Midterm and long-term follow-up in competitive athletes undergoing thoracic outlet decompression for neurogenic thoracic outlet syndrome

Shutze, William P.; Richardson, Brian A.; Shutze, Ryan; Tran, Kimberly D.; Dao, Allen; Ogola, Gerald; Young, Allan; Pearl, Greg

doi:10.1016/j.jvs.2017.06.108

Cited by 33 publications

(31 citation statements)

References 26 publications

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“…Individuals who participate in high-level repetitive physical activity involving the upper extremity have an increased risk of developing TOS. Previous reports have linked TOS to high-performance athletes who engaged in repetitive overhead motions, such as baseball pitchers, volleyball players, and swimmers [ 3 , 4 , 5 ]. High-performance musicians who play instruments with repetitive arm motions are at risk of developing similar musculoskeletal ailments and nerve entrapment syndromes commonly seen in athletes, with typical examples including carpal tunnel syndrome, ulnar neuropathy, and cubital tunnel syndrome [ 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments

et al. 2018

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Thoracic outlet syndrome (TOS) is a neurovascular condition involving the upper extremity, which is known to occur in individuals who perform chronic repetitive upper extremity activities. We prospectively evaluate the incidence of TOS in high-performance musicians who played bowed string musicians. Sixty-four high-performance string instrument musicians from orchestras and professional musical bands were included in the study. Fifty-two healthy volunteers formed an age-matched control group. Bilateral upper extremity duplex scanning for subclavian vessel compression was performed in all subjects. Provocative maneuvers including Elevated Arm Stress Test (EAST) and Upper Limb Tension Test (ULTT) were performed. Abnormal ultrasound finding is defined by greater than 50% subclavian vessel compression with arm abduction, diminished venous waveforms, or arterial photoplethysmography (PPG) tracing with arm abduction. Bowed string instruments performed by musicians in our study included violin (41%), viola (33%), and cello (27%). Positive EAST or ULTT test in the musician group and control group were 44%, and 3%, respectively (p = 0.03). Abnormal ultrasound scan with vascular compression was detected in 69% of musicians, in contrast to 15% of control subjects (p = 0.03). TOS is a common phenomenon among high-performance bowed string instrumentalists. Musicians who perform bowed string instruments should be aware of this condition and its associated musculoskeletal symptoms.

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Section: Introductionmentioning

confidence: 99%

A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments

et al. 2018

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“…This was the first study looking at MLB pitchers returning after surgical decompression and demonstrated that they had capabilities equivalent or better than their historical baselines-even prior to the onset of symptoms. Schutze et al reported similar satisfaction with outcomes in a survey of competitive athlete who had undergone surgical treatment for neurogenic TOS [28]. They surveyed 67 athletes ranging from 14 to 48 years old, at an average of 3.9 years post procedure.…”

Section: Discussionmentioning

confidence: 79%

Thoracic Outlet Syndrome in the Overhead Athlete: Diagnosis and Treatment Recommendations

Ohman

Thompson

2020

Curr Rev Musculoskelet Med

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Purpose of Review Neurovascular compression in the upper extremity is rare but can affect even those participating in high-level competitive athletics. To assess optimal approaches to treatment, in this review, we evaluate the current literature on neurovascular compressive syndromes affecting the upper extremity, with a special focus on the thoracic outlet syndrome (TOS). Recent Findings Neurovascular compression at the thoracic outlet can involve the brachial plexus, subclavian artery, or subclavian vein, each with distinct clinical manifestations. Neurogenic TOS is best treated with surgical decompression, if physical therapy has not improved symptoms. Venous TOS results in acute thrombosis superimposed on chronic venous compression. Treatment is best directed at early anticoagulation, catheter-directed thrombolysis, and surgical decompression, with most patients able to discontinue anticoagulation and return to high-level athletic activity. Arterial TOS is related to aneurysmal degeneration of the subclavian artery with distal embolization, leading to limb-threatening ischemia. This should be aggressively treated with surgery. Similar degenerative changes can occur in the axillary artery and its branches, leading to distal embolization. Prompt recognition of these potential sources of limb-threatening ischemia is critical to limb preservation. Summary TOS includes rare but important conditions in the overhead athlete. Recent advances in physical therapy and imageguided diagnostic techniques have facilitated more accurate diagnosis. Surgical treatment remains the gold standard to maximize function or for limb preservation, and future research is needed to clarify optimal pain and physiotherapy regimens, as well as to examine novel approaches to neurovascular decompression.

