Collette Calls: Wheels Down

Zack Wheeler had a dominant stretch of the summer where he pitched to a 2.03 ERA and 0.85 WHIP while holding opposing batters to a .188 average with a 30.4 percent K-BB%. Fantasy managers and Phillies fans were expecting a continued push into the summer heading toward the playoffs, but then August hit. Something was not quite the same with Wheeler over his three August starts. The strikeouts were still there, but he allowed three homers in a start against Detroit and one each in his next two starts, but also went six, five and five innings respectively. It was only a day after the last start that we learned of the blood clot found in his arm, and then the diagnosis that Wheeler was suffering from venous thoracic outlet syndrome (TOS) that would require season-ending surgery to relieve the decompression in his arm. 

The road to recovery is typically six-to-eight months. I can already hear some fantasy managers thinking about how they will handle Wheeler in the 2026 draft season, because a six-month timeline gets us to February while an eight-month timeline gets us to April. As a well-known lover of memes, a couple come to mind when considering this situation. First, we will hear from Michael Jordan:

...and since the kids are alright, let's hear what the seniors from Bayside High have to say about this situation:

Let us first focus on the fact that Wheeler is OK. It is fortunate the medical team caught the blood clot in time, because there are serious consequences with clots in the bloodstream. Many of us are famiilar with how J.R. Richard's life and career took an abrupt turn in 1980. Richard made waves with a dominating performance in the 1980 All-Star game, tossing two scoreless innings while throwing electric fastballs and filthy sliders. Yet, it is worth noting the comments the great Keith Jackson makes in the opening of the audio clip, because we cannot even fathom a big-league club allowing a prized pitcher to work in an exhibition game in today's game with "stiffness in his right forearm," yet there was Richard flinging filth on the mound at Dodger Stadium:

This article, from the SI Vault, provides some further background on Richard's situation that summer. It mentions Richard "first began to experience an inexplicable tiredness, a deadness, in his throwing arm" on June 17 in a game at Wrigley Field. The only sign in the box score of such an issue would be Richard working just five innings, because he had thrown at least seven innings in each of his previous seven starts while going nine in each of the three outings leading up to that game on the 17th. Houston skipped his next start and sent him back out June 28 against Cincinnati, where Richard failed to make it out of the fourth inning and struck out just one batter. He bounced back in his next outing against Atlanta, and the team allowed him to travel to Los Angeles to pitch for the National League All-Star team. 

While there, Richard visited with Dr. Frank Jobe, who told Richard he should skip his next start and pitch only five to six innings in the start after that. Richard altered that diagnosis and told the press that he was told to take 30 days off, and when the stories didn't add up, it further buried Richard in the press as a complainer — a theme that had come up throughout the season in the shadows of teammate Nolan Ryan becoming the first million-dollar man in baseball. Richard made another start against Atlanta on July 14 but didn't make it out of the fourth in that one either, complaining about a cold hand and nauseated stomach in between the third and fourth innings, leading to Bill Virdon pulling him after one out in the inning, concerned about how Richard looked on the mound. Richard was once again buried in the media for this.

The club put Richard on the disabled list July 16, and the team allowed him to go back home for a week to Louisiana. He returned to Houston on July 23 for three days of testing, where an arteriography revealed the issues to his collateral artery system and the clot within it. The perceived whining and complaining now had a diagnosed accomplice, yet there was consensus not to yet operate, because the clot wasn't likely to move, and there concerns about diminishing Richard's ability to pitch. It was decided Richard could work out under close observation with the club, but one week later, Richard's clot did in fact move, leading to a stroke which effectively ended his major-league career and nearly killed him.

Now that we've taken that sobering trip down memory lane, let us not forget that most recovery timetables are best-case scenarios. On one end of the spectrum, you have Richard, who nearly lost his life and had his career ended by a situation which went undiagnosed for too long and was written off as nothing more than whining in 1980. On the other end of the scale, you have Merrill Kelly, who underwent the exact same surgery Wheeler did back in September of 2020 and returned to pitch 158 innings with a 4.44 ERA and 1.29 WHIP the following season, missing just six starts. Kelly was four years younger than Wheeler when the former had his surgery, but Kelly went onto pitch 30-plus starts in each of the next two seasons, which were arguably the best seasons of his career. 

I will not even pretend to be a medical doctor, but research shows there are three different types of thoracic outlet syndromes:

• Neurogenic: The most common type, which involves compression of major nerves
• Venous: Occurs when veins become compressed, leading to blood clots, and has a "silent chronic component," that isn't apparent until a thrombus forms
• Arterial: The least common type, which involves compression of arteries

This table shows some of the pitchers who have undergone each of the first two; I was unable to find a pitcher who needed surgery to correct a diagnosis of Arterial TOS:

This published study looked at 52 players who underwent surgery for TOS, 46 of which were pitchers. Neurogenic TOS was diagnosed in 69 percent of the players, venous in 29 percent, and one unnamed player had arterial TOS. The good news is 76 percent of pitchers returned to play at the same or higher level by 9.5 months after surgery. They also found that pitchers who had surgery to correct TOS "had no significant differences in pitching performance metrics after surgery compared with matched controls."

This study looked at 26 pitchers at the major-league level who had surgery to correct TOS ; 22 of them had surgery to correct a neurogenic diagnosis, while four had surgery to correct a venous diagnosis. The success rate in returning to performance for both groups was identical, but one of the four in the venous group did not return to perform. The data in this study is particulary fascinating, because tables three and four look at many of the same indicators fantasy managers and analysts consider when evaluating pitchers. In its conclusion, it states:

The results of this study demonstrate that MLB pitchers who undergo rib resection for TOS can expect high return to performance (RTP) rates, comparable with the more commonly performed ulnar collateral ligament (UCL) reconstruction rates of 79% to 100%. 9,12 Furthermore, our findings show that pitchers generally return quickly from surgery and most play the following season, with an average RTP time of only 10 months from the time of surgery. One study of rib resection for TOS in competitive athletes documented a mean recovery rate of 4.4 months, 5 with another study reporting 50% of their athletes returning within 6 months and the remainder returning within 12 months

In conclusion, Wheeler is the second named pitcher to have a rib resection to correct a venous TOS diagnosis. We saw what Merrill Kelly did just a few years ago, but he was also four years younger than Wheeler. The study above states 50 percent of athletes return in six months and the remainder within 12 months, which frames Wheeler's return in 2026 within the sample size of...one.

As you sit down to decide how you are going to approach Wheeler in 2026, consider these data points as well as the return on investment you may have suffered in your optimistic hopes evaluating Spencer Strider and Sandy Alcantara this year. Strider has earned -$9 dollars this season and Alcantara -$14 in standard mixed leagues, yet both pitchers had ADPs inside of 140 in RotoWire Online Championships this season and ADPs inside the top 90 in Main Event leagues. I personally will not have Wheeler on my board unless he makes it to the reserve rounds in my leagues because of my persistent cynicism when it comes to pitching injuries and recovery.