Surgery removed this Nats prospect’s rib. It might also give him a career.

Cole Henry, a pitcher in the Nationals’ system, is returning from TOS surgery, a procedure typically associated with players searching for one last chance.

Cole Henry, a Nationals pitching prospect, has undergone surgery for thoracic outlet syndrome, a procedure typically associated with players at the end of their careers, not the beginning. (John McDonnell/The Washington Post)
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PINEVILLE, N.C. — For months, then weeks, then days, then minutes, Cole Henry had thought about this second, when he could finally throw a real-life fastball into a real-life catcher’s mitt. Not in a game. No, not quite yet. But after he spent years fighting arm issues, and after those arm issues led to the removal of one of his 24 ribs, Henry, a top pitching prospect for the Washington Nationals, found himself fantasizing about the small bits of progress.

Such as a late January bullpen session in a converted warehouse outside Charlotte. If only a catcher had been squatting behind the plate.

“Almost there,” Henry said with a smile, flipping a baseball to himself. In August, he decided to undergo surgery for thoracic outlet syndrome, which often raises alarm because of its association with Matt Harvey, Chris Carpenter and Stephen Strasburg, among others. Harvey, the thinking goes, was never the same after the procedure. Carpenter tried it to extend his career and wasn’t successful. Strasburg opted for it in 2021, hoping to fix unrelenting arm issues, and might never rejoin the Nationals’ rotation.

If the recovery for, say, Tommy John surgery is a simple equation, the postscript for TOS surgery seems more like multivariable calculus.

But unlike those pitchers, Henry was 23 when the anesthesia — or, as a nurse called it, his “margarita” — hit in an operating room near Dallas. He didn’t choose surgery for neurogenic TOS as part of his last chance. He chose it while still pushing for his first.

A day before the bullpen session, Henry sat at a four-top in the Flipside Cafe, just across the border in South Carolina. When he started the story of his right arm, the lunch rush was in full swing, almost every table full and some spillover at the bar. For an hour, he talked and talked, turning his black hat from forward to backward, picking at the meatloaf mac and cheese in front of him. And when he finished, the restaurant was near empty and a waitress swept the floor under his feet.

“I mean, this is my whole life,” Henry said. “I’ve now told this end to end to so many people. But I hope that I eventually feel so good and normal that I forget this all ever happened.”

He grinned, stirred his food a little.

“Okay, I probably won’t ever forget it.”

So it goes when you have your first rib stored in a clear plastic jar at home. How the rib got there — how Henry opted for a major surgery that six months before he knew nothing about — is the part he wants to bury deep in the past.

Henry, 6-foot-4 and lean, spotted in recent years with a throwback mustache, landed with the Nationals after only 18 outings at LSU. He had climbed atop the Tigers’ rotation despite regular forearm and elbow pain. Washington took him in the second round and enticed him to leave school with a $2 million signing bonus. After the draft, though, Henry tested positive for the coronavirus, delaying the beginning of his professional career. And that only began a long series of starts and stops.

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The next spring, he felt solid in major league camp before elbow soreness limited him to 43 innings with the high Class A Wilmington Blue Rocks in 2021. But through it all — college, his early months of pro ball, the next winter and into this past year — every MRI exam was just about clean. Sometimes they showed inflammation in his elbow or shoulder, nothing a week or two off couldn’t fix. Sometimes they didn’t even show that, making Henry feel as if the pain and numbness were out of step with reality.

“He’s calling me, he’s explaining what’s going on, and, man, I have no idea what to tell him,” said Jeff Henry, Cole’s father and a former minor league pitcher. “I felt really helpless, you know? Because I’m supposed to have the answers. We were all frustrated.”

Late last spring, Henry finished a bullpen session in Harrisburg, Pa., and told a coach his elbow nagged him every time he threw a curveball. This wasn’t new, nor had his performance sagged; Henry allowed two earned runs in his first 19⅔ innings. But Henry split from the Class AA Senators and headed for Washington, where team doctors diagnosed a minor forearm strain.

After two weeks of rest, Henry was promoted to Class AAA and debuted for the Rochester Red Wings in early June. He pitched five innings, a season high, and didn’t feel any pain, numbness or tingling. Then later that night, his shoulder went dead as he was eating dinner with his now-fiancee. He couldn’t lift his fork, let alone think about throwing a baseball again in five days. Yet that’s what he did, trying to prove he could take the last step to the majors — the last step to his lifelong dream.

“I come out after three innings, and my arm just feels really weak — anytime I reach out for something or reach up, I just can’t do it,” Henry recalled. “It was almost in my neck area, not my shoulder, so I’m confused. The problems were kind of spreading around, so I knew something was really wrong.”

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The next step was another MRI with the Nationals’ team doctors. That diagnosis: a shoulder impingement, if anything, which could heal with anti-inflammatories and a two-week break from throwing. But while Henry rehabbed at the Nationals’ facility in West Palm Beach, Fla., he could tell his arm wasn’t getting better. His right hand would tingle at night. He felt pain in the space between his collarbone and neck. He felt, really, as if there was “no electricity” from his wrist to his shoulder.

