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Cavanna AC, Giovanis A, Daley A, Feminella R, Chipman R, Onyeukwu V. Thoracic outlet syndrome: a review for the primary care provider. J Osteopath Med 2022; 122:587-599. [PMID: 36018621 DOI: 10.1515/jom-2021-0276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Thoracic outlet syndrome (TOS) symptoms are prevalent and often confused with other diagnoses. A PubMed search was undertaken to present a comprehensive article addressing the presentation and treatment for TOS. OBJECTIVES This article summarizes what is currently published about TOS, its etiologies, common objective findings, and nonsurgical treatment options. METHODS The PubMed database was conducted for the range of May 2020 to September 2021 utilizing TOS-related Medical Subject Headings (MeSH) terms. A Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) systematic literature review was conducted to identify the most common etiologies, the most objective findings, and the most effective nonsurgical treatment options for TOS. RESULTS The search identified 1,188 articles. The automated merge feature removed duplicate articles. The remaining 1,078 citations were manually reviewed, with articles published prior to 2010 removed (n=771). Of the remaining 307 articles, duplicate citations not removed by automated means were removed manually (n=3). The other exclusion criteria included: non-English language (n=21); no abstracts available (n=56); and case reports of TOS occurring from complications of fractures, medical or surgical procedures, novel surgical approaches, or abnormal anatomy (n=42). Articles over 5 years old pertaining to therapeutic intervention (mostly surgical) were removed (n=18). Articles pertaining specifically to osteopathic manipulative treatment (OMT) were sparse and all were utilized (n=6). A total of 167 articles remained. The authors added a total of 20 articles that fell outside of the search criteria, as they considered them to be historic in nature with regards to TOS (n=8), were related specifically to OMT (n=4), or were considered sentinel articles relating to specific therapeutic interventions (n=8). A total of 187 articles were utilized in the final preparation of this manuscript. A final search was conducted prior to submission for publication to check for updated articles. Symptoms of hemicranial and/or upper-extremity pain and paresthesias should lead a physician to evaluate for musculoskeletal etiologies that may be contributing to the compression of the brachial plexus. The best initial provocative test to screen for TOS is the upper limb tension test (ULTT) because a negative test suggests against brachial plexus compression. A positive ULTT should be followed up with an elevated arm stress test (EAST) to further support the diagnosis. If TOS is suspected, additional diagnostic testing such as ultrasound, electromyography (EMG), or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) might be utilized to further distinguish the vascular or neurological etiologies of the symptoms. Initial treatment for neurogenic TOS (nTOS) is often conservative. Data are limited, therefore there is no conclusive evidence that any one treatment method or combination is more effective. Surgery in nTOS is considered for refractory cases only. Anticoagulation and surgical decompression remain the treatment of choice for vascular versions of TOS. CONCLUSIONS The most common form of TOS is neurogenic. The most common symptoms are pain and paresthesias of the head, neck, and upper extremities. Diagnosis of nTOS is clinical, and the best screening test is the ULTT. There is no conclusive evidence that any one treatment method is more effective for nTOS, given limitations in the published data. Surgical decompression remains the treatment of choice for vascular forms of TOS.
