Thoracic outlet syndrome causes shoulder discomfort, becoming more common in non-athletes

LANCASTER, Pa. (WPVI) -- It's a condition that's threatened the careers of professional athletes.

However, thoracic outlet syndrome isn't limited to sports.

Danielle Moniz has had shoulder problems since childhood.

Danielle says the main symptoms are, "A lot of numbness and tiredness in my shoulder,"

Two years ago, out of the blue, a blood clot formed and blocked a vein.

Her first doctor did a mini-surgery aimed at clearing the clot. But unfortunately, her first doctor had no permanent fix.

"There's nothing we can do. You're gonna live on blood thinners for the rest of your life," she recalls.

After some research, a nurse pointed Danielle to thoracic surgeon Dr. Cherie Erkmen at Temple Health, who immediately spotted Thoracic Outlet Syndrome.

"Where people have a compression of the nerves and vessels that travel from the middle of the chest out to the arm," says Dr. Erkmen.

The squeeze is in the thoracic outlet - the space between the collarbone and first rib.

It was first described 200 years ago, though not formally named till 1956.

Danielle had numbness and fatigue, but other signs include tingling, a weakened grip, cold fingers, hands or arm, and a bluish color to fingers or hands.

Another sign is if symptoms get worse when the arms are overhead, or while driving, walking, or running.

It's often misdiagnosed.

"It takes a full team to really parse out exactly what the diagnosis is," notes Dr. Erkmen.

Some people like Danielle are born with the condition, a smaller thoracic outlet due to an unusually large first rib. It becomes aggravated with sports or jobs repeatedly having the arms overhead for long periods of time.

It can also happen due to trauma to the chest, neck, and shoulders, such as from an accident

Markelle Fultz, the Sixers' 2017 top draft pick, developed it and unknowingly made it worse by trying to work through it.

The once-sharp shooter became unable to reliably hit the basket. Fultz was ultimately traded to the Orlando Magic, where he underwent lengthy physical therapy and rehabilitation, regaining some of his skill.

Pitcher Steven Strasburg of the Washington Nationals had surgery for it in July 2021.

Mets pitcher Matt Harvey has also done battle with TOS.

Dr. Erkmen says physical therapy can help, but sometimes surgically removing the first rib is best.

And at Temple, it is usually done robotically.

"Using cameras, instruments, and robotic techniques, we're able to remove the first rib from inside the chest," says Dr. Erkmen.

"We've had excellent results with minimal scarring," she notes.

A year later, Danielle's re-strengthening her right shoulder, free of numbness, the blood clot - and blood thinners.

"I feel as though I've never been healthier," she says with a confident smile.

Danielle's daily exercises are also aimed at preventing symptoms on the left side, where her first rib is also unusually large, but not yet squeezing nerves or blood vessels.