Dr. Mark Schwartz

Dr. Mark Schwartz weighs in on diagnosis of thoracic outlet syndrome for Markelle Fultz

Dr. Mark Schwartz weighs in on diagnosis of thoracic outlet syndrome for Markelle Fultz

Markelle Fultz has been diagnosed with thoracic outlet syndrome.

If you’re not a medical professional, chances are you’re unfamiliar with his new diagnosis.

Dr. Mark Schwartz, medical director for Virtua Sports Medicine, gave more insight into Fultz’s diagnosis and the medical prognosis for the Sixers’ second-year guard on Tuesday in a phone interview with NBC Sports Philadelphia.

Schwartz is not treating Fultz. 

The treatment

Sixers vice president of athlete care Dr. Daniel Medina said in a statement that Fultz will begin physical therapy immediately.

While the Sixers say Fultz is out indefinitely, ESPN’s Adrian Wojnarowski reports that there’s optimism he can return within three to six weeks. 

The typical physical therapy program for thoracic outlet syndrome focuses on relieving pressure from the nerves, according to Schwartz.

“The physical therapy, a lot of it is stretching exercises to help take the pressure off the nerves. The goal of stretching is to relieve compression in that thoracic outlet area. So there will be stretching exercises, followed by postural exercises to help the alignment around the neck and then also strengthen the muscles around that area, with the goal of taking the pressure off the nerves.”

Is this connected to the reported wrist issue?

According to a report by The Athletic on Nov. 21, Fultz had been “been playing with an apparent injury in his right wrist area that has adversely affected his ability to shoot.”

Though TOS affects the nerves between the neck and shoulder, Schwartz said the syndrome can also cause symptoms in the wrist area.

Typically, Thoracic outlet syndrome gives you sensations of some pain, burning sensation, numbness, tingling. If those were the symptoms he was experiencing distally, it is possible. People with thoracic outlet syndrome, classically their symptoms are pain, numbness, tingling in the arm, which is exacerbated by certain motions involving the neck and shoulder. Sometimes they notice that when they turn their neck or rotate the shoulder their symptoms worsen because the nerves up in that area are getting pinched. It’s not uncommon to have symptoms down in the wrist and hand. Those symptoms classically are pain, burning sensation, and tingling.

The "bumps and bruises" 

Fultz said on Nov. 6 that, while he wasn’t 100 percent healthy, he was just dealing with typical “bumps and bruises.” While TOS can cause pain and a burning sensation, it’s not inconceivable that Fultz was experiencing numbness and tingling judged by himself and by the Sixers to be “normal.”

“That’s the tough part,” Schwartz said. “Lots of basketball players get lumps, bumps and pain in their hands and wrists — typical signs of neurogenic thoracic outlet are neurogenic signs, which are classically numbness and tingling. That’s what you generally see in the hands and fingers with people with thoracic outlet. They generally will complain of a burning sensation or numbness and tingling. A true wrist problem, if he had one, he would have localized tenderness in the wrist, some swelling, stuff like that. That’s more of a wrist problem rather than a nerve problem.”

The unusual free-throw routines 

In his last few games, Fultz’s routines at the foul line were unorthodox, to say the least. 

On Nov. 12 in Miami, Fultz double-pumped on a free throw. Afterward, he said the ball slipped

Against the Jazz on Nov. 16, Fultz juggled the ball up from his waist to his release point. 

Those routines may have been a way for Fultz to try to relieve the symptoms he was experiencing. 

“It’s possible,” Schwartz said. “If he developed this thoracic outlet from the repetitive use of his shoulder, maybe these things we’ve seen in his motion lately, they might have been compensatory things to do to try to release some of the symptoms.”

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More on the Sixers

Dr. Schwartz says 2 weeks 'very optimistic' for Embiid's return

Dr. Schwartz says 2 weeks 'very optimistic' for Embiid's return

The question is bigger than his 7-foot-2 frame.

How long will Joel Embiid be out?

Embiid, who was diagnosed Thursday with a concussion and will undergo surgery for an orbital fracture of his left eye, is sidelined just as the Sixers are striving for home-court advantage in the postseason (see story).

It's a precarious situation because of the timing and the unknown. The playoffs open April 14, while the second round starts as early as April 28. Per a report by ESPN's Zach Lowe, Embiid could miss two to four weeks following the date of his surgery, which has yet to be announced.

Two weeks would have Embiid shooting for the first round. Four weeks is another ballgame.

What complicates the return is the orbital fracture coupled with the concussion, according to Dr. Mark Schwartz of Virtua Health.

"A timeframe of two weeks is I think very optimistic," Schwartz, who is not treating Embiid, said during Thursday night's edition of Philly Sports Talk. "It can be as long as four weeks depending on the concussion, swelling around the eye, any potential vision problems and the fact that he's really not going to be able to be aggressively practicing even in a non-contact way because of the concussion protocol."

While the league has seen varying recovery rates for orbital fractures (see story), Embiid's path back becomes murkier because of the concussion.

"NBA players have been known to get back on the court as early as two weeks after such surgery," Schwartz said, "but now with the concussion, that may delay his time to get back to practicing, you don't know whether he's having any vision problems with this."

And it looks like clearing concussion protocol won't be Embiid's only obstacle.

"Plus, he's going to have to get used to wearing this protective mask," Schwartz said. "It doesn't take much more than another elbow to that area to ruin good work."

With all the questions hovering over the Sixers' biggest star, there's no doubt the team's work just got much tougher.

Dr. Schwartz on Embiid: 'He should be back for next season with no restrictions'

Dr. Schwartz on Embiid: 'He should be back for next season with no restrictions'

Despite significant healing in the bone bruise in Joel Embiid's left knee, the rookie was ruled out for the remainder of the regular season on Wednesday after his latest MRI also revealed a bigger meniscus tear than initially diagnosed (see story).

So now what?

The Sixers have not announced any specific course of action for Embiid such as surgery. On Monday, team president Bryan Colangelo said the organization was in no rush to put the oft-injured Embiid back under the knife (see story).

Meniscus tears typically require trimming out the piece that's torn or completely stitching it back into place. If the Sixers do opt for one of those options, Dr. Mark Schwartz of Virtua Health still expects Embiid to be back for the start of the 2017-18 campaign.

"Ideally, you hope you can actually repair it. Long term, it's in his benefit," Schwartz, who is not treating Embiid, said on Wednesday's edition of Comcast SportsNet's Philly Sports Talk. "Either way, he should be back for next season with no restrictions."

With Embiid sidelined since Jan. 27 because of continued swelling and soreness, Schwartz does think it's time to undergo a procedure to remedy the tear.

"I think initially the bulk of the symptoms were coming from the bone bruise and the meniscal symptoms were probably in the background," Schwartz said. "Now that the recent MRI reportedly shows improvement in the bone bruise, I think now that the symptoms from the menisci have come to the surface and I think the new MRI shows the meniscal tear to be bigger than originally thought.

"I think the next step now that you know that he's not going to be playing for the rest of the season and he still has these symptoms and he's had this meniscal tear for quite some time now, I think the next logical step is to look into his knee arthroscopically."