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Affiliation(s)
- Angela C Cavanna
- Department of Clinical Medicine, Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Athina Giovanis
- Department of Osteopathic Manipulative Medicine, Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Alton Daley
- Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Ryan Feminella
- Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Ryan Chipman
- Touro College of Osteopathic Medicine, Middletown, NY, USA
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Takaba K, Takenaga T, Tsuchiya A, Takeuchi S, Fukuyoshi M, Nakagawa H, Futamura H, Futamura R, Sugimoto K, Murakami H, Yoshida M. Elasticity of the Scalene Muscles in Collegiate Baseball Pitchers Using Shear Wave Elastography. Orthop J Sports Med 2022; 10:23259671221114930. [PMID: 36003968 PMCID: PMC9393373 DOI: 10.1177/23259671221114930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Thoracic outlet syndrome is more common in overhead athletes. The anterior and middle scalene muscles have been associated with thoracic outlet syndrome; however, the relationship between the elastic moduli of the scalene muscles and the overhead-throwing position has not been evaluated. Purpose: To investigate the elastic moduli of the anterior and middle scalene muscles in simulated throwing positions using shear wave elastography. Study Design: Descriptive laboratory study. Methods: We enrolled collegiate baseball players who underwent preseason medical checkups in January and February 2020. The anterior and middle scalene muscles were visualized in the short-axis view using ultrasound. In this view, the elastic moduli of the anterior and middle scalene muscles were measured using shear wave elastography in the following arm and neck positions: (1) adduction and neutral rotation of the shoulder (neutral), (2) 90° of abduction and external rotation of the shoulder (ABER), and (3) ABER with neck rotation toward the nonthrowing side (ABER+NR). Repeated-measures analysis of variance and a paired t test were used to compare the elastic modulus values among the 3 positions and between the 2 muscles, respectively. Results: Overall, 30 baseball players were included. In both scalene muscles, the elastic moduli were significantly greater in the ABER versus neutral position (anterior scalene: 14.4 ± 3.8 vs 9.4 ± 2.0 kPa, respectively [P < .001]; middle scalene: 15.8 ± 5.0 vs 10.9 ± 3.4 kPa, respectively [P < .001]). In the neutral position, the elastic modulus was significantly greater in the middle scalene than the anterior scalene (10.9 ± 3.4 vs 9.4 ± 2.0 kPa, respectively; P = .03). In the ABER+NR position, the elastic modulus was significantly greater in the anterior scalene than the middle scalene (18.1 ± 4.6 vs 15.8 ± 2.6 kPa, respectively; P = .03). Conclusion: Because the ABER position was a simulation of the throwing position, these results indicate that this position could be associated with high elastic moduli of the scalene muscles, and both the anterior and middle scalene muscles may be involved.
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Affiliation(s)
- Keishi Takaba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuya Takenaga
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Tsuchiya
- Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | | | | | | | | | | | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Colbert L, Harrison C, Nuelle C. Rehabilitation in Overhead Athletes With Thoracic Outlet Syndrome. Arthrosc Sports Med Rehabil 2022; 4:e181-e188. [PMID: 35141550 PMCID: PMC8811512 DOI: 10.1016/j.asmr.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a clinical diagnosis resulting from the impingement of neurovascular structures between the clavicle and first rib. Effective prevention and nonoperative treatment in high-performance athletes with TOS are not well documented. The objective of reporting this case was to discuss the symptom progression, relevant clinical findings, and rehabilitation of an overhead athlete with diagnosed neurogenic TOS. Numerous rehabilitative techniques may be used to treat an athlete with TOS, with an emphasis on restoring full shoulder mobility, motor control, and normalized scapular mechanics in a throwing athlete, as well as improving functional thoracic range of motion. Modalities such as neuromuscular electrical stimulation and targeted muscle exercises are incorporated in the process. In the case presented, a collegiate-level throwing athlete returned to full participation at her previous level of play within 18 weeks of rehabilitation initiation. This report details the clinical findings and treatment options available to address pathology in an overhead athlete with a diagnosis of TOS. The clinical case example shows techniques that may help guide the clinician in establishing effective nonoperative or postoperative treatments for TOS. Level of Evidence Level V, expert opinion.
