Hammers publish important research

West Ham United's Sports Medicine and Sports Science department have published ground-breaking research into a little-known neck and shoulder condition.

Hammers medical officer Dr Richard Weiler, a leader in the field of sports and exercise medicine, and head of sports science and sports medicine Andy Rolls have co-published a paper in the respected British Journal of Sport and Exercise Medicine examining thoracic outlet syndrome (TOS) in sport.

Mark Noble woke in 'agony' one morning in February 2013, with sharp, intense pain in his right upper arm, restriction in movement in his right shoulder and muscle weakness and tingling in his right hand.

The midfielder was immediately examined by Dr Weiler and Rolls, with the range of symptoms leaving the medical staff considering four possible diagnoses: a mechanical problem with the shoulder, a historical neck and spine injury, neuralgic amyotrophy (a nerve-based shoulder condition) or TOS.

Further investigations pointed to Noble suffering from the painful but previously little-known condition, where pain is caused by compression of the thoracic outlet - an anatomical opening created by the first rib, collarbone and neck muscles through which pass nerve fibres and blood vessels travelling from the heart to the right arm.

Read the published Thoracic outlet syndromes in sport paper in full

Noble underwent scans to confirm the diagnosis of TOS, while also dismissing the presence of an extra 'cervical' rib near to the player's neck - a possible cause of the condition.

After taking advice from a leading specialist nerve injury clinic, it was decided to treat the condition by 'conservative management', asking Noble to rest for a month and using painkillers and anti-inflammatory medicine.

After two weeks, however, the symptoms had worsened and the decision was taken to perform surgery on Noble's thoracic outlet. During the operation, surgeon Marco Sinisi found an enlarged neck muscle, soft tissue scarring and inflammation causing the player's TOS.

To remedy the situation, one of Noble's neck muscles was loosened, while a layer of tissue around the nerve fibres and blood vessels was also released to relieve the pressure.

Six weeks after surgery, the No16 returned to action in the 2-2 Barclays Premier League draw with Manchester United and has had no further problems.

Noble said: "I was in absolute agony and had never felt pain like it before. With the other symptoms, I was obviously worried about what was wrong.

"The medical staff diagnosed the condition and, thanks to them and to the surgeon and his team, I underwent an operation and rehabilitation and am now pain-free and able to play football again.

"If publishing what happened to me can help other players to be correctly diagnosed and treated too, then I am more than happy to help."

Dr Weiler praised everybody involved in treating Noble, as well as the player himself, for working together towards a positive outcome.

He said: "Thoracic outlet syndrome is a rare condition in football and Mark was in a great deal of pain, so it was fantastic to make the diagnosis so quickly.

"The work done by our own medical staff alongside surgeon Marco Sinisi and his team was outstanding, and it was great to see Mark playing football again so quickly.

"This publication will hopefully benefit other medics and athletes unfortunate enough to suffer from this condition and we thank Mark for sharing his story to help others."

Rolls added: "This case illustrated the expertise both within and at the disposal of the Club's medical department. Jointly, we were happy to publish our findings for the benefit of others in the future."

While TOS remains a rare condition, it is one that has reportedly been diagnosed in a number of high-profile athletes, including Chelsea defender Gary Cahill and West Bromwich Albion winger Scott Sinclair.

With little research into the condition published previously, Noble, Dr Weiler and Rolls hope the case will help others in a similar situation.