What Does a Collapsed Lung Have to Do With Trey Yesavage’s Injuries?

When an athlete gets injured, we naturally focus on the structure that hurts. Shoulder pain leads us to the shoulder. A meniscus injury leads us to the knee. But one of the things I have learned working in rehabilitation and performance is that the current injury doesn’t always tell the whole story.

Sometimes you have to go back through an athlete’s history and ask what happened before it.

Toronto Blue Jays pitcher Trey Yesavage has an injury history that makes me want to do exactly that.

To be clear from the beginning, I have never assessed or treated Yesavage. I don’t know whether any of the injuries discussed here are connected, and I’m not suggesting that they are. What I am interested in are the questions his history raises and what I would want to investigate if he were standing in front of me.

It Starts With a Collapsed Lung

In May 2024, while pitching at East Carolina, Yesavage suffered a partially collapsed right lung following dry needling around the scapular region. He was hospitalized, yet remarkably returned to competition roughly 10 days later.

At first glance, a collapsed lung might seem completely unrelated to the orthopedic injuries that followed. I don’t think it’s something I would dismiss that quickly, particularly in a right-handed pitcher.

The thorax is incredibly important to an overhead athlete. Pitching requires enormous amounts of rotation, extension and force transfer through the trunk. The scapula has to move efficiently around the rib cage while the humerus moves at extraordinary speeds relative to it. The shoulder doesn’t operate independently. It sits on top of a moving thorax.

That makes the location of Yesavage’s 2024 injury interesting. His pneumothorax occurred on the right side—the same side as his throwing shoulder.

A pneumothorax involves air entering the pleural space and disrupting normal expansion of the lung. In Yesavage’s case, it reportedly occurred when a dry needle around the scapular region penetrated deeply enough to puncture the lung. There would have been local tissue trauma as well as pleural irritation, pain and difficulty breathing.

The medical question at the time was understandably whether his lung had recovered sufficiently for him to return to baseball.

The question I would be asking now is slightly different.

What, if anything, happened to the way his thorax moved afterward?

The Lung Doesn’t Function in Isolation

The lungs are surrounded by the pleura and live inside a constantly moving thoracic cage. Breathing requires coordinated movement between the lungs, diaphragm, ribs, intercostal musculature and thoracic spine.

When an area becomes painful or irritated, we protect it. Breathing can change. Rib excursion can decrease. Muscular tone can increase. Rotation can become asymmetrical.

Most of those adaptations are completely appropriate at the time. The body is protecting an injured area.

The interesting question is what happens after the tissue heals.

The pneumothorax can resolve. The athlete can become pain-free. Imaging can look normal. But that doesn’t necessarily guarantee that every movement strategy adopted during the injury has automatically returned to what it was before.

For a pitcher, even a relatively small change in thoracic movement could potentially matter because of what sits directly on top of the rib cage: the scapula.

The Scapula Has to Move on Something

The scapula doesn’t float independently behind the shoulder. It moves around the thorax.

During throwing, it must retract, protract, upwardly rotate, externally rotate and tilt as the arm moves through the pitching motion. The thoracic spine and rib cage provide the surface on which all of that happens.

If thoracic rotation, extension or rib excursion changes, the shoulder still has to find a way to put the hand in the position required to throw a baseball.

And elite athletes are exceptionally good at finding another way.

That’s an important distinction. Compensation doesn’t necessarily mean poor performance. An athlete can compensate extraordinarily well and continue throwing at elite velocities. The body simply redistributes movement somewhere else.

If less motion is available through the thorax, for example, more may eventually be demanded from the shoulder or another part of the kinetic chain.

That’s why simply measuring whether a pitcher can still throw hard doesn’t necessarily tell us how efficiently he is producing that velocity.

The Myofascial Relationship

There are also significant myofascial relationships between the thorax and shoulder.

The serratus anterior originates from the ribs and attaches to the scapula. The pectoralis minor connects the ribs to the coracoid process. The latissimus dorsi connects the humerus into the trunk and thoracolumbar fascial system. The intercostals influence rib mechanics, while the trapezius and rhomboids connect the scapula with the cervical and thoracic spine. Below all of this sits the diaphragm, influencing respiration, lower-rib mechanics and pressure management.

I don’t look at these structures as independent pieces. They form a region that has to coordinate movement and force.

So when someone has experienced significant trauma to one component of that region, I’m interested in what happened throughout the rest of it.

Did right-sided rib excursion change? Did thoracic rotation become asymmetrical? Did the athlete develop increased tone around the thorax? Did the scapula begin moving differently on the rib cage? Did the shoulder eventually have to contribute movement that previously came from somewhere else?

We don’t know that any of this happened with Yesavage.

But I would want to know.

There Is a Neurological Relationship Too

There is another interesting connection that isn’t purely mechanical.

