Nats prospect Cole Henry candidly details decision to undergo Thoracic Outlet surgery

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Nationals pitching prospect Cole Henry will undergo season-ending surgery for Thoracic Outlet Syndrome, Henry disclosed in an interview with Grant Paulsen of 106.7 The Fan.

The 23-year-old right-hander hasn't pitched since June 11 for Triple-A Rochester and was officially placed on the Injured List on June 24. Henry was a second-round selection for Washington in 2020 and is the No. 6-ranked prospect in Washington's system.

Henry was remarkably candid about his decision to proceed with surgery during an appearance with Paulsen on the Bustin' Loose Baseball podcast, going into great detail about what led up to this moment.

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Henry was remarkably candid about his decision to proceed with surgery during an appearance with Paulsen on the Bustin' Loose Baseball podcast, going into great detail about what led up to this moment.

It's the same surgery that Stephen Strasburg underwent in July 2021, and the same injury that — dating back to before the surgery — has limited Strasburg to just 31.1 innings since winning the World Series with the Nationals in 2019.

"I've been down here rehabbing in Florida," Henry told Paulsen. "I took about four weeks off right whenever my shoulder started bugging me and kind of just came down here, didn't touch a baseball for four weeks, just did a bunch of rehab stuff trying to make my way back, and basically started throwing again and it didn't feel any better. We kind of sat around for a couple days trying to re-evaluate and see what the root cause of this problem has been.

"So we decided to take a trip down to Dallas and see Dr. [Keith] Meister and his people," he said. "Basically, after talking with him and chatting with him, he looked at all my MRIs and took me through all the different tests and sort of things and just had me explain exactly what I was feeling and when I was feeling it, when I was throwing, and things like that."

Henry is 1-0 with a 1.71 ERA in nine starts across Double-A Harrisburg and Triple-A Rochester in 2022. He boasts a 2.06 ERA across both seasons of his young minor league career.

"[Dr. Meister] came to the conclusion that I might have Thoracic Outlet Syndrome," Henry detailed. "So he sent me over to Dr. [Gregory] Pearl, who is also in Dallas and a pretty good friend of his, and just wanted to confirm what he thought might be true. So I went over to see Dr. Pearl that day and he also ran a few tests on me, kind of took me through his little deal."

"And he wanted me to get a nerve block done to kind of simulate what the Thoracic Outlet surgery would actually do for me," he continued. "So they basically put a nerve block into my scalene, which is in your neck right next to your collarbone, and then a nerve block into my pec, and he had me throw later that day. And basically, if there was no pain while throwing, then I probably would need the surgery, and if there was still pain when I was throwing with the nerve block, then it was probably a different thing altogether. So went and threw with the nerve block later that day and felt incredible. It felt like the electricity was back in my arm."

"So, good news that we figured out what we think it is," Henry said. "Bad news is I'll probably have to have season-ending surgery. So, never good, but I'm pretty young and I feel like guys bounce back pretty well when they're young from this surgery, so I don't think it'll be much of an ordeal hopefully. And I should be back ready to go for spring training or right there at the end of it, so it shouldn't be too much of a holdup."

Thoracic Outlet Syndrome appears to be an emerging injury in baseball that's appearing with more and more prevalence, but with much still to be learned about it, teams are grappling with how to best recover from it. Strasburg returned for one start in June and allowed seven runs in 4.2 innings, after which, he was shut down again and placed on the Injured List with what's officially listed as a "stress reaction of the ribs." He hasn't appeared since.

Still, Henry remains positive that this is the correct course for him to take and that he's young enough that he should be able to recover from the surgery in a relatively timely manner.

"A few sleepless nights over the past couple of months just trying to figure out exactly what's going on," he said, "but from talking to the doctors and our medical staff and all that, I think we've kind of got a good grasp on what my problems have kind of been for the past few years and they think that this has been the main cause of all of them."

"All my MRIs, elbow and shoulder looked pretty dang good as far as structural things go," he explained. "So rotator cuff, labrum, all that stuff, very clean. UCL, all that stuff, really clean. And they think it just comes down to a neurological problem. So basically I just go in and they remove my first rib and they also, I think they release something in my neck and then maybe my pec or something.

"It's only about a 12-week rehab and then after that I think it's basically good to go, all full steam ahead. I think we'll get a good rehab going this offseason and I think I'll come back even better than before. I think this is just one of those things I have to get through and hopefully we'll have zero problems after this, so that seems to be the case."

"This is a dumb question," Paulsen intervened. "But you just brushed past the removal of a rib, so I'm gonna go back to that. I mean the rib doesn't go back in, right? Like it stays out? That's just okay? Everyone's fine with that?"

"Oh yeah, yeah," Henry said. "I think Strasburg actually had this surgery about maybe this past year."

"So basically it's sort of the same things," he said. "I'm not sure if we have the same symptoms or anything like that. But, yeah, just one of those things. Throwing a baseball is a very unnatural thing for your body to do and sometimes you gotta, they remove things that are hindering you from being able to throw a baseball at your best. That seems like the case for me."

"We looked at mostly all of our options, and I talked to family members, my agent, other people that have had the surgery, and I think our best case right now is just to go in and get the surgery done and then bounce back quickly from the rehab," Henry said. "And it should be all systems go, hopefully."