Has the Markelle Fultz ailment mystery been solved?
Trust the Diagnosis?: Has the mysterious shoulder ailment that #1 overall pick Markelle Fultz has been battling finally been decoded?
It very well may be that the diagnosis of Thoracic Outlet Syndrome could be what has been troubling Markelle Fultz for almost two years since being drafted by the Sixers No. 1 overall in the 2016 draft.
It could also be that it’s an attempt to save face by the Fultz camp to prevent any further deterioration of the player’s worth for future employment. Whatever the case what I can tell you is that Thoracic Outlet Syndrome is a diagnosis that is real and one that can be treated conservatively through physical therapy. And if Thoracic Outlet Syndrome is the true problem and reason for Markelle’s shooting woes then he very well could be on his way back to the player that was drafted for his remarkable ability to drive to the rim, but more importantly to knock down 24 footers with precision.
Over the past few days I have heard a lot of misinformation on sports talk radio and in conversation with my own patients, so I want to provide a little insight to the diagnosis of Thoracic Outlet Syndrome.
Thoracic Outlet Syndrome is a diagnosis that involves multiple nerves and blood vessels as they exit the neck and travel into arm. The blood vessels involved supply the muscles of the shoulder and arm and the nerve bundle, otherwise known as the brachial plexus, control the muscles of the shoulder and arm. Often what occurs is that either through direct injury, poor posture, or a combination of both, the blood vessels and nerves can be compressed, often due to tight musculature in the front of the shoulder and neck. Another possibility
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is an anatomic anomaly in which a person is born with an extra rib that causes limited space for the nerves and blood vessels to travel.
Regardless of what is causing the compression, if the blood vessels are involved it can cause poor circulation, and if the nerves are involved it can cause the innervation of the muscles in the shoulder and arm to be compromised. There are a few issues that can occur if the nerve innervations are affected. First the muscles of the shoulder and arm can begin to weaken, second the motor control of the muscles can be affected. If there is weakness in the muscles and motor control is affected, then the ability to use the arm correctly will be significantly affected for normal daily use, let alone the mechanics that are required for a professional basketball player to have a consistent 3-point shot night in and night out.
Because the symptoms of Thoracic Outlet Syndrome can present like a multitude of other diagnoses that occur in the neck and shoulder, it can often be overlooked until every other possibility is ruled out. This could be the issue that Fultz has been going through, he saw multiple specialists that found no structural issues in his neck or shoulder and therefore no explanation for the reported symptoms. Diagnostic tests can highlight if soft tissues have been injured or if there is a circulation issue, but determining which nerve is directly responsible for the symptoms is very challenging because the brachial plexus is a spider web of different nerve branches.
Physical therapy is usually the first treatment approach when treating Thoracic Outlet Syndrome, which is what Fultz will be doing for the next 4-6 weeks. Having treated patients with this diagnosis in the past, patients respond well to conservative PT treatment and quite often strength and motor control are restored.
As a PT I am always looking to promote my profession and educate people that PT’s do a lot more than just rehab patients after surgery. PT’s can evaluate, diagnose, and treat a wide range of musculoskeletal and neurologic issues.
And as a Sixers fan I am hopeful that if in fact this is the reason for his shot being affected, than Fultz could bounce back and be the player the Sixers expected when they traded up and made him the No. 1 pick in the draft.