Performance and Return to Play After Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis.

Background: Thoracic outlet syndrome (TOS) remains a rare diagnosis but is being recognized as a cause of upper extremity dysfunction in professional baseball players.
Purpose/hypothesis: The purpose was to determine performance and return-to-play (RTP) outcomes in professional baseball players after surgical treatment of TOS. The hypothesis was that there would be a high RTP rate in professional baseball players after TOS surgery with no statistical differences in performance between pitchers who had TOS surgery and matched controls.
Study Design: Cohort study; Level of evidence, 3.
Methods: All professional baseball players who underwent surgical treatment of TOS between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after surgery) for each player were recorded. Performance variables were then compared between players who underwent TOS surgery and matched controls. The matching criteria were no history of previous surgeries on affected arm, age at time of surgery, throwing side, level of play (Major or Minor League Baseball), and years of experience playing professional baseball.
Results: Overall, 52 players underwent surgery for TOS, of whom 46 (88%) were pitchers. The type of TOS was neurogenic in 69% and venous in 29%. One player had arterial TOS. After TOS surgery, 79% of players returned to play at the same or higher level (RTSP) by 9.5 months and played ≥3 years after surgery. No differences were found in RTSP rate based on the type of TOS. No statistical difference was found in RTP rates between major and minor league players. Pitchers had a 76% RTSP, which was similar to the natural attrition for control pitchers ( P = .874). After TOS surgery, pitchers saw a decline in several performance metrics, but these declines were not different from those of control pitchers, indicating that the decline in performance after TOS surgery was no faster than is seen in healthy professional pitchers as they age.
Conclusion: The rate of RTSP after surgery for TOS in professional baseball players was 79%. There was no difference in RTP based on the type of TOS. Pitchers who underwent surgery for TOS had no significant differences in pitching performance metrics after surgery compared with matched controls.
Competing Interests: Presented as a poster at the annual meeting of the AOSSM, Colorado Springs, Colorado, July 2022.One or more of the authors has declared the following potential conflict of interest or source of funding: A.C. has received support for education from Medwest Associates, Smith & Nephew, Axogen, and SportsTek Medical; speaking fees from Covidien; a grant from DJO; and hospitality payments from Encore Medical and TriMed. P.N.C. has received IP royalties from Responsive Arthroscopy and DePuy; consulting fees from DePuy, DJ Orthopedics, Medical Device Business Services, and Encore Medical; hospitality payments from Smith & Nephew; support for education from Active Medical; and compensation for services other than consulting from Arthrex. B.J.E. has received consulting fees from Arthrex and DePuy; research support from Arthrex, DePuy, Linvatec, Smith & Nephew, and Stryker; and support for education from Pinnacle and Gotham Surgical. A.A.R. has received royalties and consulting fees from Arthrex and research support from Arthrex and Paragen Technologies; he holds stock or stock options in Paragen Technologies. H.R.H. has received consulting fees from Smith & Nephew, Stryker, and Wright Medical Technology; royalties from Stryker and Wright Medical Technology; and hospitality payments from Integra LifeSciences Corporation. K.M. and Z.T. are employees of Major League Baseball. J.F. has received support for education from ImpactOrtho and hospitality payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.