13:38 PM

Merrill Kelly’s thoracic outlet surgery isn’t the scary procedure it used to be

The Athletic reports on Merrill Kelly’s surgery to address symptoms of thoracic outlet syndrome (TOS). Kelly, a pitcher for the Arizona Diamondbacks, underwent surgery last week to remove his first rib.

The Athletic spoke to James B. Carr II, MD, sports medicine surgeon at HSS Florida, who did not treat Kelly, but commented on the recovery for this type of injury. What might give Kelly a better chance to return to sport is the type of TOS he had. Most pitchers develop neurogenic TOS, which is when the nerves are compressed in the area between the shoulder, the clavicle and the top rib. Kelly had vascular TOS, which involves the compression of the blood vessels. Vascular TOS is the more serious condition, but it offers a less complicated recovery. Dr. Carr noted it’s rare, but some pitchers with neurogenic TOS experience neuropraxia, which is the damaging or deadening of the nerves during surgery. Some operations to alleviate neurogenic TOS involve cleaning up scar tissue around the nerves. Kelly’s procedure involved the removal of his rib and the detachment and reattachment of one of his scalene muscles. This doesn’t mean his recovery will be stress free, but it gives him a better shot. “Some players just don’t tolerate having their neck muscles and core muscles violated from the surgery,” explained Dr. Carr. “It’s a little bit less of a risk of having a complication just because you’re not having to do a lot of nerve work,” he said.

The success rate for thoracic outlet surgery is far lower than that for Tommy John surgery. Pitchers who never recapture their form offer the reminder "that we have probably a little more work to do to understand it better and make sure we understand the whole rehab process," said Dr. Carr. There have been improvements with diagnosis and the key is that team medical staffs now know to keep TOS on the mind when examining a player. Dr. Carr cited there are a few tests he can do just in his office that will alert him to any thoracic outlet issues. “In the past, the disease was seeing us, but we weren’t necessarily seeing it,” he said. “Now, we know what to look for.”  

Read the full article at Theathletic.com.