These are all signs of thoracic outlet syndrome, something Henry didn’t consider until he visited Cressey Sports Performance, a leading training facility, and someone there suggested he look into it. Soon, Henry was on a plane to see Gregory Pearl, a TOS specialist and vascular surgeon, in Dallas. Pearl looked over every one of Henry’s MRIs and didn’t see an obvious problem. That’s when Pearl injected a nerve block in his lateral neck muscle, designed to simulate how Henry might feel after TOS surgery.

The condition is caused by the compression of major nerves (neurogenic) or blood vessels (vascular) near the base of the neck, affecting a nerve network that provides movement and feeling to the arm and hand. So if Henry still felt pain or numbness while throwing with the nerve block injected, he probably would have to search for another solution. But if he felt good, it would be a compelling reason to undergo an operation that would address TOS by removing his first rib and a neck muscle.

“I didn’t sleep at all the night before,” Henry said. “I felt like my whole career was riding on how this throwing session went, and I was worried about my mind maybe tricking me because I so badly wanted an answer. Like, would I truly know if I felt good, or would I just want to? That sort of thing.

“I go to the facility in Dallas with Gene [Basham], the Nats’ minor league rehab guy, and he tells me has never seen me look so good. I felt awesome. It was weird because that meant surgery was probably the best option. I talked to my dad, my agent, my girlfriend who’s now my fiancee, and then I did it [Aug. 25]. The worst part was right after. My ribs and side hurt so bad that I would cry from sneezing or laughing. But ever since …

“Ever since I have honestly felt good as new.”

Just before the bullpen session outside Charlotte, Henry stared down Tyler Zombro, his coach here at Tread Athletics, and called his shot.

“Next one is 90,” Henry said, incrementally building toward that number in the high-end performance facility. He crow-hopped and threw straight into the net in front of Zombro.

“Nope!” Zombro said, looking down at the radar gun in his hand. “Eighty-nine.”

The ideal recovery from TOS surgery is both detailed and not too tentative. Zombro, a minor league pitcher for the Tampa Bay Rays, would know.

Two months ahead of Henry, Zombro, 28, underwent surgery with Pearl to address neurogenic and vascular TOS. Once a pre-med major at George Mason University, Zombro thoroughly researched the procedure, including probing Pearl with questions. Zombro believes the negative view of TOS surgery is unwarranted, though he does understand why removing a rib sounds scary — and why it could be hard to trust a diagnosis that doesn’t come through a traditional MRI.

“When you are younger and you can actually push it in the weight room and you’re kind of adapting through the tissue modifications that are taking place, you’re getting the scar tissue to behave how you’d like, I really don’t think there is a negative to the surgery,” Zombro said, adding that losing a first rib and scalene muscle doesn’t alter joint integrity in any way. “I know a lot of people told me before the surgery: ‘Well this surgery as-is is kind of a death sentence for pitchers. This feels like an impossible comeback.’

“But I’m like, ‘How in the world do you expect me to function when I have terrible feel of the baseball, don’t know where my arm is in space and clearly my velocity is declining?’ At that point, it’s like: What other options are we really navigating to? Oftentimes, with the TOS guys, they are at a really low point. Usually it’s at a point where you’re only going to get better out of it.”

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The stigma might come, at least in part, from big-name pitchers who underwent surgery toward the end of their careers — and in some cases underwent unnecessary surgeries before landing on a TOS diagnosis. That is Zombro’s view, and it’s shared by some who have opted for the surgery in recent years. Strasburg, for example, was 33 when he underwent TOS surgery and believes he only did so after an ill-advised procedure to address carpal tunnel syndrome the previous summer. Clayton Richard, a former MLB pitcher, says he had a superfluous second shoulder surgery that delayed his eventual comeback from TOS.

Henry, by contrast, had never been operated on before August. Antoine Kelly, a minor league pitcher for the Texas Rangers, also underwent TOS surgery without any major league service time, doing so at 20 years old in November 2020. Looking back a few decades, Jeff Henry remembers a number of guys who left the game because they had constant tingling in their throwing hands or plain old “dead arm.” He wonders if any of them, even a small handful, could have had their playing days extended by a TOS procedure.

“It’s more relieving than concerning,” Mike Rizzo, the Nationals’ general manager, said of Henry’s situation. “There are no miles on his arm. I think that’s the issue you see with Stras. Stras had a lot of trauma to his arm and that side of his body, and I’m hoping that because the kid is clean everywhere else, he can bounce back from this and be one of the success stories of this surgery.”

Twenty pitches at 90 percent effort, all fastballs. That was it. Henry never even learned the name of the guy who caught his bullpen session.

What mattered was that he felt normal — so normal that as soon as he stepped off the mound he and Zombro were already planning his next session. In a week, he would head to West Palm Beach, this time for spring training instead of an extended rehab. In five weeks, give or take, he could maybe pitch with a batter in the box, maybe in front of a coach or executive who could once again tap him for the fast track.

Imagine that. A real-life batter in the box, nothing but the moment and the rest of his career ahead.