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Supernumerary Head of the Biceps Brachii Muscle: An Anatomic Variant With Clinical Implications. J Chiropr Med 2021; 20:37-42. [PMID: 34025304 DOI: 10.1016/j.jcm.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/18/2020] [Accepted: 02/03/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The purpose of this anatomic case report is to describe a variation of the biceps brachii muscle identified in an adult male cadaveric specimen and its potential clinical relevance. Methods A cadaveric specimen with a left supernumerary biceps brachii muscle was dissected. Adjacent neurovascular structures were isolated, and their pathways were observed for possible areas of compression. Results A tricipital supernumerary head of the biceps brachii muscle was noted on the left upper extremity in an embalmed human cadaveric specimen. The median nerve and brachial artery maintained their common neurovascular path. The musculocutaneous nerve passed deep to the third head of the anatomic variant before distributing its cutaneous branches as the lateral antebrachial cutaneous nerve. Conclusion The presence of a supernumerary biceps brachii muscle may cause neurovascular compression of the median nerve, musculocutaneous nerve, or brachial artery, resulting in peripheral nerve deficits. When patient conditions are refractory to care, they may warrant careful evaluation of the anterior compartment of the arm for potential anomalous muscle variations.
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Menon D, Onida S, Davies AH. Overview of arterial pathology related to repetitive trauma in athletes. J Vasc Surg 2019; 70:641-650. [PMID: 31113722 DOI: 10.1016/j.jvs.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Sport-related vascular trauma is an important consequence of increased physical activity. Repetitive, high-intensity movements predispose athletes to vascular disease, including arterial pathology, by exerting increased pressure on neurovascular structures. This is an important source of morbidity in an otherwise young and healthy population. Arterial pathology associated with repetitive trauma is often misdiagnosed as musculoskeletal injury. This article increases awareness of sport-related arterial disease by reviewing the symptomatology, investigation, and treatment modalities of this pathology. In addition, prognostic outcomes specific to the athlete are discussed. RESULTS Arterial thoracic outlet syndrome and vascular quadrilateral space syndrome are associated with athletes involved in overhead throwing exercises. Sport-related arterial pathology of the lower limb include external iliac artery endofibrosis (EIAE), popliteal artery entrapment syndrome (PAES), and adductor canal syndrome. Vascular stress and kinking secondary to vessel tethering are important contributors to pathology in EIAE. Chronic exertional compartment syndrome must also be considered, presenting with clinical features similar to PAES. In addition, athletes are predisposed to blunt mechanical trauma. Hypothenar hammer syndrome is one such example, contributing to a high burden of morbidity in this population. CONCLUSIONS In arterial thoracic outlet syndrome and vascular quadrilateral space syndrome, surgery is advocated in symptomatic individuals, with postoperative outcomes favorable for the athlete. Acute limb ischemia may occur as a result of secondary thrombosis or embolization, often without preceding claudication. PAES and adductor canal syndrome are associated with functional entrapment in the athlete, secondary to muscular hypertrophy. Surgical exploration may be indicated. Poorer outcomes are noted when this process is associated with vascular reconstruction. Surgical treatment of EIAE follows failure of conservative management, with limited data available on postoperative prognosis. Investigations for all these conditions should be targeted based on clinical suspicion. A delay in diagnosis can have severe consequences on return to competition in these high-functioning individuals.
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Affiliation(s)
- Deepak Menon
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
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Sayadi LR, Shah A, Chopan M, Thomson JG. Axillary artery pseudoaneurysm and distal ulnar embolization in collegiate pitcher: a case report and review. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2018; 5:27-30. [PMID: 29707610 PMCID: PMC5917312 DOI: 10.1080/23320885.2018.1458311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/25/2018] [Indexed: 10/26/2022]
Abstract
Twenty five-year-old pitcher presented with acute right middle and index finger numbness and coolness. Angiogram showed a 5mm axillary pseudoaneurysm and near complete occlusion of ulnar and common interosseous artery, ulnar side of the palmar arch, and ulnar digital artery. Patient deferred surgery, treatment with tPA and heparin succeeded in reperfusion.
