Objectives: To compare functional outcomes among adolescent athletes with venous (VTOS) and neurogenic thoracic outlet syndrome (NTOS) after thoracic outlet decompression.
Methods: Single-institution retrospective review of a prospective database of adolescent athletes (age 13-19) from 6/1/1996-12/31/2021 who underwent operative decompression for TOS. Demographics, preoperative symptoms, operative details, and postoperative outcomes were compared. Primary outcome was postoperative return to sport. Secondary outcomes included resolution of symptoms, and assessment of Pain Score, QuickDASH, and Derkash Scores. Fisher's-Exact test and T-test were used to evaluate categorical and continuous variables respectively. Logistic regression model was constructed to adjust for the influence of preoperative factors and return to sport. Significance defined as p< 0.05.
Results: Sixty patients were included: 40.0% patients with VTOS, 60.0% with NTOS. Average age of VTOS patients was 17.2 vs 16.6 among NTOS (p=0.265). NTOS patients were more likely to be female (88.9% vs 62.5%, p=0.024). NTOS patients more frequently presented with pain (97.2% vs 70.8%, p=0.005), paresthesia (94.4% vs 29.1%, p=0.021), and weakness (67.7% vs 12.5%, p=0.004), but less often endorsed swelling (25.0% vs 95.8%, p< 0.001). At presentation, NTOS patients reported longer duration of symptoms (17.7 vs 3.1 months, p< 0.001).
First rib resection (FRR) was performed in 100% VTOS and 94.4% NTOS patients, with the remaining patients undergoing cervical rib resection (CRR) (2.8%) or scalenectomy alone (2.8%). Additionally, 11.1% of NTOS patients underwent combined FRR and CRR. For VTOS, postoperative venogram showed 27.8% patent subclavian veins, 44.4% required venoplasty, 16.8% required thrombolysis, 11% chronically occluded. There was no significant difference in blood loss, operative time, or length of stay between groups. There were no surgical complications.
Average follow-up was 6.3 months. Significant differences between VTOS and NTOS exist for pre- and post-operative Pain, QuickDASH, and Derkash Scores (Figure 1 and Table 1). Complete symptom resolution was noted in 83.3% VTOS and 75% NTOS (p=0.074).
No statistically significant difference in return to sport was observed between groups (VTOS 94.4% vs NTOS 73.9%, p=0.123). Of NTOS patients, 8.7% had other concomitant injuries and 4.3% had medical conditions that precluded return to sport. Logistic regression found no significant relationship between preoperative pain score, QuickDASH score, and duration of symptoms with return to sport.
Conclusions: Adolescent athletes with VTOS and NTOS have good functional outcomes and return to sports after surgery. Greater initial symptom severity and concomitant injuries were observed in adolescents with NTOS. Return to sport was not predicated on relief of TOS symptoms alone.
