Chris Carpenter -- St. Louis Cardinals MLB Pitcher
 

Major League baseball pitchers and overhead atheletes in general seem to be susceptible to TOS. Chris Carpenter was recently diagnosed with TOS and actually had a procedure done in mid-July. I find it shocking that yesterday, he was already back pitching in the major leagues in some rehab assignments.

I'd be very curious a) what his official diagnosis was, b) what procedure was done, and c) Who did it.

All of us struggle here trying to find solutions. I'd gather that Chris Carpenter has access to the best that money could buy. Would love to understand how somebody who puts extreme stress on the thoracic outlet area gets back so quickly...and immediately starts putting stress right back in the same spot.

KY

JKL626 just posted an article about him, too. It's hard to imagine throwing a baseball that soon after surgery.

Look at my thread about him. Several articles I posted answer
some of your questions

Dr. Pearl (CC's surgeon) did the same procedure on me two weeks after he did CC; I went back to work this past Monday, and my job is fairly physical. I started PT at the 3 week mark and, while I'm not doing anything as strenuous on the surgery spot as pitching a ball, I am rapidly getting close to having the same use of the area I did prior to surgery. I would guess that, since CC was (and is) in far better physical shape than I, his recovery went much quicker.

I was unsure what to expect with recovery, as I had heard widely varying estimates and experiences - everything from "completely incapacitated for 3 months" to "it's been a year and I'm in more pain than I was when I started." Maybe Dr. Pearl is unusual, but I was only in the hospital overnight and, since I live within three hours of Baylor, I was allowed to go home the next night (patients further away are required to stay in the Dallas area for an additional 3 days, like CC did). I was allowed to use the arm/hand for simple things like writing and using cutlery the day after surgery. I'm still restricted from "jarring" activities like jogging or horseback riding, and no weight-bearing pushing/pulling motion just yet - probably another month of PT.

I don't know what CC had available during recovery and for physical therapy (he probably had daily PT instead of twice per week like I have), but as far as surgery/hospital, having Dr. Pearl do the procedure was no pricier than anywhere else I investigated, and Baylor accepts most insurance. I certainly don't have amazing insurance, just the basic BCBS through my job, and I'm far from rich - my annual income is less than what is generally considered middle class, in fact. No major surgery is cheap, but it's not a "Surgeon of the Stars" type of situation at Baylor. :-)

I suffered unrelenting pain 24/7 for three long years before making it to Dr. Pearl - I'd done PT, massage, acupuncture, nerve blocks, prescription drugs of all descriptions, traction, TENS, ice/heat therapy - you name it. Now, five weeks post-op, I am able to work (albeit light duty) taking only Lyrica & ibuprofen throughout the day, and cyclobenzaprine at night. Not yet pain-free, obviously, but I had given up being able to ever get back to where I am now, and Dr. P says it should get even better over the next 7 weeks. I've heard so many stories (many on this very board) about surgery ending up poorly or people having terrible long-term effects that I'm hesitant to be too optimistic this soon after the procedure, but I feel safe saying I wish I'd had the option of surgery years ago.

And I would enthusiastically recommend Dr. Pearl to anyone needing TOS surgery. He is very friendly and was reassuring both to me and my attending family member (in my case, my sister); he answered all my questions fully and gave me his cell number in case I needed to contact him after surgery. The hospital was clean and well-run; I was able to talk with the anesthesiologist and surgical team prior to the procedure, and the staff that took care of me during recovery was great. Everyone was very concerned about everything from pain control to making sure I got something to eat when I wanted it.

This is a surgical procedure that has come a long way in the past decade and continues to get more advanced all the time, and that may be a big part of why CC's rapid recovery seems so incredible to us. Shorter surgery times, hospital stays and recovery will likely become the norm as medical advances continue. I heard there is a place in CA that does it as an outpatient procedure now! Maybe one day it will be a ten-minute laparascopic procedure! ;-) But I'd settle for TOS being something that more general care doctors are at least vaguely familiar with so that those of us afflicted with it don't have to suffer and wonder for years and years.

This is great to hear. I'm so glad you are doing well. Where did dr.Pearl come from? did he study with Urshel?Has he done alot of operations? I am curious why CC went to him instead of Thompson in St. Louis.

Could you share what you had done? were your cervical ribs removed? Scalectomy? first rib? thanks.
Statistiacally , cervical rib removal has a better success rate then some of the other procedures.

Thanks,
jkl

Glad to hear you are doing better. Was your surgery trans-ax or superclavicular?

I agree that tos surgery has gotten better in the last ten years. People were getting butchered in the past by people who had no experience. That is how some of these sites got started in the first place.

My surgery was supraclavicular. The cervical rib & fibrous band, anterior scalene and a portion of the second scalene were removed, as well as a lot of scar tissue/adhesions. Dr. P had figured he would also remove the first rib, but he said once he got in there that it obviously wasn't needed. This was all on the right side. Currently, my left side feels better, too, which he said could be happening because I'm able to carry my body more normally now, or because with severe nerve compression sometimes the body feels the pain bilaterally, or maybe only because I've been taking it easy during recovery. Time will tell. I have the extra rib on the left, too, so I imagine I'll be under the knife again one of these days, although Dr. P did say some people with bilateral ribs get lucky and don't have to have both sides done.

Dr. Pearl did study with Dr. Urshel, and he has done a lot of TOS surgery. I actually asked him why CC came to him when there is a TOS specialist in St. Louis, and he was very modest (almost bashful, actually) about it, sticking with generalities about everyone having their own criteria for choosing a doctor, etc. but his staff was a little more forthcoming and said that it was because the word is out in the world of professional athletes that, for TOS, Dr. Pearl is the one to see. Apparently he's done quite a few - I don't follow sports at all, so the names meant nothing to me, but my brother-in-law, who is Mr. Baseball Fan, was impressed by the roster and said there were several pitchers on it that apparently returned to their pitching careers afterward. It seems incredible to me that someone with TOS could even think about pitching a ball without wincing, much less pitching in the pros...

On an only-loosely-related note, if anyone is worried about scarring from the supraclavicular approach, be reassured that the incision is minimal (mine is about an inch and a half, it was closed with intradermal sutures that will dissolve and the top layers of skin closed with tissue glue - no external stitches at all), a skilled surgeon can place it so that, in most lights, the incision/scar falls into the shadow of the clavicle and, with this Mederma Scar Therapy stuff, my incision already looks more like I got a severe cat scratch than that I had surgery. Seriously, this stuff is great - it's really pricey, but totally worth it, in my opinion. Although if anyone knows of any off-brand or similar product that works as well but costs less, I'd be interested to know what it is... ;-)

Walgreens sells a generic Mederma labelled Scar Gel. You get twice as much for half the price and it seems to work just as well. My ACDF scar from 18 months ago is virtually invisable now. CVS likely offers a generic as well.

I have been reading this thread with great interest. First thanks to you for sharing this information. I get the feeling that most people who get well leave these types of forums.

Did Pearl ever suggest Botox injections? What tests did he do to confirm TOS before surgery? Botox is supposed to be a 3 - 4 month relief option but also another confirmation of TOS. I had a scalene block that worked very well to confirm TOS but a botox injection that failed miserably. My local vascular surgeon does not know what to do. He was trained at John Hopkins for this so I thought he was a good choice. However I question his experience. I realize I need to see a national expert.