Managing pediatric thoracic outlet syndrome

Abstract

BackgroundThoracic outlet syndrome (TOS) is largely overlooked in children and adolescents because the condition is not widely viewed as a pediatric disorder. This study aimed to clarify the causes, best treatment approaches, and prognosis for young patients with TOS.MethodsA retrospective study was conducted on 13 patients, from 4 to 13 years of age, with TOS. Ten children underwent surgical treatment, and three were treated conservatively. All patients received local nerve blocks on two occasions and were followed-up for more than 2 years.ResultsAmong the 10 children who underwent surgery, six school-aged children returned to school 10 to 14 days after surgery. Parents of the three children treated conservatively reported that activity within the affected limb and overall muscle strength had increased in their children and none of the three children had complained about discomfort in the affected limb.ConclusionA diagnosis of TOS should be considered when a child or adolescent has neck and shoulder discomfort, hand numbness, and upper limb weakness. As with adults with TOS, detailed physical examination is the key to diagnosing pediatric TOS. Conservative treatment is effective for young TOS patients who have mild changes in the length and thickness of the affected limb and is an option when parents refuse surgical treatment.

Síndrome de opérculo torácico. Alivio de dolor en paciente pediátrico a propósito de un caso

“…El síndrome de opérculo torácico, en pacientes pediátricos, es una entidad poco conocida y en ocasiones infradiagnosticado, pueden estar relacionados con varias entidades, tales como, anomalías anatómicas, trauma, movimientos repetitivos o presencia de algunos síndromes [12], [16]; muy recientemente Rehemutula et al, indica como posibilidad infección aguda o crónica de los ganglios linfáticos cervicales, que posteriormente desarrollan inflamación cervical [12].…”

“…Dada la rareza del diagnóstico en pacientes jóvenes y pediátricos, probablemente este trastorno esté infradiagnosticado e infratratado. Al considerar la incapacidad que produce, debido al dolor, la necesidad de un tratamiento eficaz es necesaria [10]- [12].…”

A case of symmetric retrograde thromboembolic cerebral infarction in an 8-year-old child due to arterial thoracic outlet syndrome

“…However, to date, no clear evidence on the success rate of such treatment in aTOS children with stroke has been provided. Reported pediatric series [ 3 , 13 , 17 , 19 , 20 ] contain only single aTOS cases younger than 10 years. Although surgery seems effective for distal (forearm, hand) complaints, the risks and benefits of vascular reconstruction of the potential SA aneurysm are still a matter of debate.…”

Torasik Çıkış Sendromlu İki Pediatrik Vaka

“…Literatürde pediatrik vakaların bildirildiği yazılara bakıldığında nörojenik ve arteriyal TÇS ayrımının net olarak yapılamadığını görmekteyiz. Çünkü her iki TÇS alt tipinde de trofik değişiklikler, ağrı, parestezi ve güç kaybı gibi ortak bulguların olabileceği belirtilmektedir [8,12,13]. Erişkinlerde daha sık olarak brakiyal veya aksiler arterlerin kısmi veya tam tromboembolik oklüzyon veya anevrizmalarının, çocuklarda ise servikal kosta veya anormal fibröz kostanın nadiren kompressif etki ile arteriyal TÇS'na neden olduğu bildirilmektedir [10].…”

“…Davranış değişiklikleri, iş alanlarında ergonomik düzenlemeler, uygun postür eğitimleri ve gevşeme egzersizleri (abdominal solunum, yumuşak masaj, sinir kaydırma egzersizleri ve boyun ve omuz germe egzersizleri gibi) önemli konservatif tedavi yöntemleridir [16]. Kas gevşeticiler, analjezikler, anti-inflamatuarlar ve tetik nokta enjeksiyonları diğer konservatif tedavi seçenekleridir [13]. En az 3 aylık konservatif tedavi ile semptomları gerilemeyen hastalara cerrahi tedavi uygulanmaktadır.…”