Neurogenic Thoracic Outlet Syndrome – Making big headlines lately

If you even remotely follow the NBA you might have heard the ongoing drama regarding the health of Philadelphia 76ers’ young guard, Markelle Fultz. The former number one overall draft pick has begun his once-promising career with a bizarre sudden inability to properly shoot a basketball. You don’t need to be an expert to understand that a player who mysteriously loses his jump shot is both equally unheard of as it is concerning for their future career. After over a year of endless speculation Fultz recently saw a specialist and was diagnosed with neurogenic thoracic outlet syndrome (nTOS).

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome (TOS) is a complex and controversial disorder. Generally speaking, it refers to a very broad group of conditions that stems from the compression of nerves and blood vessels between your collarbone and first rib. As both nerves and blood vessels are potentially affected, TOS can be further subcategorized as either neurogenic thoracic outlet syndrome or vascular thoracic outlet syndrome.

How do I know if I have it?

TOS can be a very difficult diagnosis to make even from a clinician’s standpoint. The number of structures that can cause TOS is enormous as it includes all sorts of different muscles, bones, nerves, etc. Compression of your vessels and nerves can also occur at multiple points in your upper extremity and symptoms of TOS can mimic symptoms of other shoulder and nerve-related pathologies. Consequently, the symptoms for one person will not necessarily be the same for another. Often times the condition is diagnosed by ruling out all other potential pathologies. Statistically, if you do have TOS you are far more likely to have neurogenic thoracic outlet syndrome than its vascular counterpart.

Below are some of the most common symptoms of nTOS:

  • Numbness and/or tingling down the arm into the hands
  • Fatigue of the arms particularly with overhead movements
  • Weak grip
  • Vague shoulder pain

What causes it?

There can be many different causes for developing nTOS. It can range from something as simple as poor posture to something more traumatic such as whiplash from a motor vehicle accident. Certain jobs can also predispose an individual to developing TOS – particularly those involving repeated overhead movements such as hairdressers or assembly line workers. Interestingly, women have been found to be up to four times more likely to develop TOS than males.

Treatment

Before doing any treatment, it is important to first seek out a physiotherapist to get a thorough assessment done to rule out any other potential causes. A multidisciplinary approach involving clinicians from varying healthcare disciplines is generally recommended for both assessment and treatment given how complex TOS can be. If TOS is indeed suspected, then treatment typically involves targeting whatever structures are at fault through rehabilitation, manual therapy and exercise. Education regarding eliminating any behavioural or environmental causes is another important component of treatment.

If you are experiencing any symptoms of thoracic outlet syndrome, come into see one of our Registered Physiotherapists for an accurate clinical assessment today.

References:

https://www.sbnation.com/nba/2018/11/13/18090592/markelle-fultz-jump-shot-history-injury-free-throw

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101069/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526474/

Orthopaedic Physical Assessment 6th Edition. Magee.

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