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Abdalla BA, Kakamad FH, Namiq HS, Asaad SK, Abdullah AS, Mustafa AM, Ghafour AK, Kareem HO, Ahmed SQM, Mohammed BA, Hasan KM, Mohammed SH. Pediatric thoracic outlet syndrome: a systematic review with metadata. Pediatr Surg Int 2024; 40:186. [PMID: 39003407 DOI: 10.1007/s00383-024-05769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Thoracic outlet syndrome (TOS) typically considered a condition of the adult population; it is often disregarded in children and adolescents due to its limited recognition within the pediatrics. The current study aims to systematically review and provide insights into TOS among pediatric patients. METHODS PubMed, Scopus, Web of Science, and Google Scholar databases were thoroughly searched for English language studies published until March 15th, 2024. The study included those articles focusing on pediatric or adolescent individuals diagnosed with TOS. Data collected from studies encompassed date of publication, number of participants or reported cases, age (years), gender of participants, type of TOS, affected side, type of treatment, surgical approach, bony abnormality, duration of symptoms (months), outcome, and follow-up time duration (months). RESULTS The current study comprised 33 articles, 21 of which were case reports, 10 of which were case series, and the remaining were cohort studies. In this study, 356 patients were included. Females constituted 234 (65.73%) of the patient population. Among TOS types, neurogenic TOS was found among 201 (56.5%) patients. Sporting-related activity or physical activity was present in 193 (54%) patients, followed by a history of trauma in 27 (7%) patients. CONCLUSIONS Pediatric patients exhibited a higher percentage of vascular TOS than their adult counterparts, with the supraclavicular approach emerging as the preferred treatment method. Sports-related activities were identified as the primary risk factor associated with pediatric TOS.
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Affiliation(s)
- Berun A Abdalla
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Kurdistan, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq.
- Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Kurdistan, Iraq.
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq.
- Doctors City, Building 11, Apartment 50, Sulaimani, 46001, Iraq.
| | - Hiwa Shafiq Namiq
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- College of Pharmacy, Department of Basic Science, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Saywan Kakarash Asaad
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Aland S Abdullah
- College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Ayman M Mustafa
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Abdullah K Ghafour
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
- Shahid Peshraw Hospital, Chamchamal, Sulaymaniyah, Kurdistan, Iraq
| | - Honar O Kareem
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Samen Qadir Mohammed Ahmed
- Xzmat Polyclinic, Rizgari, Kalar, Sulaymaniyah, Kurdistan, Iraq
- College of Medicine, University of Garmian, Kalar, Kurdistan Region, Iraq
| | - Bilal A Mohammed
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Karzan M Hasan
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Kurdistan, Iraq
- Xzmat Polyclinic, Rizgari, Kalar, Sulaymaniyah, Kurdistan, Iraq
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Betancourt A, Benrashid E, Gupta PC, McGinigle KL. Current concepts in clinical features and diagnosis of thoracic outlet syndrome. Semin Vasc Surg 2024; 37:3-11. [PMID: 38704181 DOI: 10.1053/j.semvascsurg.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/14/2023] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
The diagnosis and clinical features of thoracic outlet syndrome have long confounded clinicians, owing to heterogeneity in symptom presentation and many overlapping competing diagnoses that are "more common." Despite the advent and prevalence of high-resolution imaging, along with the increasing awareness of the syndrome itself, misdiagnoses and untimely diagnoses can result in significant patient morbidity. The authors aimed to summarize the current concepts in the clinical features and diagnosis of thoracic outlet syndrome.
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Affiliation(s)
- Alexis Betancourt
- Division of Vascular Surgery, University of North Carolina at Chapel Hill, Burnett Womack Building, 3(rd) Floor, Campus Box 7212, Chapel Hill, NC, 27599
| | - Ehsan Benrashid
- University Surgical Associates, University of Tennessee at Chattanooga, Chattanooga, TN
| | - Prem Chand Gupta
- Department of Vascular and Endovascular Surgery, Care Hospital, Banjara Hills, Hyderabad, India
| | - Katharine L McGinigle
- Division of Vascular Surgery, University of North Carolina at Chapel Hill, Burnett Womack Building, 3(rd) Floor, Campus Box 7212, Chapel Hill, NC, 27599.
