Seventeen-year-old Angelo Bellizzi, a high school junior from Oakland, New Jersey, first picked up a baseball at age 5. Since then, he has never looked back.
"Baseball has been my whole life," he said. "It's the reason I get up in the morning. It's the reason I work out and go to school every day."
By his freshman year of high school, Angelo had become a flame-throwing righthanded pitcher with aspirations of playing Division 1 college baseball and, eventually, going pro. He had been training with pitching coach Thomas Atlee and was preparing for the upcoming high school season. But then he began experiencing extreme pain in his arm and chest when throwing.
Over the next 10 months, Angelo and his parents visited multiple doctors to figure out what was wrong. No one knew. Then they received a referral to Massachusetts General Hospital thoracic surgeon Dean Donahue, MD, one of the country's foremost experts on thoracic outlet syndrome (TOS). This rare disorder results from compression or irritation of the nerves and/or blood vessels near the base of the neck and collarbone.
TOS is notoriously hard to diagnose. However, his deep experience with the disorder allowed Dr. Donahue to draw an educated conclusion and map out a treatment plan.
After months of frustration and fear that his baseball career was over, Angelo suddenly had hope.
"We were very, very lost for a long time," said Angelo's mother, Heather. "Dr. Donahue saved not only Angelo's baseball career but also his life. I don't know what this kid would have done if he couldn't have played this game again."
"The ball felt like a 10-pound weight."
The pain that struck Angelo in the spring of his freshman year was like nothing he had felt before. "There was a heaviness in my arm," he recalled. "The ball felt like a 10-pound weight. Every time I got on the mound, this pain ran up my whole arm."
Buoyed by his love of the game, Angelo kept pitching through the spring and into the summer. But during a game in August, the pain became unbearable. He had to take himself off the mound.
Angelo saw several doctors with his parents over the next few months. All the tests—MRIs, X-rays, CT scans—came back normal. Rest didn't provide relief; neither did medications.
"I'll never forget one time he was throwing in the bullpen," said Angelo's father, Gerard. "He screamed so loud, threw off his glove, and said, 'This isn't normal. I can't do this. I think my career may be over.'"
As the months dragged on, Angelo became inconsolable. After school, he would head straight to his room. He barely spoke with his parents.
"It was the hardest thing I ever had to deal with because baseball is my life—and it was taken away from me," he said. "I struggled a lot mentally."
Highly specialized expertise in TOS
In the winter of Angelo's sophomore year, an orthopedic surgeon that he had previously seen had a revelation: Angelo might have TOS. The surgeon said only three doctors in the country specialize solely in TOS. One was Dr. Donahue.
Dr. Donahue is director of Mass General's Thoracic Outlet Syndrome Program. He has been seeing patients with TOS since joining the hospital's staff in 1997. Young, high-level athletes like Angelo represent around one-third of his practice, though anyone could develop the disorder.
"TOS happens when the nerves or blood vessels in the part of the body that we call the 'thoracic outlet' are compressed—usually from a combination of the anatomy they were born with and repetitive arm motion," Dr. Donahue said. "It often affects athletes who use their arms overhead, like pitchers, swimmers, and tennis players, or people with physically demanding jobs."
A difficult condition to diagnose
While Dr. Donahue typically has a months-long waitlist, he was able to see the Bellizzis the day after they contacted his office. At the appointment, Dr. Donahue examined Angelo and reviewed his imaging.
"TOS is tricky because the symptoms are associated with many other conditions, and no test can definitively prove a patient has it," Dr. Donahue said. "So, whenever I tell a patient they have TOS, the last two words of that sentence are 'I think,' because there's no way to know for sure."
In Angelo's case, Dr. Donahue felt confident it was TOS. Specifically, he thought Angelo had neurogenic TOS, the most common form of the disorder. Dr. Donahue suspected that the symptoms were being caused by nerve compression near the pectoralis minor muscles, which are small muscles situated deep in the chest.
For some patients, treatment for neurogenic TOS begins with botulinum toxin A (Botox) injections to relieve nerve pressure. However, because Angelo's symptoms were so severe, Dr. Donahue recommended surgery. The procedure would entail detaching the pectoralis minor muscles from the shoulder blade. Freeing up the nerves being squeezed would take away the pain.
Surgery—a success
