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What is thoracic outlet syndrome and what does it mean for Markelle Fultz?

December 5, 2018 Sports 3 Views According to ESPN's Adrian Wojnarowski, Philadelphia 76's Guard Markelle Fultz has been diagnosed with…

According to ESPN’s Adrian Wojnarowski, Philadelphia 76’s Guard Markelle Fultz has been diagnosed with neurogenic thoracic outlet syndrome and is expected to miss three to six weeks when he is undergoing rehabilitation.

Thoracic outlet syndrome (TOS) refers to a collection of signs and symptoms resulting from neurovascular compression at the thoracic outlet. The neurovascular denotes the structures – both nerve and vascular – that might be compromised.

The thoracic outlet is an anatomical region between the neck and the shoulder where key blood vessels and nerves travel and route to supply the upper extremity. Compression or abnormal pressure of structures in the thoracic outlet may be due to soft tissue (such as muscle or ligament) or bone (such as a normal rib, an extra rib or collarbone) anomalies.

Courtesy of Jason T. Lee , MD

Symptoms are wide-ranging and variable. In vascular thoracic outlet syndrome, symptoms such as coldness and numbness reflect limitations in blood flow to the hand. In neurogenic thoracic outlet syndrome, nerve compromise can lead to sensory changes such as numbness, tingling, pain and potential weakness or early fatigue in the arm and hand.

Arriving at a diagnosis of TOS can be challenging. De variabiliteit van klinische presentaties is reflecterend of de specifieke structuren worden gecomprimeerd en de mate waarin die tissues zijn gecompromitteerd. In other words, TOS often looks very different from one person to the next. Additionally, the symptoms can fluctuate depending on the position of the head / neck / shoulder and arm, making reproducibility difficult.

Diagnostic testing and imaging can be helpful, though not always conclusive. In het geval van imaging zoals X-ray of MRI, een zichtbare “extra” rib of zachte tissueband die duidelijk de thoracische uitlaat kan beïnvloeden en waardoor compressie kan een TOS diagnose ondersteunen. Doppler studies can identify areas of altered blood flow in vascular TOS. Electrodiagnostic testing can highlight impaired nerve conduction in neurogenic TOS. Det er imidlertid mulig for en idrettsutøver å ha symptomer som er konsistente med TOS i det manglende klare diagnostiske fund, som kan føre til frustration, når man forsøger at bestemme årsagen til problemet.

TOS typically affects athletes who perform repetitive overhead Motion that narrows the thoracic outlet and either compresses or places stress on the vulnerable structures involved. Cases involving baseball players, especially pitchers, are perhaps the most familiar; In recent years, Chris Carpenter, Phil Hughes and Matt Harvey have all undergone surgical procedures to address TOS.

According to Dr. Jason Lee, professor of vascular surgery at Stanford University Medical Center, basketball players are not among those athletes commonly affected. In zijn meer dan 15 jaar van specializing in caring for TOS patients, Lee has treated collegiate to professional athletes with TOS hailing from a wide range of sports, including swimming, diving, water polo, rowing, volleyball, tennis, lacrosse, football, softball and, of course, baseball.

But never a basketball player.

“Typically, the athletes who develop thoracic outlet syndrome are performing a repetitive overhead motion of their shoulder and arm that involves force such as throwing or hitting as hard as they can, “Lee said.” Basketball shots, even though they involve repetitive motion, require more finesse than force. “

Lee was quick to point out that there are always unique cases, potentially influenced by an athlete’s specific sports , injury history, playing style, mechanics, workout regimen and anatomy. Former NBA player Ben Uzoh dealt with symptoms of the condition for several years, but the diagnosis remained a mystery until he stepped away from basketball.

Given that the presentation of TOS in a basketball player is so rare, it is difficult to provide Alle relevante vergelijkbare scenario’s voor Fultz met betrekking tot een prognose of een timetable.

Wanneer het komt bij behandeling, de aanpak varieert van conservatieve maatregelen zoals fysieke therapie tot meer agressieve chirurgische interventie. De mål om fysisk terapi er at lindre kompression ved at adressere områder med begrænset mobilitet i atletens spine eller skulder og ved styrkelse af regional muskulatur som kan være mangelfuld som følge af sport-induceret ubalance.

The athlete may have to relearn certain movement Patterns as part of a return to play, especially if there have been compensatory adjustments as a result of the condition. I tilfeller der der er en åbenbar strukturel anomalie, som ikke er acceptabelt for konservativ behandling, kan kirurgi for at afhjælpe kilden til kompression være berettiget.

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