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Neurogenic Thoracic Outlet Syndrome

Neurogenic Thoracic Outlet Syndrome

Like many fans of basketball and the NBA I’ve been absolutely floored by the wild start to the 2017 number 1 draft pick out of Washington, Markelle Fultz’s NBA career with the Philadelphia 76ers.

For casual Australian basketball fans, the 76ers have become the defacto expat Aussie team with star Ben Simmons running the point, long time Australian coach Brett Brown barking the orders and the recent addition of Jonah Bolden to the frame. Combine that with the immense presence and star power of Joel Embiid and you’ll find brand new 76ers jerseys gracing every gym and blacktop around Melbourne.

So with the 76ers having their best start to the season in years many expected Fultz, now a 2nd year guard to be shining but his “broken shot”, patchy playinability to grasp a ping pong paddle like a human and now diagnosis of Neurogenic Thoracic Outlet Syndrome (TOS) have overshadowed his 8.2ppg average.

 

With TOS in the news let’s bring in our expert physiotherapist Naveena Seethapathy for an explanation and some advice.

 

Tim

Hey Naveena, clinical Q – this is way outta my wheelhouse! Do you have much experience with Neurogenic Thoracic Outlet Syndrome?

 

Naveena

Sure do. TOS is a relative common condition for certain athletes, particularly pitchers in baseball. It’s a tricky one where the nerve and or blood vessel that sneaks between the clavicle and the first rib gets squeezed. Vascular TOS can be really serious where the blood vessel is occluded and there is even a case of death from vascular TOS (via a stroke) happen to Astro’s pitcher J.R.Richard in the 1980’s.

Neurogenic TOS is where the nerve is the primary structure which gets occluded.

 

Tim

Right, so is it similar to an upper limb version of sciatica (ever the podiatrist I need to low to get me head around this one.)

 

Naveena

Not really.

 

Tim

Teach!

 

Naveena

The area between the clavicle and the first rib can be compromised, some people actually have an extra rib! Others due to the unique differences between us all just have a smaller gap to work with. Basically it is an overuse of the scalene muscles where you elevate your first rib more, compromising the space. This occurs when the scapula isn’t stable within glenohumeral joint.

 

Tim

Thanks, so have you worked with people suffering from TOS much?

 

Naveena

TOS is most common in baseball pitchers and Tim as you know I worked in Baltimore, Maryland for many years. Baltimore has lots more baseball players than Melbourne so I used to see quite a lot, a few less these days in Pascoe Vale. There is a little difference in the treatment of the two forms of TOS. For Vascular TOS – that needs urgent assessment from a vascular surgeon. For Neurogenic TOS the prognosis is really good with physiotherapy.

 

Tim

What kind of physio would you be referring to Naveena?

 

Naveena

Obviously it’s case by case, addressing the client’s individual needs. Hypothetically, for a basketballer who was struggling raising his or her arms consistently with power and accuracy I would be focusing on strength and range through the shoulder rotators. There’s also the option of rib removal if care needs to be escalated to a surgeon.

 

Tim

Awesome, thanks Naveena. Any final words relating to TOS?

 

Naveena

With the various kinds of TOS you really need a thorough assessment to get the best advice. For the basketballer you mentioned he will be working really hard over the next weeks and months to get that strength and shot back.

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