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Affiliation(s)
- Lohrasb R Sayadi
- Plastic Surgery, UC Irvine, Center for Tissue Engineering, Orange, CA, USA
| | - Ajul Shah
- Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Mustafa Chopan
- Plastic Surgery, University of Florida Health, Gainesville, FL, USA
| | - James G Thomson
- Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Sato T, Tsai TL, Altamimi A, Tsai TM. Quadrilateral Space Syndrome: A Case Report. J Hand Surg Asian Pac Vol 2017; 22:125-127. [PMID: 28205489 DOI: 10.1142/s0218810417720108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a case of quadrilateral space syndrome (QSS) in a patient with left arm pain. The patient sustained a trauma to his left arm, and QSS was successfully diagnosed by physical examination, magnetic resonance image, electromyographic evaluation, and nerve conduction studies. Surgery was performed to decompress the axillary nerve and the patient recovered fully with minimal residual symptoms.
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Affiliation(s)
- Takuya Sato
- 1 The Cristine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Center, KY, USA
| | - Tsai-Lung Tsai
- 1 The Cristine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Center, KY, USA
| | - Anas Altamimi
- 1 The Cristine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Center, KY, USA
| | - Tsu-Min Tsai
- 1 The Cristine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Center, KY, USA
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Laudner K, Selkow N, Burke N, Meister K. Upper extremity blood flow changes in professional baseball pitchers between two consecutive seasons. J Shoulder Elbow Surg 2015; 24:1069-73. [PMID: 25842025 DOI: 10.1016/j.jse.2015.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 02/04/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Because of the tremendous forces produced and the repetitive nature of baseball, players have shown various shoulder adaptations in strength and range of motion. However, no research has identified whether alterations occur in the blood flow to the dominant arm among competitive baseball players. METHODS Twenty professional baseball pitchers and 16 position players participated. Measurements were taken on day 1 of 2 consecutive spring training seasons. Diagnostic ultrasound was used to measure blood flow of the throwing arm brachial artery. These measurements were taken in a standing position with the test arm resting at the participant's side and again with the test arm in a provocative shoulder position. Separate 1-way analyses of variance were conducted to compare blood flow between seasons (P < .05). RESULTS In a resting position, the blood flow of the pitchers did not change from 1 year to the next (P = .48). However, blood flow of the pitchers in the provocative position significantly decreased after the first year (P = .009). The position players did not have any significant changes in blood flow for either arm position (P > .11). CONCLUSIONS In a provocative shoulder position, the blood flow of pitchers significantly decreased after 1 competitive baseball season. These results indicate that after a competitive season, the blood flow to the upper extremity of pitchers may be compromised.
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Affiliation(s)
- Kevin Laudner
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA; Texas Metroplex Institute for Sports Medicine and Orthopedics, Arlington, TX, USA.
| | - Noelle Selkow
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Nick Burke
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Keith Meister
- Texas Metroplex Institute for Sports Medicine and Orthopedics, Arlington, TX, USA
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Gratl A, Frech A, Glodny B, Hoh A, Klocker J, Fraedrich G. Subclavian artery rupture in a young man during excessive weight lifting. J Vasc Surg Cases 2015; 1:194-196. [PMID: 31724629 PMCID: PMC6849966 DOI: 10.1016/j.jvsc.2015.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/30/2015] [Indexed: 11/05/2022] Open
Abstract
We report a 19-year-old man with rupture of the right subclavian artery after an excessive exercise of weight lifting. Imaging showed a hematothorax and hematomediastinum, a pseudoaneurysm with a maximum diameter of 4 cm, and a dissection of the right vertebral artery. As an emergency procedure an interposition graft was performed for reconstruction of the right subclavian artery. The patient's postoperative course was uneventful, and he was symptom free except for regressive hoarseness due to a paresis of the right recurrent laryngeal nerve.
