of Dreams

      They would let Jeter start games before Chamberlain.

      • dryankeegirl23

        With the way things are going THAT might be an otpion! Does anyone have Andy Pettitte’s number?

    • Gonzo

      This needs to be trademarked along with, “if George were alive…”

  • Bpdelia

    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.:)

    • Gonzo

      I don’t think it’s official yet.

  • http://salarydump.com Joltin’ Joe

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

  • Uke

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

  • adeelmd

    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.

  • EndlessMikeJr

    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

      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

        “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

        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.

        • adeelmd

          it is pretty common. I would fail my board exam if I didn’t identify it on the angiogram.

          • Midland TX

            Keep digging, boys. We’ll get to the bottom of this and then we’ll NAIL them by Jove!

            Cashman, Girardi, and Ahmad YOU’RE GOING DOWN. Congrats on being first in line to join the firing squad.

          • gworge

            Why would u get an angiogram?

          • S

            is that really such a common condition over tendinitis?

            If someone is out of breath after running, does a doctor immediately assume sarcoidosis? I doubt it, also in todays NY Post:

            ” “It’s a very rare thing,” said Dr. Bradford Parsons, an assistant professor at Mount Sinai Hospital in the Leni and Peter W. May Department of Orthopedics. A shoulder specialist ”

            Read more: http://www.nypost.com/p/sports.....z1Kpeq7POE

          • gworge

            Uh why would you look for thoracic outlet syndrome with an angiogram

            • Klemy

              Also, why go right to an angiogram in spring training for reduced velocity?

  • jackstrawelf

    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

      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.

  • http://facebook.com/andrewjcalagna Drew

    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?

  • The Big City of Dreams

    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.

  • MannyGeee

    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

  • Snake Plissken

    This can be solved via group prayer.

    • Klemy

      Cool. But if we all have to hold hands, his career is over.

  • lion

    is he going to live?

    • Johnny On The Spot

      I blame Dave “Revis” Island.

  • Yankee fan

    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.