Thoracic Outlet Syndrome in Baseball Players: Symptoms, Treatment & Return to Throwing
By Dr. Carmen Jansante, PT, DPT, CSCS
For baseball players, especially pitchers, not every arm problem starts at the shoulder or elbow.
Thoracic Outlet Syndrome (TOS) is one condition that can cause arm symptoms that may be difficult to identify at first. While TOS is not one of the most common injuries in baseball, it is an important condition to recognize in overhead athletes, and it has been documented in professional baseball players.
At Undefeated Physical Therapy & Performance in Pittsburgh, PA, we work with baseball players through injury rehabilitation, strength development, and return-to-throwing programs. Understanding where symptoms are coming from is an important part of getting an athlete back to throwing with confidence.
What Is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome occurs when nerves or blood vessels become compressed or irritated as they travel through the area between the neck, shoulder, and upper chest.
The brachial plexus, which is the network of nerves that supplies the arm, and the subclavian blood vessels travel through this region. Compression can occur around structures including the scalene muscles, first rib, clavicle, and surrounding soft tissues.
TOS is generally categorized as:
Neurogenic TOS — involving compression or irritation of the nerves of the brachial plexus
Venous TOS — involving compression of the veins
Arterial TOS — involving compression of the arteries
Neurogenic TOS is the most common form, including among athletes. Because symptoms can overlap with other shoulder, neck, elbow, and nerve conditions, identifying TOS can sometimes be challenging. (PubMed)
Why Does Thoracic Outlet Syndrome Matter for Baseball Players?
Baseball players perform thousands of repetitive overhead movements throughout a career.
Throwing places significant demands on the entire upper-quarter kinetic chain, including the:
Neck
Thoracic spine
Scapula
Shoulder
Brachial plexus
Arm and forearm
Blood vessels supplying the upper extremity
Repeated overhead activity can place stress on the structures around the thoracic outlet. For a baseball player, symptoms may become more noticeable during throwing rather than during normal daily activities.
This is one reason TOS can sometimes be confused with a traditional shoulder or elbow injury.
What Does Thoracic Outlet Syndrome Feel Like?
Symptoms can vary depending on the structures involved.
A baseball player with TOS may experience:
Arm heaviness or fatigue
Numbness or tingling
Weakness
Changes in hand sensation
A feeling that the arm “goes dead” during throwing
Swelling or changes in circulation
Changes in hand or arm color
Symptoms that increase with prolonged overhead activity or throwing
Neck, chest, shoulder, or arm discomfort
One important clue is that symptoms may become more pronounced as the athlete continues to throw.
A pitcher might feel fine during everyday activities but notice that the throwing arm becomes heavy, weak, numb, or fatigued after a certain number of throws.
That pattern deserves further evaluation.
Why Can TOS Be Difficult to Diagnose?
TOS does not always present like a traditional orthopedic injury.
A pitcher with shoulder pain may immediately think about the rotator cuff, labrum, or UCL. However, symptoms such as numbness, tingling, unusual arm fatigue, hand swelling, or changes in circulation can point toward a different problem.
Neurogenic TOS is often a diagnosis that requires careful clinical evaluation and ruling out other potential causes of the athlete’s symptoms. (PubMed)
For that reason, athletes with suspected TOS may benefit from evaluation by a team that includes sports medicine, physical therapy, orthopedic specialists, vascular specialists, or other appropriate medical professionals.
Does Every Baseball Player With TOS Need Surgery?
No.
Treatment depends on the type of TOS, severity of symptoms, the athlete’s response to treatment, and the recommendations of the medical team.
Physical therapy is an important component of treatment, particularly for neurogenic TOS. Rehabilitation may focus on restoring mobility, improving posture and breathing mechanics, developing better scapular control, improving thoracic mobility, and progressively strengthening the muscles responsible for controlling the shoulder and upper-quarter kinetic chain. (PubMed Central (PMC))
For some athletes, nonoperative treatment can be successful.
For others, particularly athletes with persistent symptoms or certain vascular presentations, surgery may ultimately be recommended.
What Happens During TOS Surgery?
When surgery is necessary, the goal is to decompress the thoracic outlet and relieve pressure on the affected nerves or blood vessels.
Depending on the individual anatomy and type of TOS, a surgical procedure may include:
First-rib resection
Scalenectomy, or removal/release of part of the scalene musculature
Other procedures to decompress the brachial plexus or vascular structures
The exact surgical approach depends on the individual athlete and the structures involved.
Surgery is not the end of the rehabilitation process. For a baseball player, the goal is ultimately to restore the mobility, strength, endurance, coordination, and throwing capacity necessary to return to the field.
What Does TOS Rehabilitation Look Like?
Whether an athlete is being treated nonoperatively or returning after surgery, rehabilitation needs to be individualized.
At Undefeated Physical Therapy & Performance, our approach to baseball rehab starts with the basics before progressing toward the demands of throwing.
1. Restore Mobility
We want to make sure the athlete has appropriate mobility throughout the:
Cervical spine
Thoracic spine
Shoulder
Scapula
Restoring motion allows the athlete to move through the throwing motion without unnecessarily placing additional stress on the surrounding structures.
