It’s been a tumultuous two years for Markelle Fultz, the Philadelphia 76ers guard whose reputation as a college basketball wunderkind went up in smoke as he joined the NBA and his celebrated jump shot vanished overnight. As Fultz’s performance declined starkly over his first season, NBA insiders whispered about his psychological state: Perhaps 2017’s No. 1 overall draft pick, they said, had gotten a case of the yips.
On Wednesday, a doctor’s diagnosis helped silence the rumors. Fultz has neurogenic thoracic outlet syndrome (TOS), a poorly characterized nerve issue that causes weakness in the arms and hands, reported ESPN. Serious as the diagnosis is — Fultz is out indefinitely — Dr. Karl Illig, Director of the Regional Medical Center Thoracic Outlet Center and surgeon specializing in treating TOS, tells Inverse that it’s great news.
“I think it’s a blessing,” he says. “Because this is treatable. It’s a real thing.” Once the admittedly difficult-to-diagnose syndrome is identified, says Illig, it’s fairly straightforward to treat.
"Because no longer is it just: ‘We can’t figure out what’s wrong with this kid, it’s all in his head, he’s crazy.’
“Because no longer is it just: ‘We can’t figure out what’s wrong with this kid, it’s all in his head, he’s crazy.’ All of a sudden, now it becomes a real, honest-to-goodness diagnosis.” Illig isn’t surprised that Fultz has had a hard time convincing people his issue was physical, not psychological.
Many patients with TOS, he says, know exactly how he feels.
Few believed Fultz when he denied having the yips, especially not after well-known shooting coach Drew Hanlen said he “completely forgot how to shoot.” At a 76ers media day in September, Fultz insisted: “What happened last year was an injury. Let me get that straight. It was an injury that happened that didn’t allow me to go through the certain paths that I needed to shoot the ball.” Many people weren’t convinced.
Because TOS is an orphan diagnosis — one that affects fewer than 200,000 nationwide — it’s “been a little bit ignored” by the medical community, says Illig. TOS is a catch-all term for several problems in the thoracic outlet, the area at the base of the neck through which nerves pass through. “Through that triangle go the nerves,” says Illig. “And those nerves can be squeezed.” But there is no single test to determine whether someone has TOS or not.
“It’s a diagnosis that is a little bit not obvious as to what’s going on,” says Illig. “The person’s athletic ability will decline. Their pitches won’t break, they can’t throw as hard, their jump shot won’t be good. Things kinda decline and you can’t put your finger on it.”
Because of this vague characterization, says Illig, on average the patients who eventually come to see TOS experts like himself have been seen by six previous doctors. This also explains why — like so many people have wondered online — it took so long for doctors to diagnose Fultz.
"It’s a big psychological burden for the patient.
“And a substantial number of them have already been labeled with ‘it’s all in your head’, or ‘maybe you should see a psychiatrist’, or ‘there’s nothing really wrong with you’, or ‘you’re just malingering to get out of work’,” he continues. “It’s a big psychological burden for the patient.”
There have been no official statements from Fultz or his agent Raymond Brothers since Brothers broke news of the diagnosis to ESPN on Wednesday. But if Illig’s experience is any indication, Fultz is likely feeling an enormous sense of relief.
“When you tell them they actually have a real diagnosis, they actually sometimes start crying, they’re so grateful,” he says.
Fortunately for Fultz, Illig says diagnosis by a trained professional is the first step to a recovery. Treatment varies depending on the anatomy and cause of the particular TOS case, but both physical therapy and surgery have been shown to be effective. ESPN reports that Fultz will undergo rehab for his right shoulder for three to six weeks. Should that fail, says Illig, surgery is usually the next step, and it is successful in “80 to 90 percent of people.”
In an interview with ESPN on Tuesday, Brothers doubled down by denying Fultz suffered from the yips. “People were saying it was a mental problem and it is not,” Brothers said. “There’s no way you’re the No. 1 pick in the world and all of a sudden you aren’t able to consistently raise your arms to shoot a basketball. Something is physically wrong. Now we have the answer to that problem.”
Things may finally be looking up for Fultz, who, at 20, could still have a long career ahead of him.
“Assuming he’s been diagnosed by someone who knows what he’s talking about,” says Illig, “his prognosis, I think, is very good.”