It was confirmed today that oft-scrutinized second-year player Markelle Fultz will be out indefinitely with and injury. The injury has been revealed as being Neurogenic Thoracic Outlet Syndrome, an ailment that affects nerves between the neck and shoulder that severely affects a person’s range of motion and functional movement.
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Sources: 76ers‘ Markelle Fultz will be out indefinitely with thoracic outlet syndrome, starting physical therapy immediately. Likely weeks.
— Shams Charania (@ShamsCharania) December 4, 2018
ESPN’s Adrian Wojnarowski was among the very first to break the news, and says that the injury is treatable by physical therapy.
Though Fultz’s future in the NBA is uncertain, here’s what you need to know about the injury:
1. Common Causes: Physical Trauma, Repetitive Injury, Anatomical Defects
According to Mayoclinic.org, the injury can be caused by physical trauma, say, like the trauma experienced in a car accident. It can also be caused by repetitive sports (or job-related) injuries, pregnancy, or “certain anatomical defects (such as having an extra rib).”
Fultz has famously referenced lingering pain in the affected shoulder from a motorcycle accident last year, and he’s obviously been playing through pain (“repetitive sports injuries”) as he attempts to get back into shape.
It may be possible that he’s caused additional damage to the shoulder by attempting to play through the pain–his strange shooting form is almost definitely the result of this injury and his attempts to work through it, though for a long time it was assumed that his lackluster play had something to do with an over-the-summer attempt to adjust his shooting form.
2. The Thoracic Outlet is the Space Between Your Collarbone and First Rib
The thoracic outlet region begins in the lower part of the neck, near the clavicle, and extends to the upper part of the arm. This explains Fultz’s apparent pain or discomfort whenever his shooting arm reaches the angle where this specific space on the body would be engaged.
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Markelle Fultz free throw shooting form is hard to watch. pic.twitter.com/h9QzEtodak
— NBA Inside Stuff (@NBAInside_Stuff) October 22, 2017
He seems to experience a sort of barrier–whether of pain or simply a limited range of motion–when his arm reaches the 90-degree angle point of his shot. This has confused the league all season, wondering what could have possibly been to blame for this strange downfall of a former No. 1 pick.
3. The Syndrome Occurs When Blood Vessels or Nerves Become Compressed
According to Healthline.com, the important blood vessels, nerves, and muscles required for such ranges of motion as a basketball shot pass through the thoracic outlet. Compression of any or all of these things can occur if the outlet is too narrow as a result of physical trauma, injury, or structural abnormalities in the patient’s body.
If compression occurs in the thoracic outlet, the pressure places upon those nerves can cause noticeable pain in the area: the shoulders, neck, or arms.
4. Surgery May be Needed to Correct the Syndrome
Markelle Fultz will begin physical therapy immediately, which can heal the injury as well as anything else. In fact, though the syndrome sounds pretty scary, it’s typically treated by just that: medication and physical therapy.
However, surgery may be in the cards, depending on the severity of the injury and the quality of the recovery process. If the symptoms don’t improve after therapy, surgery may be needed to ultimately correct the issue.
The Sixers are optimistic that Fultz could return within three to six weeks, but this will entirely depend upon his recovery and how the physical therapy progresses. If he ends up needing surgery, his return date will likely be much further away.
5. TOS is Diagnosed via ‘Provocation Tests’
After going through a physical exam and having his symptoms reviewed by a specialist, Fultz was likely subjected to so-called “provocation tests” in order to ultimately diagnose the injury.
The tests are meant to induce the symptoms so that the doctor can get a clear idea of what the patient is dealing with. They can include specifically-directed movements of the neck, shoulders, and arms in varying positions, or you may be asked to put your hands over your head for a few minutes at a time.
Additional tests can include X-rays, MRIs, or Electromyography (EMG). EMG is a way to check out the condition of the muscles and the nerves that control them. Since TOS affects the muscles and nerves at a base level, an EMG could have been easily been used to support or confirm a diagnosis for Fultz.
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