Another setback? Rangers’ Max Scherzer receives injection for latest arm issue.

ARLINGTON, Texas – Max Scherzer got Botox injections.

Funny as it may sound, the popular cosmetic procedure can help with the nerve issue in his arm that has pushed off Scherzer’s return from the injured list indefinitely. On Wednesday, before their 4-0 win against the Cleveland Guardians, the Rangers moved Scherzer to the 60-day IL to create room for reliever Shaun Anderson, whose contract was purchased from Triple-A Round Rock. He is not eligible to return before May 27

Botox also beats another potential treatment: surgery. In the last couple of years, Botox injections have become a popular and successful treatment for neurogenic thoracic outlet syndrome (TOS), which has previously necessitated the removal of a rib. A number of Rangers pitchers have been diagnosed with the condition over the last 25 years. The club’s medical staff was among the first to identify and diagnose the issue in Major League Baseball pitchers. Doctors have used Botox to also treat other nerve pain.

TOS can be vascular, reducing blood flow to the arm, as was the case with Rangers third baseman Hank Blalock in 2007. More commonly, it is described as the compression of a nerve, often being irritated by a tight muscle. The injections can temporarily “paralyze” the muscles surrounding the thoracic outlet, giving the patient a significant period of relief.

Scherzer said he saw Dallas-based vascular specialist Dr. Greg Pearl, who has a long history with the Rangers, for the injections this week. He played light catch on Tuesday and Wednesday, but the treatment takes up to 72 hours to really have an impact.

“We’ve got to figure out a way to manage it,” Scherzer said of the nerve condition. “You are talking about nerves. It can screw up your arm for the rest of your life. It’s aggravating to deal with nerve issues in your shoulder.”

It has been especially frustrating for Scherzer, who dealt with a torn teres major muscle in September, underwent back surgery in December and has not yet pitched this year.

He had been making what appeared to be rapid progress on his back recovery and went out for a rehab start on April 24, pitching 2 1/3 innings. He planned to make one more rehab start after that before rejoining the Rangers. But he felt irritation in his hand, which then leaked to his forearm. The symptoms mimicked those he had before the teres major injury. After a week of rest with no real relief, he sought further answers, which led to the suspicion of the nerve issue.

Given the amount of time Scherzer has missed, even a May 27 return may be optimistic. He has not pitched since the 52-pitch minor league outing on April 24.