Occurrence, management, and outcome of thoracic outlet syndrome in a National Collegiate Athletic Association Division I conference

Abstract

Objective: Thoracic outlet syndrome (TOS; neurovascular compression at the thoracic outlet) is a disabling condition affecting the upper extremities. Athletes are at risk of developing TOS. Prior reports of TOS in athletes have been largely restricted to single-center experiences. No data at the level of a National Athletic Conference have been reported previously. Our objective was to describe the epidemiology of TOS in a National Collegiate Athletic Association division I conference.

Methods: Athletes with TOS were identified in the prospectively maintained Pacific 12 Health Analytics Program Database from 2016 to 2022. Data included demographics, sports, treatments, and outcome. TOS subcategories of neurogenic TOS (NTOS) and venous TOS (VTOS) were identified.

Results: In the 7-year period studied, 15,609 athletes (6874 men and 8735 women) playing 21 sports were registered. The average age was 19.3 years (men, 18.9; women, 19.5). TOS was identified in 76 athletes (0.48%): 7 VTOS (9.2%) and 69 NTOS (90.8%). These athletes included 30 (39.5%) men and 46 (60.5%) women. TOS was found in 2.6% of tennis players, 1.3% of softball players, and 1.3% of rowers. Most TOS patients (96.0%) were managed without surgery and 84.9% experienced resolution of symptoms with physical therapy, testing, and medication. Of the 14.5% of athletes who required surgery, 72.7% experienced resolution of their symptoms postoperatively. Overall symptom resolution was noted in 81.6% (79.7% NTOS and 100% VTOS; P = .19) Unrestricted return to competition was noted in 80.6% of patients managed without surgical decompression (83.6% NTOS vs 100% VTOS). After surgery, 89.9% returned to unrestricted competition (85.7% NTOS vs 100% VTOS). Overall, successful return to unrestricted competition was noted in 95.4% (100% VTOS, 95% NTOS; P = .019). Four athletes (5.3%) graduated, not returning to competition. Return to competition data were unavailable for seven athletes (9.2%).

Conclusions: This report of TOS in athletes is the first based on data from a National Collegiate athletic conference. Injuries leading to TOS are rare in collegiate athletics. The risk of TOS is not distributed equally in all sports; most likely to be affected include tennis, softball, and rowing. The majority of athletes with TOS were successfully managed nonoperatively and surgical intervention was uncommon. With timely diagnosis and appropriate care, >95% of athletes with TOS return to competition.

Keywords: Athlete; Competition; Neurogenic; TOS.