Thoracic outlet syndromes in sport: a practical review in the face of limited evidence — unusual pain presentation in an athlete

Twaij, H; Rolls, Andrew; Sinisi, Marco; Weiler, Richard

doi:10.1136/bjsports-2013-093002

Cited by 28 publications

(13 citation statements)

References 43 publications

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“…Diagnosis of TOS is challenging, as the wide panel of symptoms described is nonspecific especially in N-TOS. Therefore there is a lack of precise diagnostic criteria ( Twaij et al, 2013 ; Povlsen et al, 2014 ; Masocatto et al, 2019 ). Most of the time TOS is diagnosed after exclusion of other pathologies ( Freischlag and Orion, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Thoracic Outlet Syndrome in Sport: A Systematic Review

et al. 2022

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Thoracic outlet syndrome (TOS) is a rare and heterogeneous syndrome secondary to a compression of the neurovascular bundle in the thoracic outlet area. Muscle hypertrophy is recognized to induce vascular or neurogenic compression, especially in sports involving upper-arm solicitation. Athletes represent a distinctive population because of a specific management due to an ambitious objective, which is returning to high-level competition. We evaluated the scientific literature available for the management of TOS in athletes. Article research extended to March 2021 without other restriction concerning the date of articles publication. The search was performed independently by two assessors. A first preselection based on the article titles was produced, regarding their availability in English or French and a second preselection was produced after reading the abstracts. In case of doubt, a third assessor’s advice was asked. Case reports were selected only if the sport involved was documented, as well as the level of practice. Cohorts were included if data about the number and the sport level of athletes were detailed. Seventy-eight articles were selected including 40 case reports, 10 clinical studies and 28 reviews of literature. Baseball pitchers seem to be highly at risk of developing a TOS. The surgical management appears particularly frequent in this specific population. The prognosis of TOS in athletes seems to be better than in the general population, possibly due to their better physical condition and their younger age. Some studies showed interesting and encouraging results concerning return to previous sport level. Literature shows a strong link between TOS and certain sports. Unfortunately, this syndrome still lacks rigorous diagnostic criteria and management guidelines for athletes.

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Section: Introductionmentioning

confidence: 99%

Thoracic Outlet Syndrome in Sport: A Systematic Review

et al. 2022

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“…This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery. Fractured cervical rib 9-y-old male 2 mo after fall with fractured cervical rib Progressive pain, numbness, and tingling along ulnar side forearm and palmar hand Cervical rib pseudarthrosis 27 Pseudarthrosis mass of cervical rib 14-y-old girl 6 mo after blunt trauma to neck while swimming, with pseudarthrosis of cervical and first rib Disabling pain in neck, radiating down arm, paresthesias, bony supraclavicular mass, decreased grip strength Pseudarthrosis of clavicle 28 Clavicular pseudarthrosis 15-y-old girl with thoracic outlet syndrome due to congenital pseudarthrosis of clavicle Eden 29 Costoclavicular Soldiers with loaded knapsacks with arm pain, numbness, and fatigue while standing "at attention" Obese, large-breasted women; women with tight, narrow bra-straps exerting direct, downward clavicle pressure Scalene-anticus 30 Anterior and middle scalene compression Subclavian artery and brachial plexus compression due to muscular growth, tightness/spasm, and inflammation Absent anterior scalene 31 Absence of the anterior scalene muscle…”

Section: Discussionmentioning

confidence: 98%

Nerve Injuries About the Elbow in the Athlete

Harris

Lintner²

2014

Sports Medicine and Arthroscopy Review

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The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery.

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“…The mean improvement of QuickDASH was 33, and the complete relief was obtained 43% of the patients. TOS sometimes occurs in throwing athletes 40,41 . Athletes show better improvement than non-athletes after rst rib resection and scalenectomy 42 .…”

Section: Discussionmentioning

confidence: 99%

Arthroscopy-assisted First Rib Resection and Brachial Plexus Neurolysis for Thoracic Outlet Syndrome

Satake

Honma

Nito

et al. 2021

Preprint

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The present study included 27 consecutive patients (30 limbs) undergoing arthroscopy-assisted transaxillary first rib resection and brachial plexus neurolysis for thoracic outlet syndrome (TOS). To improve visualization, we changed the intraoperative limb position in three stages. We assessed the intraoperative parameters, including the scalene interval width between the anterior and middle interscalene muscles (interscalene base), blood loss, operation time, preoperative and postoperative QuickDASH, patient satisfaction, and complications. The mean intraoperatively measured interscalene base width was 6.2 mm. Appropriate visualization could be obtained at zero-position in the late phase. Intraoperative blood loss and operation time were significantly less in the late phase (p < 0.001). The QuickDASH score was significantly improved (42 before surgery vs. 9 at final follow-up, p < 0.001), especially in athletes relative to non-athletes (0.2 vs 14, p < 0.001). The outcome was excellent in 43.3% of cases, good in 43.3%, fair in 13.3%, and poor in none. The present approach achieved complete relief in 43% of cases overall (91% in athletes and 16% in non-athletes). Pneumothorax was present at the early phase in 3.3%. There were no other complications and no recurrences. Arthroscopic surgery is useful for TOS, especially in athletes.

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Thoracic outlet syndromes in sport: a practical review in the face of limited evidence — unusual pain presentation in an athlete

Cited by 28 publications

References 43 publications

Thoracic Outlet Syndrome in Sport: A Systematic Review

Thoracic Outlet Syndrome in Sport: A Systematic Review

Nerve Injuries About the Elbow in the Athlete

Arthroscopy-assisted First Rib Resection and Brachial Plexus Neurolysis for Thoracic Outlet Syndrome

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