Following renewed speculation on the whereabouts of Markelle Fultz’s jump shot, the Philadelphia 76ers announced this month that its second-year guard had been diagnosed with thoracic outlet syndrome. The rare diagnosis did little to squash fan conspiracy theories about what was “really” going on with the No. 1 NBA draft pick, instead igniting a new flurry of questions and conjectures.
So, what exactly is thoracic outlet syndrome (TOS)? And will physical therapy restore the athlete’s shoulder back to health?
TOS is uncommon, but it’s not that uncommon, according to Thomas Trojian, MD, a professor of sports medicine at Drexel University College of Medicine and lead team physician for Drexel Athletics. Trojian said he’s seen the injury in volleyball players, pitchers, and occasionally basketball players.
“Out of 100 people who have shoulder and arm pain, two of them will be diagnosed with TOS,” he said. “It’s something that you need to be thinking about in order to diagnose.”
That explains why it may have taken so many weeks and different specialists to pinpoint Fultz’s injury.
TOS is called a syndrome, because it’s actually a group of disorders that occur when blood vessels, arteries or nerves in the space between the lower neck and upper chest are compressed. Fultz was diagnosed with neurogenic TOS, which means his nerves are affected, resulting in pain and weakness in the arm.
Trojian said that injury can easily be missed on an MRI, ultrasound, or even CT angiogram, because unless the arm is raised while it is being studied, everything might look normal during those tests. The injury can also be difficult for a patient to put into words.
“Once you raise your arm over your head and the nerve pinches, your arm would feel heavy and you might not get the feeling for the shot. It’s like your arm feels dead,” Trojian said. “That’s hard for someone to describe. You might say, ‘I go to shoot, and my arm feels weird.’”
The prognosis for athletes with neurogenic TOS is good, said Trojian. Physical therapy usually involves “opening up” tightness in the chest’s pec minor.
But many fans and commentators aren’t buying the TOS diagnosis — or at least think there is more to the mystery of Fultz’s missing jumper. That’s left some wondering whether there might be a mental health element to the young player’s struggles.
Trojian thinks Fultz could certainly be experiencing a mix of both types of pain – physical and mental – and that both kinds of injuries should be treated equally.
A 2016 study from Drexel College of Medicine sports doctors found that nearly 1 in 4 college athletes experience depressive symptoms. The authors noted that expectations to succeed paired with opportunity for failure, as well as injuries, can make young athletes particularly susceptible to depression.
“It builds on itself. When you have an injury and people can’t diagnose it, when you’re trying to figure out what’s wrong with you, then your self-confidence drops,” Trojian said. “When your self-confidence drops, you’re going to be less likely to make the shot. You’re going to feel like you can’t do the thing.”
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