Understanding Chris Archer’s Surgery To Treat Thoracic Outlet Syndrome

In a bit of surprising news, the Pittsburgh Pirates announced Wednesday morning that starting pitcher Chris Archer will be sidelined for the 2020 season after undergoing surgery to address neurogenic thoracic outlet syndrome. According to the press release, the surgery was performed by Dr. Robert Thompson at Washington University in St. Louis on Tuesday and was conducted “after consulting with several leading vascular and orthopedic surgeons in recent weeks.”

There are two types of thoracic outlet syndrome: neurogenic and vascular.

Neurogenic thoracic outlet syndrome – the more common of the two – occurs when portions of the brachial plexus – a conglomeration of nerves located between the shoulder and the neck – are constricted. This can be happen in a few ways, with tight neck and pectoral muscles being the most frequent culprit; in some people, an extra rib located in the neck can pinch the nerves. Vascular thoracic outlet syndrome is similar, though the structures being constricted are blood vessels rather than nerves.

The primary symptoms of both forms of thoracic outlet syndrome are weakness and numbness in the hand and upper extremity. These symptoms are present in a number of upper extremity pathologies, making thoracic outlet syndrome difficult to diagnose and treat effectively; often times, thoracic outlet syndrome is a diagnosis of exclusion, meaning all other diagnoses must be ruled out before it can be determined that thoracic outlet syndrome is the true pathology.

Surgery to address thoracic outlet syndrome usually involves opening up space for the nerves and/or blood vessels by removing bone or other tissue and rehabilitation focuses on stretching the muscles of the neck as well as the pectoralis major and minor; these muscles are often over-developed and tight in baseball pitchers due to their repetitive use on a near daily basis.

Thoracic outlet syndrome can be a difficult condition to treat effectively; however, return to play is often achievable. A study published in the Annals of Vascular Surgery in 2017 and written by Dr. Thompson found that 10 of 13 MLB pitchers who underwent surgery to address neurogenic thoracic outlet syndrome between 2001 and 2014 returned to play, missing an average of 10.8 +/- 1.5 months. The study also found that “pre- and postoperative career data revealed no significant differences for 15 traditional pitching metrics, including earned run average (ERA), fielding independent pitching (FIP), walks plus hits per inning pitched (WHIP), walks per 9 innings, and strikeouts to walk ratio (SO/BB). There were also no significant differences between the 3 years before and the 3 years after surgical treatment.”

Chris Archer is a two-time All-Star with a career 3.86 ERA. However, his stats have deteriorated dramatically since the 2016 season and was ultimately traded to the Pirates in 2018. Archer missed the end of the 2019 season with right shoulder inflammation.