Twins pitcher potentially dealing with career-altering condition

Minnesota Twins right-hander David Festa has been on the injured list since late July due to shoulder inflammation. Head trainer Nick Paparesta tells Betsy Helfand of the St. Paul Pioneer Press that noted surgeon Dr. Keith Meister believes Festa has neurological thoracic outlet syndrome. Festa is going to see another doctor, and a formal plan will be mapped out after that.

It’s a potentially ominous diagnosis, as thoracic outlet syndrome can significantly alter the course of a pitcher’s career. Back in 2023, Jesse Dougherty of The Washington Post did a thorough examination of the condition, noting that there are two distinct varieties.

One type is known as venous or vascular TOS. While this is a serious medical condition often involving life-threatening blood clots, it seems to have less long-term impacts in terms of throwing a baseball. Merrill Kelly is the poster boy for recovering from this type of TOS surgery. Kelly went under the knife in 2020 but has since made 132 starts with a 3.59 earned run average. Zack Wheeler of the Phillies recently had a blood clot removed and was recommended for venous TOS surgery.

The second type of TOS is neurogenic, which seems to have a larger impact on throwing ability. Paparesta used the word “neurological” to describe Festa’s TOS, but it’s possible he meant neurogenic. Stephen Strasburg, Chris Archer and Matt Harvey are some of the most famous examples of pitchers who were diagnosed with neurogenic TOS and never really seemed to be the same.

Strasburg was one of the best pitchers over the previous decade. He capped things off with an excellent 2019 season. He gave the Nationals 209 innings that year with a 3.32 ERA. He then added another 36 1/3 innings in the postseason with a 1.98 ERA, leading the Nats to a World Series title, winning himself World Series MVP in the process. But nerve issues popped up after that. He underwent TOS surgery in 2021. His repeated attempts to get back on the mound didn’t work. He only made eight appearances after the 2019 season and eventually retired.

Archer tossed 882 1/3 innings over the 2015 to 2019 seasons with a 4.05 ERA and 27.8% strikeout rate. He underwent TOS surgery in 2020. After that, he logged 122 innings with a 4.57 ERA and 20.2% strikeout rate. Harvey had a 2.53 ERA and 26.6% strikeout rate through his first 427 innings, but then had TOS surgery in 2016. In the final 446 2/3 innings of his career, he had a 6.15 ERA and 17% strikeout rate.

Festa entered 2024 as one of the top prospects in the league. He made his major league debut last year, tossing 64 1/3 innings for the Twins. His 4.90 ERA wasn’t especially impressive, but he struck out 27.8% of batters faced with an 8.3% walk rate.

This year, he has been shuttled back and forth between the majors and minors. He missed much of May while on optional assignment, due to biceps inflammation. He was placed on the major league IL in July due to shoulder inflammation. Around those transactions and injuries, he has made 11 big league appearances with a 5.40 ERA but decent strikeout and walk rates of 23.1% and 8.3% respectively. He also posted a 2.59 ERA in seven Triple-A starts.

It was reported earlier this month that Festa had a setback and would not be returning this year, with the next step being a visit to Dr. Meister. Further information on Festa’s status will undoubtedly be coming out in the future. He has not yet been moved to the 60-day IL, as the Twins only have 37 guys on their 40-man roster. If they fill those spots in the remainder of the season, Festa could eventually be moved to the 60-day IL to open another.

The Minnesota rotation has changed shape in recent months. The club fell in the standings and pivoted to sell mode. They sent out impending free agent Chris Paddack but also brought in young, controllable guys like Taj Bradley and Mick Abel, as well as prospect Kendry Rojas. Some have speculated that they will continue selling this winter, including making guys like Pablo López or Joe Ryan available. Time will tell whether that’s a realistic possibility or not. For now, the 2026 rotation mix includes those guys as well as Bailey Ober, Simeon Woods Richardson and Zebby Matthews.