Surgical Treatment of Neurogenic Thoracic Outlet Syndrome in Young Athletes - A Stepwise Approach

Wake Forest University School of Medicine, Winston-Salem, NC, USA

Kathy McGurk, MD; Sujeeth Shanmugam, MS-1

INTRODUCTION: Neurogenic thoracic outlet syndrome (NTOS) can develop secondary to repetitive motion of the upper extremity, which is common in athletes. Surgical treatment is indicated when symptoms are refractory to conservative treatment, but whether to perform concomitant procedures, including rib resection and pectorals minor lengthening, is not clear in the current literature. We hypothesize that a stepwise approach to performing concomitant procedures during NTOS decompression will lead to similar rates of symptom resolution and return to sport.

METHODS: We retrospectively reviewed all patients with NTOS who were treated by the senior author from 2015 to 2023. Pre-collegial or collegial competitive athletes who underwent thoracic outlet decompression were enrolled for this cohort study.

RESULTS: 190 patients underwent surgical intervention for NTOS, of which 11 patients met inclusion criteria with age ranged from 11 to 22. Symptoms at presentation included pain (11), paresthesia (10), 7 weakness (7), headaches (4), pectoralis minor pain (5), scapular pain (3) and atrophy (1). Four patients had a cervical rib. All were unable to play sports due to symptoms. All patients underwent thoracic outlet decompression via a supraclavicular approach with scalenectomy. Six (55%) patients underwent a rib resection based on intra-operative findings of costoclavicular compression and 5 (45%) underwent pectoralis minor lengthening based on pre-operative symptoms. All but 2 patients had complete symptoms resolution and full return to sport. One of these 2 patients had both rib resection and pectoralis minor lengthening.

CONCLUSION: NTOS can be successfully treated surgically, and the majority of young athletes were able to return to completive sprots after surgery. The decision to perform concomitant procedures should be made based on the presence of pre-operative pectoralis minor pain and intra-operative findings of costoclavicular compression.