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Affiliation(s)
- Alexandra Gratl
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Frech
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Andreas Hoh
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Klocker
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
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Brown SAN, Doolittle DA, Bohanon CJ, Jayaraj A, Naidu SG, Huettl EA, Renfree KJ, Oderich GS, Bjarnason H, Gloviczki P, Wysokinski WE, McPhail IR. Quadrilateral space syndrome: the Mayo Clinic experience with a new classification system and case series. Mayo Clin Proc 2015; 90:382-94. [PMID: 25649966 DOI: 10.1016/j.mayocp.2014.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/19/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022]
Abstract
Quadrilateral space syndrome (QSS) arises from compression or mechanical injury to the axillary nerve or the posterior circumflex humeral artery (PCHA) as they pass through the quadrilateral space (QS). Quadrilateral space syndrome is an uncommon cause of paresthesia and an underdiagnosed cause of digital ischemia in overhead athletes. Quadrilateral space syndrome can present with neurogenic symptoms (pain and weakness) secondary to axillary nerve compression. In addition, repeated abduction and external rotation of the arm is felt to lead to injury of the PCHA within the QSS. This often results in PCHA thrombosis and aneurysm formation, with distal emboli. Because of relative infrequency, QSS is rarely diagnosed on evaluation of athletes with such symptoms. We report on 9 patients who presented at Mayo Clinic with QSS. Differential diagnosis, a new classification system, and the management of QSS are discussed, with a comprehensive literature review. The following search terms were used on PubMed: axillary nerve, posterior circumflex humeral artery, quadrilateral space, and quadrangular space. Articles were selected if they described patients with symptoms from axillary nerve entrapment or PCHA thrombosis, or if related screening or imaging methods were assessed. References available within the obtained articles were also pursued. There was no date or language restriction for article inclusion; 5 studies in languages besides English were reported in German, French, Spanish, Turkish, and Chinese.
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Affiliation(s)
| | | | | | - Arjun Jayaraj
- Division of Vascular Surgery, Mayo Clinic, Rochester, MN
| | - Sailendra G Naidu
- Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, AZ
| | - Eric A Huettl
- Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, AZ
| | - Kevin J Renfree
- Department of Orthopedic Surgery, Mayo Clinic, Scottsdale, AZ
| | | | - Haraldur Bjarnason
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN
| | | | | | - Ian R McPhail
- Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN.
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Decreased blood flow in the throwing arm of professional baseball pitchers. J Shoulder Elbow Surg 2014; 23:1753-1756. [PMID: 24878036 DOI: 10.1016/j.jse.2014.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND As a consequence of the repetitive forces placed on the throwing arm of a baseball player, various bony, capsuloligamentous, and muscular adaptations occur and have been identified. However, no research has identified whether adaptations also exist in the vasculature of the upper extremity in the competitive baseball player. METHODS Fifty-one professional baseball pitchers and 34 position players participated. Diagnostic ultrasound was used to measure bilateral blood flow of the brachial artery. These measurements were taken with the participant standing with the test arm resting at the participant's side and again with the test arm in a provocative shoulder position. RESULTS The throwing arm of the pitchers had significantly less blood flow volume when in the provocative shoulder position compared with their nonthrowing arm (P = .01). Pitchers did not have any bilateral difference while in the resting position (P = .19). There were no bilateral differences among the position players while in the resting (P = .64) or provocative positions (P = .63). Pitchers had significantly less blood flow of the throwing shoulder while in the provocative position compared with position players (P = .02). There were no other between-group differences. CONCLUSIONS While in a provocative shoulder position, pitchers have significantly less blood flow in their throwing arm compared with their nonthrowing arm and with the throwing arm of position players. These results provide a descriptive profile of blood flow volume among baseball players, which may be used in the evaluation and treatment of such athletes with vascular disorders.
