David Festa Potentially Dealing With Thoracic Outlet Syndrome

Twins right-hander David Festa has been on the injured list since late July due to shoulder inflammation. Head trainer Nick Paparesta tells Betsy Helfand of the St. Paul Pioneer Press that noted surgeon Dr. Keith Meister believes Festa has neurological thoracic outlet syndrome. Festa is going to see another doctor and a formal plan will be mapped out after that.

It’s a potentially ominous diagnosis as thoracic outlet syndrome can significantly alter the course of a pitcher’s career. Back in 2023, Jesse Dougherty of The Washington Post did a thorough examination of the condition, noting that there are two distinct varieties.

One type is known as venous or vascular TOS. While this is a serious medical condition often involving life-threatening blood clots, it seems to have less long-term impacts in terms of throwing a baseball. Merrill Kelly is the poster boy for recovering from this type of TOS surgery. Kelly went under the knife in 2020 but has since made 132 starts with a 3.59 earned run average. Zack Wheeler of the Phillies recently had a blood clot removed and was recommended for venous TOS surgery.

The second type of TOS is neurogenic, which seems to have a larger impact on throwing ability. Paparesta used the word “neurological” to describe Festa’s TOS, but it’s possible he meant neurogenic. Stephen Strasburg, Chris Archer and Matt Harvey are some of the most famous example of pitchers who were diagnosed with neurogenic TOS and never really seemed to be the same.

Strasburg was one of the best pitchers over the previous decade. He capped things off with an excellent 2019 season. He gave the Nationals 209 innings that year with a 3.32 ERA. He then added another 36 1/3 innings in the postseason with a 1.98 ERA, leading the Nats to a World Series title, winning himself World Series MVP in the process. But nerve issues popped up after that. He underwent TOS surgery in 2021. His repeated attempts to get back on the mound didn’t work. He only made eight appearances after the 2019 season and eventually retired.

Archer tossed 882 1/3 innings over the 2015 to 2019 seasons with a 4.05 ERA and 27.8% strikeout rate. He underwent TOS surgery in 2020. After that, he logged 122 innings with a 4.57 ERA and 20.2% strikeout rate. Harvey had a 2.53 ERA and 26.6% strikeout rate through his first 427 innings but then had TOS surgery in 2016. In the final 446 2/3 innings of his career, he had a 6.15 ERA and 17% strikeout rate.

Festa entered 2024 as one of…