The thoracic outlet syndrome in athletes

The array of symptoms that characterize thoracic outlet syndrome (TOS) often lead to a failure or delay in diagnosing this condition in persons who are physically active.

Using the key words and phrases "thoracic outlet syndrome," "sport," "exercise," and "athlete," the MEDLINE files from 1991 to April 1996 were searched. Articles dating before 1991 were accessed by cross-referencing the more recent articles.

TOS results from compression of the neural or vascular structures of the upper extremity at the thoracic outlet. Clinical manifestations can include upper extremity pain, paresthesias, numbness, weakness, fatigability, swelling, discoloration, and Raynaud phenomenon. Four symptom patterns have been described: upper plexus, lower plexus, vascular, and mixed. The lower brachial plexus pattern is the most common. Specific causes of outlet compression include injury to the scalene or scapular suspensory muscles, anomalous fibromuscular bands, cervical ribs, clavicular deformity, and pectoralis minor tendon hypertrophy. The diagnosis of TOS is established on the results of the history and physical examination. Ancillary studies are most helpful to rule out other conditions rather than confirm the diagnosis of TOS. In most cases the initial treatment is nonoperative with an emphasis on rehabilitative exercises for the neck and shoulder girdle. Surgery is indicated for acute vascular insufficiency, progressive neurologic dysfunction, and refractory pain that fails conservative treatment. The surgical technique involves the release or removal of the structures that cause compression and can involve scalene muscle release, first rib resection, cervical rib excision, and resection of fibromuscular bands.