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Fisher AT, Lee JT. Diagnosis and management of thoracic outlet syndrome in athletes. Semin Vasc Surg 2024; 37:35-43. [PMID: 38704182 DOI: 10.1053/j.semvascsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 05/06/2024]
Abstract
The physical demands of sports can place patients at elevated risk of use-related pathologies, including thoracic outlet syndrome (TOS). Overhead athletes in particular (eg, baseball and football players, swimmers, divers, and weightlifters) often subject their subclavian vessels and brachial plexuses to repetitive trauma, resulting in venous effort thrombosis, arterial occlusions, brachial plexopathy, and more. This patient population is at higher risk for Paget-Schroetter syndrome, or effort thrombosis, although neurogenic TOS (nTOS) is still the predominant form of the disease among all groups. First-rib resection is almost always recommended for vascular TOS in a young, active population, although a surgical benefit for patients with nTOS is less clear. Practitioners specializing in upper extremity disorders should take care to differentiate TOS from other repetitive use-related disorders, including shoulder orthopedic injuries and nerve entrapments at other areas of the neck and arm, as TOS is usually a diagnosis of exclusion. For nTOS, physical therapy is a cornerstone of diagnosis, along with response to injections. Most patients first undergo some period of nonoperative management with intense physical therapy and training before proceeding with rib resection. It is particularly essential for ensuring that athletes can return to their baselines of flexibility, strength, and stamina in the upper extremity. Botulinum toxin and lidocaine injections in the anterior scalene muscle might predict which patients will likely benefit from first-rib resection. Athletes are usually satisfied with their decisions to undergo first-rib resection, although the risk of rare but potentially career- or life-threatening complications, such as brachial plexus injury or subclavian vessel injury, must be considered. Frequently, they are able to return to the same or a higher level of play after full recovery.
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Affiliation(s)
- Andrea T Fisher
- Division of Vascular Surgery, Stanford University School of Medicine, 780 Welch Road CJ350, Palo Alto, 94304, CA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University School of Medicine, 780 Welch Road CJ350, Palo Alto, 94304, CA.
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Pfnür A, Antoniadis G, Wirtz CR, Pedro MT. [Long-Term Outcomes after Surgery of the Neurogenic Thoracic-Outlet Syndrome in Adolescents]. HANDCHIR MIKROCHIR P 2024; 56:32-39. [PMID: 38316411 DOI: 10.1055/a-2234-5066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Neurogenic Thoracic Outlet Syndrome (nTOS) describes a complex of symptoms caused by the compression of neural structures at the upper thoracic outlet. Typical symptoms include pain, numbness and motor weakness of the affected extremity. The incidence of nTOS is 2-3 per 100,000 and is highest between the ages of 25 and 40. There are only a few studies evaluating the surgical outcomes of nTOS in adolescent patients. In particular, there is a lack of long-term data. MATERIALS AND METHODS In a retrospective study of nTOS cases receiving surgical treatment in our clinic between 2002 and 2021, eight patients between 15 and 18 years of age were included. Demographic data, risk factors, clinical symptoms, clinical functional tests, neurophysiological, radiological and intraoperative findings were evaluated. Postoperative data were recorded using a standardised questionnaire. Decompression of the inferior truncus and the C8 and Th1 nerve roots was performed via a supraclavicular approach. RESULTS The average duration of symptoms before surgery was two years. Of the eight patients who underwent surgery, six answered the written questionnaire and could be analysed for the study. The average follow-up was nine years (1-18 years). After surgery, all patients experienced pain reduction; three were pain-free in the long run and five no longer required pain medication. Strength improved in all patients, but two patients still had mild motor deficits. Sensory disturbances were reduced in all patients, but residual hypoesthesia persisted in five. With regard to overhead work, half of the patients had no impairment after surgery. All patients were able to work at the time of the survey. Half of the patients pursued their sports activities without impairment, while mild impairment was reported by the other half. CONCLUSION nTOS in adolescents is a rare compression syndrome. Decompression of the lower parts of the brachial plexus using a supraclavicular approach without resection of the first rib is an adequate treatment. This retrospective study showed that a reduction in pain was achieved in all patients. In some patients, slight sensory and motor disturbances as well as a certain restriction in overhead work persisted. Patients were able to return to sports.
