If thoracic outlet syndrome is the culprit for Harvey’s shoulder woes, he could need surgery
The Mets’ series win on Wednesday was quickly back-burnered due to the somber news that Matt Harvey has been placed on the disabled list with shoulder discomfort and will be examined by Dr. Robert Thompson on Thursday in St. Louis.
As Danny Abriano noted, many Mets fans remember this is the same ailment Dillon Gee suffered and eventually had to get surgery for back in 2012. While everyone waits on pins and needles with Harvey, there is a scenario where he can potentially avoid surgery.
Here’s what we know: thoracic outlet syndrome (TOS) occurs when major nerves or blood vessels are compressed near the clavicle. We also know that other pitchers besides Gee have had this diagnosis and surgery.
Among the most notable are Chris Carpenter (who was reportedly diagnosed four years before having the surgery), Josh Beckett, and Jaime Garcia. We also know that Harvey hasn’t officially been diagnosed yet so there’s no tangible cause for concern.
If Harvey is indeed diagnosed with TOS, though, his season could be in jeopardy if he opts for surgery right away.
One very recent case that has also popped up was with Phil Hughes, who is currently with Minnesota. Hughes elected for surgery after being diagnosed with TOS and his season is being pronounced as over.
When you look at cases over the years, there are some troubling instances. When Carpenter had surgery during the 2012 season, he did come back in time to pitch for the Cardinals in the postseason, but the combination of age and symptoms returning led to him never pitching again.
Perhaps the best case is with Garcia, who was younger when he had the surgery done. Though injury-plagued, Garcia came back from the surgery in 2014 to pitch to a 10-6 mark with a 2.43 ERA last year. Garcia’s numbers haven’t been eye-popping by any means this year, but the 29-year-old has been at least semi-productive. Point being, it’s a very checkered history of long term outlooks when discussing individual cases.
There are three types of TOS: arterial, venous, and neurogenic. The last of the three comprises the majority of all TOS patients while arterial is the rarest. Arterial is defined as being due to a disease and almost all cases are associated with having an abnormal first rib or even an extra rib. Surgery would be needed to fix the damaged artery and remove the abnormal rib.
Venous TOS occurs in less than five percent of patients and is due to obstruction or clotting of the main vein to the arm. It’s commonly due to strenuous use of the arm and shoulder and surgery is recommended.
The most common type is neurogenic TOS, which is initially treated with physical therapy. However, if symptoms do not improve, decompression surgery is recommended, which involves removing certain muscles in the neck, the first rib, or both. It’s worth noting as well that neurogenic TOS accounts for 95 percent of patients.
What does all this mean? Absolutely nothing for now. But if Harvey is diagnosed, there is a cause for worry not only for his ability to get on the mound this season, but for his potential long-term health and recovery from surgery.
Plus with Zack Wheeler’s return being pushed back and the issues permeating around Steven Matz, it may make the Mets re-evaluate how they attack the trade deadline.