Birth Trauma and Thoracic Outlet Syndrome: Preliminary Evidence

Thoracic outlet syndrome (TOS) arises from compression of neurovascular structures as they traverse the thoracic outlet at the base of the neck, with 3 main types: neurogenic, venous, and arterial. Established risk factors include acute trauma, repetitive upper extremity use, or congenital anatomical variations. Birth trauma, although relatively rare, remains a recognized cause of injury to the brachial plexus, yet its role in TOS development has not been investigated. This study aims to explore the prevalence of reported birth trauma among patients with clinically diagnosed and surgically treated TOS at our institution.

We conducted a retrospective cross-sectional study using a survey-based methodology among patients diagnosed with TOS, who underwent first-rib resection at our institution between 2001 and 2024. Eligible patients were contacted by telephone or electronic communication and invited to participate in a brief standardized survey that was developed in conjunction with professionals in Obstetrics and Gynecology, screening for instances of birth trauma.

A total of 41 responses were collected. Mean age was 40.1 years, with 29 females (71%) and 12 males (29%). Mean body mass index was 27.1. Most reported Caucasian race (90%). Six of the 41 patients reported shoulder dystocia (SD) (15%). Five patients reported the occurrence of forceps assisted vaginal delivery (AVD) during their birth (12% of the entire cohort, 15% of those born vaginally).

SD and AVD are relatively rare observations in the general population, with rates consistently falling between 1 and 3% per year for multiple decades. Our cohort reported a 4- to 10-fold increase in birth trauma, higher than expected. Almost one-quarter (24%) of patients surveyed with established neurogenic thoracic outlet syndrome reported SD or forceps AVD. This finding could have profound clinical implications. If SD or AVD are found to be factors that influence the development of TOS later in life, clinicians can expect an increased incidence of TOS in the coming years, they can screen for symptoms earlier in the disease course, and earlier intervention may lead to decreased morbidity in the patients we serve. We believe our pilot study findings warrant further investigation with a larger sample size.