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“…In 232 competitive athletes with nTOS (mean age, 19 years; range, 13-67 years) undergoing first rib resection with scalenectomy, 63% of those played baseball or softball. 19 Similarly, of 27 high-performance athletes diagnosed with nTOS (average age, 19 years; range, 14-32 years) and seeking either conservative or surgical care, 15% of those included baseball players. 1 Conversely, the current study does not describe treatment options but does provide an objective clinical presentation of adolescent baseball players (age, 17.2 ± 2.3 years) who have been diagnosed with nTOS.…”

Section: Discussionmentioning

confidence: 99%

“…18 Although less common (<1%), arterial TOS presentation involves digital ischemia, coldness, paresthesia, and pain in the hand, but pain is typically not found in the shoulder or cervical region. While any of the 3 presentations of TOS are possible in a baseball player, previous literature 1,19,22 supports a greater incidence of nTOS in these athletes.…”

mentioning

confidence: 91%

Differences in Passive Shoulder Range of Motion Between Baseball Players With Neurogenic Thoracic Outlet Syndrome and Matched Healthy Controls

Garrison

Hannon

Conway³

2021

Orthopaedic Journal of Sports Medicine

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Background: Neurogenic thoracic outlet syndrome (nTOS) is becoming more recognized as a diagnosis in the throwing athlete. Currently, there is limited information on the clinical presentation and development of nTOS in baseball players. Purpose: To compare passive shoulder range of motion (ROM) and anatomic humeral retrotorsion (HRT) of baseball players diagnosed with nTOS with a group of healthy, matched controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 53 adolescent baseball players diagnosed with nTOS (age, 17.2 ± 2.3 years; height, 180.9 ± 10.1 cm; weight, 80.0 ± 13.3 kg) were compared with 53 healthy baseball players (age, 17.2 ± 2.4 years; height, 183.9 ± 9.0 cm; weight, 83.8 ± 11.5 kg). Participants were measured for shoulder internal rotation (IR) and external rotation (ER) ROM and HRT. All measurements were taken bilaterally, and the differences (throwing to nonthrowing arm) were used to calculate mean values for glenohumeral internal rotation difference, glenohumeral external rotation difference (GERD), total rotational motion difference (TRMdiff), and anatomic humeral retrotorsion difference. Group comparisons were made between the nTOS and control players using multivariate analysis of variance, and descriptive comparisons were made with independent t tests. Results: There were no significant differences between groups in age, height, weight, or years of experience. Players in the nTOS group had significantly less throwing arm ER compared with controls (103.4° ± 10.4° vs 109.6° ± 7.5°, respectively; P = .001) and GERD (3.0° ± 9.2° vs 8.8° ± 9.2°, respectively; P = .002). TRMdiff was significantly greater in nTOS (–11.1° ± 11.1°) than in controls (–3.7° ± 9.4°) ( P < .001). Conclusion: In the current study, adolescent baseball players diagnosed with nTOS were evaluated with shoulder ROM differences when compared with a matched healthy cohort. A loss of throwing arm ER appeared to be the main factor behind shoulder ROM changes in the nTOS group.

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Midterm and long-term follow-up in competitive athletes undergoing thoracic outlet decompression for neurogenic thoracic outlet syndrome

Cited by 33 publications

References 26 publications

A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments

A Prospective Evaluation of Duplex Ultrasound for Thoracic Outlet Syndrome in High-Performance Musicians Playing Bowed String Instruments

Thoracic Outlet Syndrome in the Overhead Athlete: Diagnosis and Treatment Recommendations

Differences in Passive Shoulder Range of Motion Between Baseball Players With Neurogenic Thoracic Outlet Syndrome and Matched Healthy Controls

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