2. Improve Posture and Scapular Control
The position and movement of the head, neck, thoracic spine, scapula, and shoulder all contribute to how the upper extremity functions.
Rehabilitation may include exercises targeting the:
Serratus anterior
Middle and lower trapezius
Rotator cuff
Deep cervical stabilizers
Thoracic musculature
Research on overhead athletes with TOS emphasizes restoring shoulder mobility, thoracic mobility, motor control, and normalized scapular mechanics. (PubMed Central (PMC))
3. Build Strength and Endurance
Baseball players don’t just need to be strong.
They need to be able to repeatedly produce and absorb force over the course of a throwing session, practice, game, and season.
That means rehabilitation eventually progresses from basic activation and control exercises into progressively heavier strength and endurance work.
4. Progress Into Plyometrics
Once the athlete demonstrates appropriate mobility, strength, and movement control, we can begin introducing more explosive activities.
Plyometric exercises allow us to bridge the gap between traditional strength training and the high-speed demands of throwing.
This is where rehabilitation begins to look much more like athletic performance training.
5. Return to Throwing
Throwing should be introduced progressively and based on the athlete’s symptoms, strength, movement quality, and stage of recovery.
Postoperative protocols vary, but some published rehabilitation recommendations begin more progressive resistance training around the eight-week mark, with a gradual return to throwing and a full return to high-level competition often taking 9–12 months after surgical decompression. (PubMed Central (PMC))
The timeline should always be individualized and coordinated with the athlete’s surgeon and medical team.
Can Baseball Players Return After TOS Surgery?
The answer is encouraging.
A 2024 study examined 52 professional baseball players who underwent surgery for TOS. Forty-six of the 52 players, or 88%, were pitchers. Overall, 79% returned to play at the same or higher level, with the average time to return to that level being approximately 9.5 months. (PubMed)
These results show that TOS does not necessarily mean the end of a baseball career.
However, return to play is a process. A successful outcome requires more than simply allowing the surgical area to heal. The athlete needs to rebuild the physical qualities required to throw at a high level.
Baseball Rehab After Thoracic Outlet Syndrome
For a baseball player, our goal is not simply to get the athlete out of pain.
The goal is to get the athlete back to baseball.
That means progressing from:
Mobility → Motor Control → Strength → Endurance → Plyometrics → Throwing → Full Baseball Activity
Every athlete will progress at a different rate.
We also have to consider the demands of the player’s position. A pitcher returning to the mound has different requirements than a catcher, infielder, or outfielder.
Throwing volume, intensity, recovery, strength, arm symptoms, and overall workload all need to be considered as the athlete progresses.
Thoracic Outlet Syndrome and Baseball: The Bottom Line
Thoracic Outlet Syndrome is not the most common diagnosis we see in baseball, but it is an important one to recognize.
When an athlete experiences unusual arm heaviness, fatigue, numbness, tingling, weakness, swelling, or changes in circulation—especially when those symptoms increase with throwing—it may be worth looking beyond the shoulder and elbow.
Not every athlete with TOS requires surgery. Physical therapy can play an important role in restoring mobility, posture, scapular control, strength, and throwing capacity. For athletes who do require surgery, structured rehabilitation is an important part of the return-to-play process.
At Undefeated Physical Therapy & Performance in Pittsburgh, PA, our focus is helping baseball players return to the sport they love through individualized rehabilitation, strength training, and baseball-specific return-to-throwing programs.
If you are a baseball player dealing with unexplained arm symptoms, persistent throwing-related fatigue, numbness, tingling, or weakness, getting the right diagnosis is the first step.
Baseball rehab is about more than treating the painful area. It’s about understanding the entire athlete and building them back to the demands of the game.
Contact Us Today:
Phone- (412)627-2131
Email- carmen@undefeatedpt.com
Instagram- @undefeated_pt
Dr. Carmen Jansante, PT, DPT, CSCS Undefeated Physical Therapy & Performance Pittsburgh, PA
References
Chauhan A, Chalmers PN, Erickson BJ, et al. Performance and Return to Play After Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis. The American Journal of Sports Medicine. 2024;52(7):1692-1699. (PubMed)
Colbert D, et al. Rehabilitation in Overhead Athletes With Thoracic Outlet Syndrome. Arthroscopy, Sports Medicine, and Rehabilitation. 2022;4(1):e181-e188. (PubMed)
Rochlin DH, et al. Neurogenic thoracic outlet syndrome in the overhead and throwing athlete: A narrative review. (PubMed)
Fisher AT, Lee JT. Diagnosis and management of thoracic outlet syndrome in athletes. 2024. (PubMed)
Likes K, et al. Thoracic Outlet Syndrome in the Overhead Athlete: Diagnosis and Treatment Recommendations. (PubMed Central (PMC))
Current Clinical Concepts: Rehabilitation of Thoracic Outlet Syndrome. Journal of Athletic Training. (PubMed Central (PMC))
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