With spring training well under way, the biggest question that remains for the Mets is the health of the starting rotation. So far, the much-hyped rotation of young studs has yet to be healthy for a prolonged period due to new and lingering injuries sustained the past few seasons. Let’s look at the possibility that these prior injuries will limit each pitcher's action this season due to a recurrence of symptoms.
Injury: Thoracic Outlet Syndrome
Surgery: first rib resection
Harvey had season-ending surgery last year as surgeons removed his first rib to treat the thoracic outlet syndrome (TOS) he developed in his right arm. TOS results from compression of the brachial plexus (a network of nerves) and arteries that leave the neck and form several nerves that travel down your arm. Symptoms typically include poor blood supply (resulting in decreased pulse, cold hands, etc.) as well as sensation deficits (numbness and tingling) to the hand. This results in muscle weakness/atrophy and a pitcher's inability to effectively grip a baseball for various pitches.
There are three main compression sites that may cause TOS and the source of compression for Harvey was in between the first rib and the clavicle. For this reason, the surgery Harvey elected to undergo was to remove the first rib to create more space and result in decompression of the nerves and/or arteries.
According to a 2004 study, patients who underwent this procedure experienced a strong decline in symptoms, as only 17 of approximately 500 patients reported incidence of recurrent TOS. With that said, there is a strong likelihood that Harvey will not experience similar symptoms as last season and may return to his dominant form.
Injury: nerve irritation
Surgery: ulnar nerve transposition
The ulnar nerve is one of the nerves that make up the brachial plexus. The ulnar nerve is commonly irritated when someone bumps their elbow and causes them to feel their "funny bone." The path it takes to travel down the arm leaves it exposed around the elbow to therefore cause that tingling sensation when irritated.
deGrom was feeling this irritation that resulted in similar symptoms to what Harvey was feeling minus the blood supply issues. deGrom was consistently experiencing sensation deficits and muscle weakness/atrophy due to irritation of the ulnar nerve. The exact cause of the irritation is unknown, however surgery was performed to relocate the nerve to minimize the irritation when deGrom resumed throwing.
An article posted last October in the World Journal of Orthopedics indicated that 95% of athletes who underwent this procedure did so successfully and were asymptomatic during the follow-up session one-and-a-half years later. The article also mentioned that athletes returned to play on average of 12-13 weeks after the surgery. Keeping this in mind, it seems very likely that deGrom will also be able to avoid a recurrence of symptoms this season and return to pitching at an elite level.
Steven Matz and Noah Syndergaard
Injury: bone spurs
Surgery (Matz): bone spur removal
Both Matz and Syndargaard were diagnosed with bone spurs in their pitching elbows last season, however only Matz elected to undergo season ending surgery to remove his bone spur. Bone spurs are abnormal bone growth that result from the bone trying to protect itself from increased stress placed upon it. Both pitchers reported pain while they pitched, which was due to ligaments and tendons rubbing against the abnormal bone growth inciting irritation and inflammation in the area.
Surgery is not necessarily required to treat bone spurs, but depending on the size of the spurs it may be recommended to avoid receiving consistent injections and medication to minimize the inflammation. With the source of the issue removed, Matz should able to pitch without pain while being highly effective.
As for Syndergaard, the issue has not seemed to bother him during the offseason and thus far in spring training, but the bone spur is something to keep in mind going forward to see if it becomes a problem in the future.
Surgery: Tommy John surgery (TJS)
Wheeler has been out the last two seasons due to TJS and complications during the rehab process. While potential complications during this recovery is an article for another day, it is hard to project whether Wheeler is able to successfully and effectively pitch this season without knowing actual details of the case (as opposed to general, vague terms like "tenderness"). One can hope that all of his setbacks are behind him and he can be healthy enough to contribute this season.