Nonsurgical Care of Neurogenic Thoracic Outlet Syndrome in a National Collegiate Athletic Association Division 1...

Thoracic outlet syndrome (TOS) is a disabling condition which may end an athletic career. While physical therapy (PT) is the initial treatment for TOS, there is a paucity of management outcomes data. Our goal is to report the outcome of nonsurgical care in a National Collegiate Athletic Association (NCAA) Division 1 athletic conference.

The prospectively maintained PAC12 Health Analytics Program Database was searched for athletes with TOS from 2016-2022. Athletes with neurogenic TOS (NTOS) diagnosis were identified. Outcomes of nonsurgical care were analyzed according to success of PT alone, need for specialty consultation and interventional procedures. Analysis compared nonsurgical and surgical management.

Fifteen thousand six hundred nine athletes (6,874 men and 8,735 women) in 21 sports were registered. TOS was identified in 76 (0.48%) athletes: 69 (90.8%) NTOS. All 69 athletes with NTOS were initially managed with nonsurgical modalities. Ultimately, this failed in 9 (13%), who required surgery. Nonsurgical care included PT 69 (100%), subspecialty consultation in 48 (69%), and interventional procedures in 5 (7%). Of the 69 athletes with NTOS, 55 (79.7%) experienced compete resolution of symptoms and 14 (20%) noted partial resolution. PT alone was used to treat 21 athletes, 17 (81%) of these noted complete resolution of symptoms. Of the 48 who required specialty consultation complete resolution of symptoms was noted in 48 (79.2%). Interventional procedures were used to treat 5, and 3 (60%) noted complete symptom resolution. Of the 60 athletes managed with nonsurgical care complete resolution of symptoms was noted in 81.7%, whereas surgical decompression resulted in resolution of symptoms in 66.7% of athletes. All athletes returned to competition: 95% returned to unrestricted competition, and 5% with some restriction. This included 96.2% of NTOS managed without surgery and 85.7% of NTOS managed surgically.

This report details outcomes of nonsurgical care of TOS in a Division 1 NCAA Collegiate Conference based on a prospective, conference-wide database. The majority (84%) of athletes were managed with nonsurgical care. This was successful with resolution of symptoms in 93% and unrestricted return to competition in 96%. Nonsurgical care is successful and provides effective resolution of TOS symptoms for most elite collegiate athletes.