Performance in major league baseball pitchers after surgical treatment of thoracic outlet syndrome

Gutman, Michael; Gutman, Brian; Joyce, Christopher D.; Kirsch, Jacob M.; Sherman, Matthew; Namdari, Surena

doi:10.1080/00913847.2021.1880251

Cited by 8 publications

(18 citation statements)

References 20 publications

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“…The involvement of these particular sports in TOS is supported by several series of athletes such as a series of 41 athletes treated in the United States including 13 baseball players, 13 swimmers, 5 water polo players, four rowers and two volleyball players ( Chandra et al, 2014 ). Most of the case reports involve also baseball pitchers and swimmers ( Wang and Crielaard, 2001 ; Richardson, 1999 ; Shutze et al, 2017 ; Yagi et al, 2017 ; VanWye et al, 2016 ; Thompson et al, 2017 ; Norinsky et al, 2016 ; Zajac et al, 2013 ; Herbst and Miller, 2013 ; Nitz and Nitz, 2013 ; Bushnell et al, 2009 ; Almeida et al, 2007 ; Hurley et al, 2006 ; McMaster, 1996 ; Katirji and Hardy, 1995 ; Fields et al, 1986 ; Vogel and Jensen, 1985 ; J. Gutman et al, 2021 ). Another series of 97 athletes diagnosed with TOS, also included 47 baseball or softball players, 11 volleyball players, eight gymnasts and surprisingly only two swimmers ( Beteck et al, 2019 ).…”

Section: Resultsmentioning

confidence: 99%

“…Statistical analysis of MLB demonstrated that these 10 players did not decrease their performances on field according to 15 different sports parameters. More recently, Gutman et al ( J. Gutman et al, 2021 ) assessed 27 MLB pitchers who underwent surgical treatment for TOS (20 NTOS and seven VTOS). Twenty of them (74%) were able to return to play in MLB at mean delay of 297 days (14 NTOS and six VTOS).…”

Section: Resultsmentioning

confidence: 99%

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Thoracic Outlet Syndrome in Sport: A Systematic Review

et al. 2022

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Thoracic outlet syndrome (TOS) is a rare and heterogeneous syndrome secondary to a compression of the neurovascular bundle in the thoracic outlet area. Muscle hypertrophy is recognized to induce vascular or neurogenic compression, especially in sports involving upper-arm solicitation. Athletes represent a distinctive population because of a specific management due to an ambitious objective, which is returning to high-level competition. We evaluated the scientific literature available for the management of TOS in athletes. Article research extended to March 2021 without other restriction concerning the date of articles publication. The search was performed independently by two assessors. A first preselection based on the article titles was produced, regarding their availability in English or French and a second preselection was produced after reading the abstracts. In case of doubt, a third assessor’s advice was asked. Case reports were selected only if the sport involved was documented, as well as the level of practice. Cohorts were included if data about the number and the sport level of athletes were detailed. Seventy-eight articles were selected including 40 case reports, 10 clinical studies and 28 reviews of literature. Baseball pitchers seem to be highly at risk of developing a TOS. The surgical management appears particularly frequent in this specific population. The prognosis of TOS in athletes seems to be better than in the general population, possibly due to their better physical condition and their younger age. Some studies showed interesting and encouraging results concerning return to previous sport level. Literature shows a strong link between TOS and certain sports. Unfortunately, this syndrome still lacks rigorous diagnostic criteria and management guidelines for athletes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Thoracic Outlet Syndrome in Sport: A Systematic Review

et al. 2022

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“…Gutman et al 17 recently published RTP data on MLB pitchers following treatment for TOS. They found a lower RTP of 74% compared with the 81% found in the present study.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Outlet Syndrome in Major League Baseball Pitchers: Return to Sport and Performance Metrics After Rib Resection

