Q&A about Fultz on Reddit with a medical professional specializing in Neurology and Trauma. He has treated patients with Thoracic Outlet Syndrome (TOS).
Thoracic Outlet Syndrome" refers to the "neurovascular bundle" that is known as the "Thoracic Outlet". "Thoracic outlet" = The main vein, artery, and nerve that goes down your arm. Those three things are what make up the "Thoracic Outlet".
When this nerve is squeezed by surrounding tissue (muscle, bone, etc.), it can have nasty effects like numbness/tingling/pain and loss of motion in the arm. Being that the shoulder is a very complex joint, there are a lot of different ways in which this "squeezing of the nerve" can happen. How does the surrounding tissue "squeeze" the nerve? Well, a few different ways, but more than likely, Fultz issue stems from taking 1000+ shots a day with poor body mechanics (this assumption is unfounded, but very likely the case). This repetitive shooting motion caused his muscle/bone to rub together a bit too much inside of his shoulder. This rubbing caused irritation, and when things get irritated, they SWELL UP. This swelling "squeezes" the nerve in his shoulder, which causes his arm to have all sorts of funky effects like pain, numbness and restricted motion.
They are most likely working with him to fix the surrounding issues of swelling, so that the nerve is no longer being "squeezed". This might involve making small changes to his posture and shooting form, but it could also involve an invasive surgery down the road.
I'll add that I am overall VERY optimistic about his outlook. I believe he is going to get the best care anybody has ever had when it comes to his TOS, and I personally expect him to be back and playing bball with no problems in the future. His shot might take some time to develop, but the rest of his game(and his off-hand) has only had time to improve since his injury was diagnosed.
I'll bet we see Fultz return to be a very good player with a slightly limited shot. As time goes on, his shot will develop and eventually he will be shooting the ball well again. Right now he has the opportunity to focus on so many other parts of his game, and his shot is just going to be put on the back-burner while he rehabs his TOS.
Do you believe markelle has TOS and do you forsee him being available by the beginning of the season based on people you've rehabbed?
He was diagnosed with TOS, so yes I do. Though I don't know any details, I am incredibly optimistic about his rehab. I wouldn't be surprised to see him back on the court next season. I think the challenge he faces is avoiding the reaggravation of his injury.
How does therapy help with treating TOS? Is their severity levels to TOS?
Therapy typically revolves around stretching and strengthening areas of the neck and shoulder with the goal of releasing tension around the injury. This is in addition to correcting posture and making small changes to body mechanics in hopes to permanently "fix" the issue.
TOS does vary in severity, yes. I don't know exactly what the details are with Fultz, but it's safe to assume his problem stems from repetitive overhead motion(shooting), and more than likely his TOS is because the nerve that goes down his arm is being "squeezed" by the surrounding tissue, whether it's because of severe inflammation, or because his bones/muscles are obstructing the pathway of the nerve.
How does it feel to have TOS? Is it painful with movement or do you feel something all the time? Is it restrictive or do you just feel a sharp pain when trying to use force through the area?
The pain/sensory issues can vary greatly depending how severe the injury is.
It can feel like numbness/tingling in your fingertips, it can be a shooting pain/numbness down the entire arm, and it can be painful in the shoulder region where the actual injury is. If it's bad enough, the arm can become totally immobile. Symptoms can get better and worse as well. The idea of the arm feeling like it's "asleep" is not too far off, though I wouldn't say it's totally accurate. The pain/sensory loss can intensify with movement, yes. Typically an overhead movement of the arm will cause symptoms to intensify. Depending on the mechanism of injury, there can be a sharp pain in the shoulder region when doing strenuous activity, yes.
How likely is surgery to fix TOS, and is it a viable to everyone who has it?
Surgery is typically reserved for those suffering from TOS who also have an "extra rib" on the top part of the rib cage. This rib can out added pressure on the thoracic outlet which is the main cause of the injury in those cases. Surgery is also the last option once conservative treatment has failed to relieve symptoms. The surgery involved removing the extra rib entirely to create space for the nerve/vein/artery. There is a lot more to it, but that's the basic idea. The good news is that the research suggests that surgical intervention typically yields positive results 91-93% of the time. But the long term outlook (10+ years) will see many patients regress and symptoms can resurface.
It seems like his shooting movement is unencumbered at times and others it seems like he’s struggling through his shot and his form gets very labored and hitchy. And it seems like that can go back and forth for him even from possession to possession. Is it possible that TOS is causing him pain/discomfort in a sporadic way? (Ie. Markelle’s shoulder feels fine one possession but is painful/discomforting the next)
From what I've seen, either the shoulder is aggravated and it will be consistently painful, or there will be certain movements that cause a "stabbing" pain, which could very well be the case with the hitch he has from time to time. The shoulder is the most flexible joint in the body, and there is an incredible amount of movement involved when playing bball, so it wouldn't be surprising to see his form look great one second and then have it look terrible the next depending on what the player is trying to do in the moment. It would be weird to see him shoot one "normal" free throw, followed by one "hitch" freethrow. In theory, his form would be exactly the same for each free throw, so the mechanics shouldn't change. If the mechanics aren't changing, then the shot should be the same for both shots - either normal, or "hitched".....but this is just my opinion based on theory.
Can TOS be the reason of Markelle spasms in the facial and whole body area ? ( many videos during games and interviews)
TOS would not be the cause of any spasms in his face.
After he was drafted it seems like he changed his shot a lot that summer? Is it likely that changing his shot mechanics contributed to the injury or do you think he changed his mechanic BECAUSE of an existing injury?
If I had to guess, I'd say he changed his shot mechanics in order to make an improvement to his game, and this "new" movement caused massive irritation to his shoulder (too much change too soon). More than likely, the dude was putting up 1000+ shots a day to engrain an improved shooting form into his muscle memory. This is a huge stress load to put on the body, like Bambas stress fractures, he just wasn't ready for so much so soon.
Is it true the diagnosis of TOS is typically diagnosed via ruling out other diagnosis, rather than getting a positive confirmation of TOS? Also, in your medical opinion, does Markelle's ability to dunk the ball (seemingly without pain) give you pause as to whether the injury is indeed TOS?
There is no doubt it's TOS. A neurologist diagnosed it as TOS. It is TOS. There are a number of things that cause similar symptoms as TOS, and TOS is more rare than, say, a disc herniation, or tendonitis. Initial treatment for these types of symptoms often is the same - rest, ice, stretching, etc. Being able to dunk the ball does not rule out TOS. His issue could stem from a very specific movement (like his shooting form), and he could experience symptoms exclusively from that movement alone, while still having no issue raising his arm above his head to dunk.