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Twaij H, Rolls A, Sinisi M, Weiler R. Thoracic outlet syndromes in sport: a practical review in the face of limited evidence — unusual pain presentation in an athlete. Br J Sports Med 2013; 47:1080-4. [DOI: 10.1136/bjsports-2013-093002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shoulder adaptations among pitchers and position players over the course of a competitive baseball season. Clin J Sport Med 2013; 23:184-9. [PMID: 22935558 DOI: 10.1097/jsm.0b013e31826ab928] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if throwing arm shoulder range of motion (ROM) and scapular kinematic differences exist between baseball pitchers and position players over the course of a baseball season. DESIGN Prospective cohort. SETTING Professional baseball athletic training room. PARTICIPANTS Sixteen asymptomatic professional baseball pitchers and 16 position players. INDEPENDENT VARIABLES Preseason glenohumeral (GH) posterior tightness and scapular position. MAIN OUTCOME MEASURES Throwing arm GH horizontal adduction ROM and GH internal rotation bilateral asymmetry ROM, as well as bilateral differences in forward scapular posture and throwing arm scapular upward rotation at rest, 60, 90, and 120 degrees of humeral elevation were measured. These measurements were taken before and at the conclusion of a 140-game baseball season. RESULTS Analyses of covariances showed no significant differences in GH horizontal adduction or internal rotation asymmetry ROM between groups over the course of the season. However, the pitchers developed significantly less scapular upward rotation at 60 degrees (P = 0.007) and 90 degrees (P = 0.006) of humeral elevation compared with the position players during the season. Forward scapular posture (P = 0.23) and scapular upward rotation at 0 degrees (P = 0.93) and 120 degrees (P = 0.29) of humeral elevation were not significantly different between groups. CONCLUSIONS These results suggest that baseball position players develop more scapular upward rotation over the course of a competitive season than pitchers. This discrepancy may increase the pitchers' risk of injury and may partially explain their higher incidence of shoulder injury compared with position players. Therefore, pitchers may benefit from strengthening exercises and stretches aimed at increasing scapular upward rotation throughout the competitive baseball season.
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J.Niemann A, S.Juzeszyn L, Kahanov L, E.Eberman L. Suprascapular neuropathy in collegiate baseball player. Asian J Sports Med 2013; 4:76-81. [PMID: 23785580 PMCID: PMC3685164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 09/16/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suprascapular neuropathy (SSN) is generally thought of as a diagnosis of exclusion. However, increasing attention is being paid to the diagnosis, treatment and rehabilitation of this pathology to prevent chronic supraspinatus and infraspinatus atrophy in patients. To date, literature has only articulated variable or customized treatment and rehabilitation plans without clear standardized care. This case study provides a detailed description of the diagnosis, treatment, and rehabilitation of a collegiate baseball player's recovery from suprascapular nerve release. CASE PRESENTATION A 20 year-old male baseball pitcher with right shoulder pain reported for athletic training evaluation, was treated conservatively, and due to lack of resolution was referred for further imaging and evaluation by an orthopedist. Following inconclusive magnetic resonance imaging findings the patient underwent electrodiagnostic testing which showed decreased nerve conduction velocity of the right suprascapular nerve. The patient elected for surgical intervention. Post-operative rehabilitation followed and the patient was able to pitch in 22 weeks. The patient provided positive subjective feedback and was able to return to unrestricted pitching without pain, loss of velocity, or loss in pitch control. CONCLUSION This study demonstrates a need for further investigation into the most appropriate treatment and rehabilitation of suprascapular nerve injury.
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Affiliation(s)
- Andrew J.Niemann
- Address: Indiana State Unversity, Department of Applied Medicine and Rehabilitation, Terre Haute IN, 47809, USA.
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Arthroscopic trans-capsular axillary nerve decompression: indication and surgical technique. Arthroscopy 2011; 27:1444-8. [PMID: 21831569 DOI: 10.1016/j.arthro.2011.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 04/25/2011] [Accepted: 05/05/2011] [Indexed: 02/02/2023]
Abstract
Symptomatic axillary nerve compression is rare yet results in debilitating pain, weakness, and decreased athletic performance in some patients. If nonoperative modalities fail, surgical intervention is necessary to reduce symptoms and avoid functional decline. Traditionally, open techniques have been described to decompress the axillary nerve and are reported to provide satisfactory results. Similar to suprascapular nerve decompression, recent advances have provided the opportunity to develop all-arthroscopic axillary nerve decompression techniques. Although direct comparisons between open and arthroscopic techniques do not exist, arthroscopic axillary nerve decompression may provide some benefits over open techniques. Therefore we present a technique and early results for all-arthroscopic trans-capsular axillary nerve decompression.
