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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.

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brownsugar
4/28
If that is what Hughes has, that is a pretty grim set of comparables.
cidawkins
4/28
Yeah for the surgeries it's not pretty but there were also other medical conditions that also played a part. For instance Bonderman had a blood clot caused in part by the TOS and therefore needed intervention pretty quickly.
toddneckers
4/28
Is there any way we could get access to the injury database?
cidawkins
4/28
All of the information is available on the players' cards. In terms of direct access to it, it's unlikely we will give access to the database itself.
toddneckers
4/28
That's what I figured. Thanks.
beeker99
4/28
Didn't Hughes have an issue with one of his ribs before? I seem to recall that was what kept him out of action for a big chunk of 2008.
cidawkins
4/28
yes he did have an injury to his ribs but it was a stress fracture not an extra rib commonly found in TOS patients. The stress that caused the stress fracture may be indirectly related to his current symptoms. We'll go into further detail tomorrow.
jhardman
4/28
It can't be TOS. He doesn't have any affiliation with the Rangers. All jokes aside, I'd love to see that database as well because it seems like the Rangers have an uncanny number of TOS injury culprits over the years.
cidawkins
4/29
Haven't given the Rangers thing much thought until now. It will definitely be something we'll have to look at, it does feel a little too coincidental.
jhardman
4/29
Give it a look, Corey. I know there has been article or two over the years from a couple of the long term Ranger beat writers, but I actually do think it's worth exploring. I started to wonder about the dugout bench specifications of the Rangers home dugout compared to other teams', or maybe the bullpen mounds, etc. I believe Kenny Rogers, Hank Blalock, Jarrod Saltalamacchia, and a few others have been afflicted with TOS over the years. Blalock and Salty specifically had their prospect stars aligned before the affliction and never seemed to recover.
jhardman
4/29
Matt Harrison was the other current Ranger I was thinking of.