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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 4/2020

01-08-2020 | Thoracic Outlet Syndrome | Injuries in Overhead Athletes (J Dines and C Camp, Section Editors)

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

Authors: J. Westley Ohman, Robert W. Thompson

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2020

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Abstract

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 image-guided 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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Metadata
Title
Thoracic Outlet Syndrome in the Overhead Athlete: Diagnosis and Treatment Recommendations
Authors
J. Westley Ohman
Robert W. Thompson
Publication date
01-08-2020
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 4/2020
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-020-09643-x

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