Kansas City Royals: Thoracic Park – The Nate Karns Saga

KANSAS CITY, MO - MAY 3: Nathan Karns
KANSAS CITY, MO - MAY 3: Nathan Karns /

Kansas City Royals pitcher, Nate Karns is hoping to recover fully from a new trend in the medical world. Trying to make light of the situation, Karns seems to be having fun with this new procedure.

The new trend is for pitchers with balky shoulders. The procedure involves removing a small rib to relieve pressure on the neck, shoulder, and arm. The phenomenon that causes this pressure is called Thoracic Outlet Syndrome or TOS.

The “McRib” operation has become fairly common of late, but among the Major League pitchers who have opted for it, there are few qualified successes.

So is TOS a real thing? Is TOS surgery more theory and experimentation than settled science?

Symptoms of TOS include a tingling feeling in the arm, indicating compressed nerves. The operation requires removing a rib that angles from the neck area to the breastplate. The bone is small, the size of a pinky finger.

Nate Karns, the Kansas City Royals pitcher, had the surgery last year. He wears his rib on a necklace as a souvenir. Karns, who looked good in Spring Training, was put on the disabled list prior to Opening Day.

His teammate, Kyle Zimmer, underwent the same procedure last year. Zimmer, once a major prospect, was recently removed from the club’s 40-man roster (though he was just re-signed as a free agent minor leaguer). Luke Hochevar, another Royals pitcher, went under the knife for TOS two years ago. Thus far, he has yet to throw another pitch.

The Royals have indicated that Karns (acquired from Seattle before last season for Jarrod Dyson) will pitch out of the bullpen when he comes back this year – if he comes back. Although he has shown a lot of promise as a starter when healthy, that seems like a good idea. In fact, it would probably be a good idea to use all TOS survivors as relievers for at least a year or two in order to ease them back into action.

The term “Thoracic Park” was apparently coined by Karns, who is still hopeful that his lucky necklace is a symbol of a rejuvenated career.

Meanwhile, other pitchers are trying to make a comeback from recent TOS surgery, including Carter Capps, Matt Harvey, Clayton Richard, and Tyson Ross (lots of Padres, too).

The jury is still out, but, at the very least, a TOS diagnosis is a lot more serious than, perhaps, the optimists had thought. Jaime Garcia is one of the success stories. And Chris Young, the very tall and soft-throwing pitcher (formerly of the Royals), enjoyed a sort of unexpected renaissance after undergoing the procedure. But Young was cut by the Padres this spring.

Dealing with injuries

The main study, so far, about TOS with respect to pitchers, was done by Dr. Robert Thompson at Barnes Jewish Hospital in St. Louis in conjunction with PITCHf/x. The results, predictably, seem inconclusive.

Since the 1970s, Tommy John surgery on the elbow has become commonplace in MLB. Most pitchers recover and return to levels at or near previous degrees of effectiveness in about a year, maybe two.

Shoulders have always been a different story. Rotator cuff surgeries and so on are not an exact science. Far fewer pitchers overcome shoulder damage. The intricate joint anatomy making up that region is problematic (to say the least) to this day, despite medical advances. Some pitchers come back strong; the majority don’t.

Final Thoughts

One thing we do know: After this season, we will know more about the general effectiveness of this operation as it pertains to Major League pitchers. This is especially true as applied to the Royals (and the Padres) and to Nate Karns’ career.