The Prevalence and Characteristics of Thoracic Outlet Syndrome in High School Baseball Players

Abstract

Thoracic outlet syndrome (TOS) is one of the common neurovascular disorders of the upper extremities, and the compression or traction of the brachial plexus is the main pathology. We hypothesized that baseball players are more likely to be affected by TOS compared with other overhead-throwing athletes because of strenuous use of their throwing arm. The purpose of this study was to investigate the prevalence and clinical characteristics of TOS in high school baseball players. One thousand two hundred eighty-eight high school baseball players were included in this study. The prevalence of symptomatic TOS and its association to disorders of the upper extremities were investigated. The prevalence of symptomatic TOS was 32.8%. Age-and position-adjusted logistic regression analysis revealed that subjects with symptomatic TOS were at significantly higher risk of shoulder and/or elbow pain (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.50 -2.58) and a higher recurrence rate of shoulder and/or elbow pain during the previous season (OR: 2.38, 95% CI: 1.87 -3.04). As for physical findings, subjects with symptomatic TOS were also at significantly higher risk of MUCL tenderness (OR: 2.53, 95% CI: 1.83 -3.50), positive milking maneuver, (OR: 2.63, 95% CI: 1.78 -3.91), positive subacromial impingement sign (OR: 1.92, 95% CI: 1.20 -3.07), and positive posterior impingement sign (OR: 2.34, 95% CI: 1.67 -3.28) compared to the subjects without symptomatic TOS. It is necessary to recognize that TOS is not a rare pathology in overhead-throwing athletes, especially baseball players, and that players with symptomatic TOS are at significantly higher risk of shoulder/elbow pain.

A review of upper extremity peripheral nerve injuries in throwing athletes

“…One cross-sectional study of 1288 Japanese high school baseball players demonstrated a 32.8% prevalence of TOS, of which the majority was hypothesized to be nTOS. 127 This figure is three times higher than the prevalence found in industrial workers. 128 A study analyzing U.S. collegiate athlete injury data found that baseball and softball were the sports most commonly associated with nTOS, followed by swimming and water polo.…”

“…Prevalence studies of nTOS in throwing athletes compared with the general population support the anatomical and biomechanical risk factors that throwers are at increased risk for nTOS. One cross‐sectional study of 1288 Japanese high school baseball players demonstrated a 32.8% prevalence of TOS, of which the majority was hypothesized to be nTOS 127 . This figure is three times higher than the prevalence found in industrial workers 128 .…”

Neurogenic thoracic outlet syndrome in the overhead and throwing athlete: A narrative review

“…Prevalence studies of nTOS in throwing athletes compared to the general population support the anatomical and biomechanical arguments suggesting that throwers are at increased risk for nTOS. Otoshi et al showed an incidence of symptomatic TOS in 32.8% of Japanese high school baseball players, which they hypothesized was primarily nTOS 20 . This rate of TOS is three times higher than the incidence found in industrial workers by Sallstrom et al 21 A study analyzing U.S. collegiate athlete injury data found that baseball and softball were most associated with nTOS, followed by swimming and water polo 18 …”

Upper Extremity Entrapment Neuropathy

“…As a result, compression may occur in neurovascular structures in the region. [25] Clinical features: Neurogenic TOS involve include paresthesia, numbness,, and weakness radiating from the neck region and shoulder and extending into the arm and hand. TOS can cause paresthesia in a wide area.…”