Kansas City Royals right-hander Nate Karns hopes that by losing a rib he will gain some relief.
The 29-year-old pitcher will miss the rest of the season to have a rib removed Wednesday in a procedure designed to take pressure off the nerve in his forearm. Karns has been dealing with pain and soreness in his right arm for months, and a seemingly endless menu of tests and treatments failed to produce a solution.
The condition is called thoracic outlet syndrome, and pitchers including the Twins' Phil Hughes and the. Mets' Matt Harvey, along with former Royals pitchers Luke Hochevar and Dillon Gee, have undergone similar treatment in recent years.
"The biggest thing is my symptoms were kind of floating around. Every day was a little different," Karns said. "It took a little while to figure out what was going on. That's why we did so many tests. We eliminated what it couldn't be and narrowed it down to thoracic outlet syndrome. ... So I'll have the surgery and go from there."
The condition is caused by two muscles attached to the uppermost rib creating compression on the nerves. The result is a feeling of numbness, tingling and a "dead arm" – not good when your livelihood is wrapped around throwing a baseball close to 100 mph.
Karns was acquired from Seattle in an offseason trade for outfielder Jarrod Dyson and was off to a strong start with Kansas City. He went 2-2 with a 3.43 ERA in eight starts, striking out 49 and walking 11 in 44 2/3 innings.
Karns dealt with back trouble last season with the Mariners. He began feeling these symptoms several months ago and went on the disabled list May 24. The Royals hoped that rest would be enough.
Days turned into weeks, weeks turned into months, and suddenly it looked as if next season would be in question. So the Royals decided they could wait no longer to schedule the surgery, and Karns is hopeful he will be ready to pitch when spring training rolls around.
"We exhausted every avenue we could," Royals manager Ned Yost said. "We kept trying to let it work itself out. We tried injections. We tried everything you can try without getting to the point where it starts to linger into next year if you do the surgery. It just wasn't getting any better."
Other pitchers to have been diagnosed with thoracic outlet syndrome include the Rangers' Tyson Ross and Chris Young, who was Karns' teammate with the Royals earlier this year.
"After surgery, I'll reach out and get his wisdom, what he found was beneficial throughout the rehab to focus on," Karns said. "The more information I can have to get through this the better off."
Yost said the Royals think Karns will come out OK.
"(Hochevar) had some complications with his surgery and it got to the point where he was nowhere ready to pitch in spring training. But we're fairly confident Nate is going to be ready to go next spring," he said.
FELIZ RETURNS: The Royals have reinstated reliever Neftali Feliz from the paternity list and optioned right-hander Miguel Almonte to Triple-A Omaha during a series of roster moves before Monday night's game against the Tigers.
Feliz has a 2.57 ERA in seven appearances. Almonte did not pitch during his most recent stint.
Kansas City also recalled outfielder Billy Burns from the Storm Chasers and optioned Jorge Soler to the same club. The move gives the Royals a speedy pinch runner while providing Soler, who was acquired in an offseason trade for All-Star closer Wade Davis, with regular at-bats in the minors.
Meanwhile, Cheslor Cuthbert was sent to Omaha to begin a rehab assignment. The versatile infielder has been on the disabled list since June 26 with a sprained left wrist.