Stephen Strasburg to undergo thoracic outlet surgery

Nationals righty Stephen Strasburg will undergo surgery to alleviate neurogenic thoracic outlet syndrome, manager Dave Martinez announced to reporters Tuesday (Twitter link via’s Dan Kolko). The procedure will end his season, and the Nationals’ hope is that he can be ready for the start of the 2022 campaign. Martinez’s announcement was a bit more specific than most announcements on TOS surgery, but for those wondering, “neurogenic” thoracic outlet syndrome is the most common of three variations of the ailment, per the Mayo Clinic.

It’s yet another health setback for one of the game’s most talented but also most oft-injured pitchers. Strasburg’s 2020 season also ended with surgery — that one to alleviate carpal tunnel syndrome — and he’ll now head into the 2022 campaign with just 26 2/3 innings under his belt since signing a franchise-record seven-year, $245 million contract as a free agent in the 2019-20 offseason.

Thoracic outlet surgery is more ominous than the more-common Tommy John surgery, as pitchers generally have a much worse track record in returning from TOS operations. Nevertheless, Strasburg need look no further than D-backs righty Merrill Kelly to find a recent example of a pitcher who has come back from a TOS procedure as good as ever (arguably better, in Kelly’s case). Former Royals/Padres/Mets righty (and current Rangers GM) Chris Young also attributed TOS surgery to saving his career. Other success stories include former Cardinals hurlers Chris Carpenter and Jaime Garcia.

On the other side of the coin, TOS has proven quite difficult to bounce back from for a number of pitchers around the league. Matt Harvey is the most well-known example, but we’ve also seen thoracic outlet syndrome derail the careers of Tyson Ross, Phil Hughes and Nate Karns, among many others. Chris Archer’s return from thoracic outlet surgery in 2021 hasn’t gone well, as he pitched just 4 1/3 innings for the Rays before going down with a forearm issue.

Every case is unique to the pitcher in question, of course, so historical precedent only tells us so much. Strasburg is still signed another five years, so the Nats will need to hold out particularly strong hope that he’s able to work back from this and return to something approximating his previous levels of performance. He and Patrick Corbin are both locked into hefty salaries in 2022, and the Nats will also have Joe Ross, Austin Voth, Erick Fedde and Paolo Espino as in-house rotation options. Still, Max Scherzer is set to reach free agency this winter — and could be traded this week — and Strasburg’s health is again up in the air; long-term starting pitching help seems likely to be a focal point for the Nationals both this winter and in the hours leading up to Friday afternoon’s trade deadline.

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