Venous Thoracic Outlet Syndrome

Abstract

Venous thoracic outlet syndrome is a relatively rare condition. One variety that is related to effort, often referred to as Paget-Schroetter syndrome, is seen more often in persons who are athletic or occupationally active. This condition can have significant morbidity if left untreated. Diagnosis is best undertaken with duplex ultrasound or venogram. The current standard for treatment includes catheter-directed thrombolysis with surgical correction of the thoracic outlet and subclavian vein with some variability of this depending upon the presentation. Some cases may require anticoagulation for approximately 12 wk. Return to play should be expected in successfully corrected cases that include a collaborative rehabilitation program.

Thoracic Outlet Syndrome in Sport: A Systematic Review

“…Several series of cases could help understand the management of TOS in athletes. Indeed, it has been confirmed by experience-based studies and reviews ( DiFelice et al, 2002 ; Farrar et al, 2014 ). In the literature on general TOS population management, surgical approaches usually depend on the surgeons’ habits or preferences, and several surgeries have been described such as transaxillary, supraclavicular, or paraclavicular approaches.…”

“… Farrar et al (2014) presented in a review of literature outcomes after PSS. While they exposed few data about athletes, a consensus of return to physical training after 12 weeks was proposed after the anticoagulant treatment ending.…”

“…The Venous TOS or V-TOS concerns about 5%–10% of the total cases. This specific form can lead to thrombosis of upper arm veins in 10%–20% of cases and sometimes leads to pulmonary embolism ( Farrar et al, 2014 ). This acute complication is called Paget-Schroetter syndrome (PSS).…”

Effort-Associated Thrombosis: Imaging Is Key when Suspicion Is High. A Case Report

“…Multiple provocative tests, commonly Adson and Roos tests, have been proposed in the diagnosis of ET. These tests are not routinely recommended due to their lack of specificity and high false-positive rates (3,7). When ET is suspected, it is important to first evaluate for life-threatening causes and complications of upper-extremity swelling.…”

“…Surgical decompression is ideally performed in a delayed manner within 14 d of diagnosis and includes a combination of first rib resection, brachial plexus neurolysis, arterial or venous reconstruction, anterior or middle scalenectomy, and/or pectoralis minor release (1,8). Oral anticoagulation is typically continued postoperatively for 3 months, although it has been suggested that treatment can be discontinued if repeat contrast venography 2 wk postoperatively displays normal patency (3,5,6,9). While noncontact rehabilitation is often begun within a month postoperatively, it is not recommended to return to contact sports until oral anticoagulation treatment is complete (10).…”