Thoracic outlet syndrome in high-performance athletes

Area of Science:

• Orthopedics
• Sports Medicine
• Vascular Surgery

Background:

• Repetitive upper extremity use in athletes can lead to thoracic outlet syndrome (TOS), including neurogenic (nTOS) and vascular (Paget-Schroetter syndrome - PSS) forms.
• Surgical intervention offers symptom relief and disability prevention in carefully selected TOS patients.

Purpose of the Study:

• To determine the rate and timing of return to high-performance athletics after treatment for TOS in competitive athletes.
• To analyze outcomes based on TOS type (nTOS vs. PSS) and treatment modality (physical therapy vs. surgery).

Main Methods:

• A retrospective review of competitive athletes (high school, collegiate, professional) treated for nTOS or PSS between 2000 and 2012.
• Data collected included demographics, diagnostic workup, treatment approaches, and return-to-sport status.
• Quality of life was assessed using the QuickDASH scale for nTOS patients.

Main Results:

• Eighty-five percent of all treated athletes returned to full competitive activity at an average of 4.6 months post-intervention.
• Return-to-sport rates were 93% for PSS patients and 81% for nTOS patients.
• QuickDASH scores significantly improved post-treatment, and symptom recurrence was low (7% nTOS, 14% PSS).

Conclusions:

• Standardized treatment algorithms and aggressive physical therapy are crucial for optimal outcomes in athletes with TOS.
• The majority of athletes treated for venous TOS (PSS) and neurogenic TOS (nTOS) can successfully return to their previous level of competition.