Arnold

Hart

Greig

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Thoracic outlet syndrome (TOS) is a rare injury that affects Major League Baseball (MLB) pitchers and is often corrected with surgical resection of the first rib. There are limited return-to-play (RTP) data for this surgery in MLB pitchers. Hypothesis: It was hypothesized that MLB pitchers who undergo first rib resection for TOS will show (1) a high rate of RTP, (2) no difference in postoperative career length compared with controls, (3) no difference in pre- and postoperative performance, and (4) no difference in postoperative performance compared with controls. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study evaluated MLB pitchers with neurogenic or vascular TOS who underwent rib resection surgery between January 1, 2001, and December 31, 2019. Players were identified through public injury reports from press releases, the MLB website, MLB team injury reports, and blogs. A demographics- and performance-matched control group was generated for comparison. Each player in the control group was given an index year that corresponded to the surgery year of the case group. Performance data included innings pitched (IP), games played (GP), earned run average (ERA), complete GP, shutouts, saves, hits, runs, home runs (HR), walks, strikeouts (K), walks plus hits per IP (WHIP), and earned runs (ER). Results: We identified 26 MLB pitchers who underwent rib resection for neurogenic or vascular TOS; 21 players (81%) had a successful RTP. Pitchers were 30 ± 3.6 years old at the time of surgery and had played 6.2 ± 3.5 seasons before undergoing surgery. Average postoperative career length was 3.1 ± 2.0 seasons, with an average time from surgery to RTP being 10 ± 4.7 months. Pitchers who RTP showed no significant differences in performance metrics compared with controls. Players pitch 0.94 ( P < .05) more IP/GP in the season directly following RTP compared with the season before surgical intervention. Conclusion: MLB pitchers undergoing rib resection for TOS demonstrated (1) high RTP rates following rib resection, (2) no difference in postoperative career length compared with controls, (3) improvement in postoperative performance, and (4) no difference in postoperative performance compared with controls.

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“…A similar, but larger study of MLB pitchers over 2001–2017 showed that 20 pitchers with nTOS underwent surgical decompression. Of those, fast ball velocity and strike percentage were equivalent post‐operatively, but pitcher earned run average remained inferior to preoperative baseline 154 …”

Section: Peripheral Neuropathies In Throwing Athletesmentioning

confidence: 85%

“…Of those, fast ball velocity and strike percentage were equivalent post-operatively, but pitcher earned run average remained inferior to preoperative baseline. 154…”

Section: Neurogenic Thoracic Outlet Syndromementioning

confidence: 99%

A review of upper extremity peripheral nerve injuries in throwing athletes

Bowers

Cherian

Zaremski

2022

PM&R

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Peripheral nerve injuries in the upper extremities may be common in throwing athletes as the throwing motion places extreme stress on the dominant arm. The combination of extreme stress along with repetitive microtrauma from throwing uniquely places the throwing athlete at elevated risk of upper extremity peripheral nerve injury. However, because symptoms can be nonspecific and frequently coexist with pathology in the upper extremity, the diagnosis of peripheral nerve injury is often delayed. Diagnosis of peripheral nerve injuries may require a combination of history and physical examination, diagnostic imaging, electrodiagnostic testing, and diagnostic ultrasound-guided injections. The primary management should include physical therapy focusing on throwing mechanics and kinetic chain evaluation. However, some athletes require surgical intervention if symptoms do not improve with conservative management. The purpose of this focused narrative review is to highlight upper extremity peripheral neuropathies reported in throwing athletes and to provide an overview of the appropriate clinical diagnosis and management of the throwing athlete with a peripheral nerve injury.

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Performance in major league baseball pitchers after surgical treatment of thoracic outlet syndrome

Cited by 8 publications

References 20 publications

Thoracic Outlet Syndrome in Sport: A Systematic Review

Thoracic Outlet Syndrome in Sport: A Systematic Review

Thoracic Outlet Syndrome in Major League Baseball Pitchers: Return to Sport and Performance Metrics After Rib Resection

A review of upper extremity peripheral nerve injuries in throwing athletes

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