Hughes And Everything You Wanted To Know About TOS...

The good news is that Phil Hughes may finally have a definitive diagnosis as to why he's got no pop on his fastball. The bad news is that for the moment local specialists believe Hughes is suffering from Thoracic Outlet Syndrome (TOS).

According to the National Institute of Health, TOS "is a rare condition that involves pain in the neck and shoulder, numbness of the fingers, and a weak grip. The thoracic outlet is the area between the rib cage and collar bone."

"Blood vessels and nerves coming from the spine or major blood vessels of the body pass through a narrow space near the shoulder and collarbone on their way to the arms. As they pass by or through the collarbone (clavicle) and upper ribs, they may not have enough space.Pressure (compression) on these blood vessels or nerves can cause symptoms in the arms or hands.

Problems with the nerves cause almost all cases of thoracic outlet syndrome.Compression can be caused by an extra cervical rib (above the first rib) or an abnormal tight band connecting the spinal vertebra to the rib. Patients often have injured the area in the past or overused the shoulder.People with long necks and droopy shoulders may be more likely to develop this condition because of extra pressure on the nerves and blood vessels."

Hughes will be visiting the "go-to-guy", Dr. Robert William Thompson in St. Louis, to have the diagnosis confirmed or ruled out. A time table had not been set as of last night. Hughes had undergone several hours of tests before it was determined that TOS was the likeliest scenario.

Physical therapy is the first order of business in such a case to strengthen the outlying areas and improve range of motion. Meds may be added, such as a blood thinner. If symptoms don't improve than surgery is performed. Here's the "not-so-great" part. Surgery is successful in 50%-80% of patients. Not exactly a "sure thing" and disconcerting for a pitcher. Also some patients experienced weakened muscles. 5% of patients experience a recurrence.

The surgery may involve removing an extra rib and cutting certain muscles; removing part of the first rib; bypass surgery performed to reroute around the compression or remove the area causing the issues.

Texas Rangers pitcher Matt Harrison, Colorado Rockies hurler Aaron Cook, and Boston Red Sox catcher Jarrod Saltalamacchia are among those who have undergone the surgery. (The Texas Rangers in particular seem to have a problem with TOS; Saltalamacchia was with the Rangers at the time. Kenny Rogers, Hank Blalock, and John Rheinecker have all undergone the procedure as well. Blalock was the only non pitcher/catcher).

On the bright side when Rogers had his surgery he returned with an extra 4-5 mph on his fastball. Either way the recovery time can vary. But this is indeed a delicate condition to be dealt with.