The thoracic outlet is the space between your collarbone and your first rib. This narrow passageway is crowded with blood vessels, nerves and muscles. — Mayo Clinic
The Twins signed pitcher Phil Hughes in December 2013 to a three-year, $24 million contract as a free agent. He broke in with the Yankees as a 20-year-old in 2007 and had a strange run there:
Standout reliever for World Series winner in 2009; 18-8 as starter in 2010; shut down for much of 2011 because of shoulder inflammation; 16-13 in 2012; and, finally, 4-14 in 2013.
He would be 27 at the start of the 2014 season and the Twins took a flier that he could regain effectiveness. He did so in style, going 16-10 with a 3.52 ERA for a mostly futile Twins club that lost 90 games (70-92) for the fourth consecutive season.
Hughes had a live fastball, a great cutter and his control was astounding: 16 walks (one intentional) in 209⅔ innings.
He went eight innings to beat Arizona on Sept. 24. One run, five hits, five strikeouts and, as usual, no walks.
It was his 32nd and last start. He was one-third of an inning short of receiving a $500,000 bonus. Manager Ron Gardenhire (about to be fired) wanted to pitch him for one-third inning four days later in the season finale.
Hughes declined. That worked out OK for him. Three months later, the Twins ripped up the last two years of the contract and gave him a five-year, $58 million deal running through 2019.
That's how good Phil Hughes was in 2014 when he could reach back for 95 miles per hour when needed.
Come spring training in 2015, he started off at 88-89 miles per hour with his fastball. It didn't get much better as the exhibitions wound down.
He's a big man, and there was some grumbling that he was too big that spring. It also was becoming legend that cutter-reliant pitchers not named Mariano often lost velocity prematurely.
Hughes missed five starts because of back inflammation in 2015. More important was the missing mileage.
There's a likelihood the loss of velocity was an early sign of thoracic outlet syndrome (TOS), the horror for pitchers that is being diagnosed with increased frequency.
"It was that first year with the extension," Hughes said recently. "I wanted to be my best. I wasn't terrible that season; I just wasn't my best.
"I kept looking for my fastball. When you're throwing strikes at 94, 95, you can miss and get away with it. When it's 90, 91, and you miss in the middle, it's going a long way."
Hughes gave up 16 home runs in 2014 in those 209⅔ innings for a league low 0.7 homers per nine innings. In 2015, he gave up a league-high 29 home runs in 155⅓ innings.
He was a mess in 2016. He was on injured list after being drilled in the femur on a line drive by Miami's J.T. Realmuto. While sidelined, he was diagnosed with TOS and underwent surgery in June that involved removing the first rib under the collarbone.
"The surgeon decided it wasn't necessary to take the whole rib," Hughes said. "That didn't fix it. I had TOS surgery again in August 2017 to remove the rest of the rib."
The Twins designated Hughes for assignment in May 2018, then traded him to San Diego for a minor league catcher. He pitched ineffectively in 16 games for the Padres and was done at 32.
Lots of injuries in his career, but what did him in was TOS.
The most-dramatic case of this at the moment involves Stephen Strasburg, Washington's tremendous righthander, and in the midst of a seven-year, $245 million contract. He had TOS surgery last summer and has opened this season on the injured list.
Here in Minnesota, the Twins and Chris Archer are attempting to talk optimistically about a comeback from TOS surgery.
He lost the rib surgically in June 2020, before the start of the mini-season, and pitched in six games for the Rays in 2021. He also has had hip labrum surgery.
Archer has given credit to "one of the best personal trainers in the world'' for solving his hip problem.
Whether he can both regain and maintain that once very live arm after thoracic outlet syndrome surgery — well, the Twins are going to let Archer jump right into it against the Dodgers on Tuesday night.