The pleura has a significant sensory nerve supply. The costal portions receive innervation through the intercostal nerves, while portions of the diaphragmatic pleura receive sensory innervation through the phrenic nerve, which arises primarily from the C3-C5 cervical nerve roots.

Those cervical levels also have relationships with the shoulder region. It’s one reason irritation involving the diaphragm or diaphragmatic pleura can sometimes be experienced as referred pain around the shoulder.

I’m not suggesting that Yesavage’s shoulder impingement was referred pain from his lung. That would be a substantial leap without examining him.

What it does demonstrate is that the thoracic viscera, cervical nervous system and shoulder aren’t completely isolated neurological systems.

From an osteopathic perspective, I would also be interested in whether the original thoracic insult was followed by persistent changes in rib motion, thoracic paraspinal tone, respiratory mechanics or tissue mobility. Visceral afferent information and somatic structures interact through shared neurological pathways, which is part of the basis for what is commonly described as a viscerosomatic response.

Again, none of this proves a relationship. It simply expands what I would consider during an assessment.

Then the Workload Changed Dramatically

The next part of Yesavage’s history adds another layer.

After the 2024 pneumothorax, he entered professional baseball and progressed at an extraordinary rate. In 2025, he moved from Single-A through High-A, Double-A, Triple-A and eventually the major leagues before pitching deep into Toronto’s postseason run and the World Series.

His competitive workload increased from approximately 93 innings in 2024 to roughly 140 innings in 2025.

But innings alone don’t capture the entire change. His season became significantly longer, eventually extending through the end of October. The intensity of the competition increased dramatically as well. In a matter of months he went from lower-level professional baseball to pitching on baseball’s biggest stage.

Then, entering the following season, something happened.

His right shoulder became symptomatic.

The Right Shoulder Impingement

Yesavage developed a right shoulder impingement during the spring of 2026. Toronto slowed his throwing progression, and he began the season on the injured list before returning to the rotation in late April.

Shoulder problems in pitchers aren’t unusual, and there are many potential explanations. His enormous increase in workload alone deserves consideration.

But if I were evaluating him, I wouldn’t start his history in spring 2026.

I would go back to 2024.

I’d want to know whether anything changed following the right-sided pneumothorax. I’d assess his breathing mechanics, rib excursion, thoracic rotation and extension, scapular movement and glenohumeral mobility. I’d want to understand how those pieces worked together during his throwing motion.

Maybe everything would look completely normal.

That’s useful information too.

But I wouldn’t assume it without looking.

And Then the Left Knee

Several months after returning from the shoulder injury, Yesavage experienced another problem. This time it was his left knee.

Imaging identified a meniscus injury and he subsequently underwent surgery.

For a right-handed pitcher, the fact that it was the left knee is worth noting because that’s his lead leg. The lead leg plays an important role in accepting force and providing a stable platform as the pelvis and trunk rapidly rotate and transfer energy toward the throwing arm.

So now we have three very different areas involved over roughly two years: the right thorax, right shoulder and left lead knee.

It would be very easy to look at those as three separate medical events.

Maybe they are.

But I’d at least want to investigate whether there is a bigger movement story.

This Is Where Injury History Becomes Important

Imagine looking at Yesavage’s history as a sequence rather than a list of diagnoses.

In 2024, he experiences significant trauma to the right thoracic region and returns remarkably quickly. In 2025, his pitching workload and competitive demands increase dramatically. Entering 2026, his right throwing shoulder becomes symptomatic. He rehabilitates, returns to pitching and several months later develops an injury involving his left lead knee.

That sequence doesn’t establish causation.

But it gives me a lot of questions.

If Yesavage walked into my clinic tomorrow, I wouldn’t simply assess the surgically repaired knee. I’d want to understand the entire athlete.

I’d look at his breathing and rib mechanics. I’d assess thoracic rotation and extension. I’d examine scapulothoracic and glenohumeral movement. I’d look at pelvic and hip rotation and how the left leg accepts and redirects force.

I’d also want to compare his pitching mechanics before the pneumothorax, after his return, during his rapid progression through professional baseball and following the shoulder injury.

I’d be looking for changes.

Maybe there wouldn’t be any.

But if there were, they might help us understand the story differently.

The Injury Isn’t Always the Whole Story

Athletes are incredible compensators. They find ways around restrictions, redistribute movement and continue performing at extraordinarily high levels.

Sometimes those adaptations are temporary. Sometimes they become part of how the athlete moves.

That’s why I don’t think complex injuries can always be understood by looking only at the structure that’s currently painful.

The meniscus matters. The shoulder matters. The lung mattered.

But so does everything that happened between them.

With Trey Yesavage, there is no way for us to know from the outside whether his collapsed lung, shoulder impingement and subsequent knee injury are connected.

But his history raises a question that I think is much more interesting than simply asking when he’ll pitch again:

What if the injury we’re seeing today is only one part of a much longer story?

That’s where Reconditioning begins.