On Tyler Thornburg and a Difficult Condition to Diagnose

On Tyler Thornburg and a Difficult Condition to Diagnose There was a lot of buzz about Red Sox relief pitcher Tyler Thornburg heading into the 2017 season. But after a mid-March diagnosis of a right shoulder impingement and little progress since then, that buzz turned to uncertainty. Then, on June 15, the Red Sox announced that Thornburg would undergo surgery to treat thoracic outlet syndrome (TOS) in his right shoulder, and uncertainty became clarity once again. Unless, like your friendly Red Sox Injury Insider writer, you’d never heard of TOS before.

“Although baseball fans are familiar with Tommy John surgery, few are likely to know about the similar challenges of TOS and its role in baseball and other sports,” says Kathryn S. Grannatt, MD, an orthopaedic surgeon in the Division of Sports Medicine and Shoulder Surgery at Beth Israel Deaconess Medical Center.

Thoracic outlet syndrome describes a group of disorders that can happen when blood vessels or nerves between your collarbone and first rib are compressed. “It is certainly a rare condition, but can be quite debilitating,” says Grannatt.

TOS can affect people of all ages and genders but is more commonly seen in athletes, people with poor posture and workers who do repetitive tasks involving overhead activity. Symptoms usually include pain in the neck and shoulders that radiates out towards the hand, a burning or tingling sensation, and a worsening of symptoms when you raise your arm above your head.

“We usually consider TOS after other more common conditions have been ruled out,” says Grannatt. “The symptoms can be very similar to a pinched nerve in the neck or a pinched nerve near the hand, like in carpal tunnel syndrome, for example.”

In many cases, treatment for TOS is a conservative approach that involves physical therapy and medication. For others, surgery might be the best approach.

Grannatt notes that, “Physical therapy is the most common treatment, along with changes in activity, like avoiding repetitive motions and improving posture. When this fails, surgery is considered. The type of surgery depends on the underlying cause of the TOS. It is usually performed by a thoracic/chest surgeon or vascular surgeon and may involve removing the first rib, repairing a damaged blood vessel or removing a tight muscle that may be compressing a nerve.”

Fans might remember another Red Sox pitcher who overcame TOS — Josh Beckett. Beckett was able to recover from surgery in full, even going so far as to throw a no-hitter ten months after his surgery. This gives hope to Thornburg and other pitchers and athletes. And it goes to show that proper medical care and evaluation is the best way to overcome injuries and get back in the game.

View more 2017 Injury Insider articles