After the he-said, he-said spectacle of the weekend, GM John Mozeliak made the news official Tuesday: Jaime Garcia will have season-ending surgery Friday to counter thoracic outlet syndrome.
The surgery will be performed in St. Louis by Dr. Robert Thompson. It will be the second time in 14 months Garcia has gone under the knife, after having surgery to repair a torn labrum last May.
Garcia also has a history of rotator cuff problems, and Mozeliak said the syndrome is a result of the combination of issues his arm has dealt with over the last three years.
Recovery time is estimated at three to four months, but few precedents exist around baseball players and a successful comeback is not guaranteed.
Matt Harrison and Josh Beckett are two examples of pitchers who have recovered successfully from the surgery and pitched again at a high level. But some, like Chris Carpenter and Jeremy Bonderman, were never the same.
"Obviously when you think about this type of surgery there are certain risks involved," Mozeliak said. "He feels like this is a last resort."
The condition has manifested in Garcia as tingling in his neck and shooting pain in his hand whenever the lefty threw. Surgery involved removing an extra rib, and Mozeliak called it "very invasive."
Garcia is suffering from the nerve-based version of the syndrome, which comes in two forms. The vascular version is much more dangerous, and could be life threatening.
"This is more to avoid the stingers and discomfort throughout your arm and hand," Mozeliak said.
Here is some explanation of the syndrome, which is considered rare overall, from the Barnes Jewish Hospital:
"Thoracic outlet syndrome (TOS) is a group of rare conditions involving compression of the nerves or blood vessels that serve the arm and hand, as they pass through the base of the neck and behind the collarbone on the way to the arm. Patients with nerve compression caused by TOS can experience pain in the neck and shoulder, as well as pain, numbness, tingling and weakness in the hand and fingers. These symptoms are often worse during arm activity or with the arm elevated overhead. Others may experience arm swelling and discoloration due to a clot in the vein to the arm, and some have cold painful fingers and arm fatigue due to an aneurysm of the artery.
"Symptoms can be disabling and diagnosis is a substantial challenge, but fortunately, many patients with TOS respond well to targeted physical therapy or surgery when necessary. Thoracic outlet syndrome is difficult to diagnose and not well understood by physicians who haven't seen many cases, and treatment has for many years been considered controversial."
Garcia began the year on the disabled list after suffering from inflammation in his surgically-repaired shoulder. He returned on May 18 and posted a 4.12 ERA in seven starts. Now his season has been cut drastically short for the second year in a row, casting doubt on the possibility of him ever contributing to the Cardinals rotation again like he did in 2010 and 2011.
Garcia is signed through next year, when he will make 9.25 in the last of a four-year, $27M deal. The deal includes two team options for 2016 ($11.5M) and 2017 ($12M.)
The injury is not affecting the same nerve Garcia had moved from his wrist to his elbow and irritated earlier in his career. Mozeliak relented that the condition could have been sparked when Garcia was hit by a pitch in the eblow while batting on rehab assignment in May.
"It's not black and white," Mozeliak said.
Mozeliak and Garcia clashed Saturday when Garcia leaked the possibility of surgery to reporters before broaching the issue with Mozeliak, according to the GM. Mozeliak then held an impromptu sessions with reporters during which he expressed frustration with Garcia's handling of the situation.
"I sound frustrated, look frustrated. I'm frustrated," Mozeliak said then. "Certainly we would have loved to have heard from him."
Garcia met with Dr. Thompson for a consultation Monday, and Mozeliak announced the surgery date Tuesday.
"I understood where he was coming from the other day," Mozeliak said. "That was more about protocol."
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