Joe Girardi finally gave us a little insight into what might be going on with Phil Hughes during his post-game press conference tonight. Hughes may (or may not) have a mild case of thoracic outlet syndrome.
Thoracic outlet syndrome (TOS), in the simplest terms, occurs when there is compression of the nerves and/or blood vessels somewhere in between the neck and the armpit. TOS is believed to be either congenital–such as being born with an extra rib–or developed as a result of poor posture and multiple other factors. Many times TOS is not recognized until other medical conditions present as a result of the TOS (such as blood clots from decreased blood flow or nerve damage from the compression).
Treatment for TOS is not automatically surgery, although certainly advanced cases or cases with a large extra rib do require surgery. Conservative treatment focuses on physical therapy with a very detailed set of exercises that alleviate the compression through improved posture and flexibility. Several major leaguer players have undergone surgery to relieve their symptoms –recently Hank Blalock, Noah Lowry, and Jeremy Bonderman–and none of them have come back in the same year according to our database.
After Hughes meets with Dr. William Thompson and undergoes further examination, we will have a better idea of whether or not this is a surgical case.
I'm not ready to count him out for the year yet because he may not even have TOS. Even if he does, it may not require surgery. We should find out more information soon.