Phil Hughes may finally have an answer for what’s caused his arm soreness, fatigue and numbness — a potential circulatory issue. The Yankees said their young starter, who has suffered through arm problems since spring training, may have thoracic outlet syndrome, and plan to send him to a specialist.
“One of the tests they did with Phil showed — and we’re not saying that he has it, and we’re not saying that he doesn’t — but a low-level, real low-level risk of thoracic outlet syndrome, which is basically a circulatory problem,” manager Joe Girardi said.
TOS is treated with physical rehab and — if necessary — surgery. If surgery is necessary, it may require the removal of a rib.
Girardi said there is no time frame yet for Hughes’ recovery, and despite a radio report stating the right-hander is out for the year, a Yankees source said there “is no diagnosis yet.” Either way, clearly Hughes is out indefinitely.
After going on the 15-day disabled list on April 15, Hughes’ setback in a Monday bullpen session raised a red flag. After 9½ hours of tests Tuesday and yesterday at New York Presbyterian Hospital, team physician Dr. Christopher Ahmad will send Hughes to see Dr. William Thompson in St. Louis. Until then, the Bombers said they have no idea how to treat him or how long he’ll miss.
“I don’t know. If he was to have [TOS], the specialist would determine what they would do. . . . I think you wait to see what the specialist says and you go from there,” said Girardi. “Anytime you talk about circulation problems there’s some concern. Circulation problems, this is different than what [David Cone] had, but there’s always a concern.”
Cone had a variant case of TOS — an arterial aneurysm of the upper aspect of his pitching arm. Kenny Rogers was diagnosed with TOS in 2001 and Hank Blalock was diagnosed in 2007. Blalock had surgery that May and returned in September, but did not play the field until the next season.
Hughes — who was at the Stadium after last night’s win but didn’t address the media — is 0-1 with a 13.94 ERA. He has just three strikeouts, and his average velocity has dipped from 93.8 mph in 2009 and 92.5 last season to just 89.3, according to FanGraphs.com. TOS would explain that.
“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 who has appeared on TV and radio, Parsons said there’s no way to give a recovery time. “It’s going to depend on what’s causing it, how he recovers, the period of rest and rehabilitation. Then they’ll reassess it.
“It depends on what’s causing the syndrome. If they find something that’s actually causing compression, then they would have to treat that. If it’s just inflammation that’s causing it, they try to rest him and rehabilitate him and wait for the inflammation to get better. It’s a case by case situation, it’s not like you have a rotator cuff tear where you get it fixed. It’s not that cut and dried.”
Dr. Parsons described thoracic outlet syndrome as a condition that affects “a group of nerves that come out of the neck and exit out to the arm. There’s a major artery there, too [that sends] the blood supply and nervous information to the arm and shoulder blade area. It happens in certain positions — throwing positions — where it gets pinched. The muscles will get fatigued faster, cause muscle weakness, soreness, numbness and tingling in the hand and the arm.”