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Arthroscopic Transcapsular Axillary Nerve Decompression. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2011. [DOI: 10.1097/bte.0b013e31822daaa2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lotun K, Soukas PA, Bueno R, Igbokidi O, Owens C, Schainfeld RM. Bilateral arterial thoracic outlet syndrome with intermittent subclavian artery occlusion. Interv Cardiol 2011. [DOI: 10.2217/ica.11.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Duwayri YM, Emery VB, Driskill MR, Earley JA, Wright RW, Paletta GA, Thompson RW. Positional compression of the axillary artery causing upper extremity thrombosis and embolism in the elite overhead throwing athlete. J Vasc Surg 2011; 53:1329-40. [PMID: 21276687 DOI: 10.1016/j.jvs.2010.11.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/28/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the spectrum of axillary artery pathology seen in high-performance overhead athletes and the outcomes of current treatment. METHODS A retrospective review of patients that had undergone management of axillary artery lesions in a specialized center for thoracic outlet syndrome (TOS). Treatment outcomes were assessed with respect to arterial pathology and operative management. RESULTS Nine male athletes were referred for arterial insufficiency in the dominant arm between January 2000 and August 2010, representing 1.6% of 572 patients treated for TOS (19% of 47 patients treated for arterial TOS). Seven were elite baseball pitchers (six professional, one collegiate), and two were professional baseball coaches with practice pitching responsibilities, with a mean age of 30.9 ± 2.9 years. Presenting symptoms included arm fatigue (five), finger numbness (four), cold hypersensitivity/Raynaud's (two), rest pain (one), and cutaneous fingertip embolism (one). Three patients underwent transcatheter thrombolysis prior to referral, including one with angioplasty and stenting. At angiography and surgical exploration 2.5 ± 0.8 weeks after symptom presentation (range, 1-8 weeks), six patients had occlusion of the distal axillary artery opposite the humeral head either at rest (three) or with arm elevation (three), one had axillary artery dissection with positional occlusion, and two had thrombosis of circumflex humeral artery aneurysms. Five patients had embolic arterial occlusions distal to the elbow. Treatment included segmental axillary artery repair with saphenous vein (n = 7; five interposition bypass grafts and two patch angioplasties), ligation/excision of circumflex humeral artery aneurysms (n = 2), and distal artery thrombectomy/thrombolysis (n = 2). Mean postoperative hospital stay was 3.8 ± 0.5 days, and the time until resumption of unrestricted overhead throwing was 10.8 ± 2.7 weeks. At a median follow-up of 15 months (range, 3-123 months), primary-assisted patency was 89%, and secondary patency was 100%. All nine patients had continued careers in professional baseball, although one retired during long-term follow-up. CONCLUSIONS Repetitive positional compression of the axillary artery can cause a spectrum of pathology in the overhead athlete, including focal intimal hyperplasia, aneurysm formation, segmental dissection, and branch vessel aneurysms. Prompt recognition of these rare lesions is crucial given their propensity toward thrombosis and distal embolism, with positional arteriography necessary for diagnosis. Full functional recovery can usually be anticipated within several months of surgical treatment, consisting of mobilization and segmental reconstruction of the diseased axillary artery or ligation/excision of branch aneurysms, as well as concomitant management of distal thromboembolism.
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Affiliation(s)
- Yazan M Duwayri
- Department of Surgery (Section of Vascular Surgery), Washington University School of Medicine, St. Louis, Missouri 63110, USA
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