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Affiliation(s)
- Andreas Pfnür
- Neurochirurgie, Bezirkskrankenhaus Günzburg, Günzburg, Germany
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Stern E, Karzon AL, Hussain ZB, Khawaja SR, Cooke HL, Pirkle S, Bowers RL, Gottschalk MB, Wagner ER. Arthroscopic Pectoralis Minor Release After Reverse Shoulder Arthroplasty: A Novel Consideration for Postarthroplasty Pain. JBJS Case Connect 2023; 13:01709767-202306000-00024. [PMID: 37146169 DOI: 10.2106/jbjs.cc.22.00804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
CASE A 74-year-old male patient presenting with chronic radiating shoulder pain, paresthesias, and weakness had previously undergone reverse shoulder arthroplasty and anterior cervical discectomy and fusion for an irreparable cuff tear and cervical radiculopathy, respectively. After being diagnosed with neurogenic thoracic outlet syndrome and undergoing physiotherapy, the patient's recalcitrant condition was surgically managed with arthroscopic pectoralis minor tenotomy, suprascapular nerve release, and brachial plexus neurolysis. CONCLUSION This ultimately led to complete pain relief and improved function. By sharing this case, we aim to shed light on this overlooked pathology and help prevent unnecessary procedures for others suffering from similar conditions.
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Affiliation(s)
- Elinor Stern
- Department of Orthopaedic Surgery Emory University, Atlanta, Georgia
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Milenovic N, Klasnja A, Skrbic R, Popovic Petrovic S, Lukac S, Devecerski G. Sleep Problems and Disabilities of the Arm, Shoulder, and Hand in Persons with Thoracic Outlet Syndrome-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12486. [PMID: 36231785 PMCID: PMC9566055 DOI: 10.3390/ijerph191912486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Thoracic outlet syndrome (TOS) arises as a result of a specific relationship among the anatomical structures that may cause compression in the muscles, nerves, and/or blood vessels in the neck, thereby compromising the local circulation. The aim of the current study was to establish the presence of sleep disturbance and disability in the shoulder, arm, and hand in individuals affected by TOS, as well as to ascertain if there are any differences in these findings relative to TOS-free individuals. The study sample comprised 82 TOS patients and 81 TOS-free individuals aged 19-66 years. Data were gathered by administering the Disabilities of the Arm, Shoulder, and Hand (DASH) and Pittsburgh Sleep Quality Index (PSQI) instruments. The results showed that both the DASH (t = -13.21, p < 0.001) and PSQI (t = -7.27, p < 0.001) scores obtained by the TOS group were higher relative to the controls and were strongly and positively correlated (ρ = 0.58, p < 0.01). As positive DASH scores may be indicative of TOS, they signal the need for further diagnostic evaluations. In individuals in whom TOS is already diagnosed, high DASH scores imply that further sleep quality assessments are required, as compromised sleep patterns may undermine quality of life.
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Affiliation(s)
- Natasa Milenovic
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- The Special Hospital for Rheumatic Diseases, 21 137 Novi Sad, Serbia
| | | | - Renata Skrbic
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
| | - Svetlana Popovic Petrovic
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- Oncology Institute of Vojvodina, 21 204 Sremska Kamenica, Serbia
| | - Sonja Lukac
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- Center of Radiology, University Clinical Center of Vojvodina, 21 137 Novi Sad, Serbia
| | - Gordana Devecerski
- Faculty of Medicine, University of Novi Sad, 21 137 Novi Sad, Serbia
- Department at the Clinic for Medical Rehabilitation, University Clinical Center of Vojvodina, 21 137 Novi Sad, Serbia
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