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Garraud T, Pomares G, Daley P, Menu P, Dauty M, Fouasson-Chailloux A. Thoracic Outlet Syndrome in Sport: A Systematic Review. Front Physiol 2022; 13:838014. [PMID: 35755427 PMCID: PMC9214221 DOI: 10.3389/fphys.2022.838014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a rare and heterogeneous syndrome secondary to a compression of the neurovascular bundle in the thoracic outlet area. Muscle hypertrophy is recognized to induce vascular or neurogenic compression, especially in sports involving upper-arm solicitation. Athletes represent a distinctive population because of a specific management due to an ambitious objective, which is returning to high-level competition. We evaluated the scientific literature available for the management of TOS in athletes. Article research extended to March 2021 without other restriction concerning the date of articles publication. The search was performed independently by two assessors. A first preselection based on the article titles was produced, regarding their availability in English or French and a second preselection was produced after reading the abstracts. In case of doubt, a third assessor’s advice was asked. Case reports were selected only if the sport involved was documented, as well as the level of practice. Cohorts were included if data about the number and the sport level of athletes were detailed. Seventy-eight articles were selected including 40 case reports, 10 clinical studies and 28 reviews of literature. Baseball pitchers seem to be highly at risk of developing a TOS. The surgical management appears particularly frequent in this specific population. The prognosis of TOS in athletes seems to be better than in the general population, possibly due to their better physical condition and their younger age. Some studies showed interesting and encouraging results concerning return to previous sport level. Literature shows a strong link between TOS and certain sports. Unfortunately, this syndrome still lacks rigorous diagnostic criteria and management guidelines for athletes.
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Affiliation(s)
- Thomas Garraud
- Hôpital Privé du Confluent, Rhumatologie, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Germain Pomares
- Institut Européen de la Main, Luxembourg. Luxembourg.,Medical Training Center, Hopital Kirchberg, Luxembourg. Luxembourg
| | - Pauline Daley
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France
| | - Pierre Menu
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,IRMS, Institut Régional de Médecine du Sport, Nantes, France
| | - Marc Dauty
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,IRMS, Institut Régional de Médecine du Sport, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,IRMS, Institut Régional de Médecine du Sport, Nantes, France
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2
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Heo J, Medani K, Juma H. Paget-Schroetter syndrome from manual handling at work: Case report and review of the literature. Am J Ind Med 2022; 65:281-285. [PMID: 35195925 DOI: 10.1002/ajim.23337] [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: 07/29/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/11/2022]
Abstract
Paget-Schroetter syndrome (PSS) is a primary deep venous thrombosis of the subclavian-axillary vein complex occurring after repetitive and strenuous use of the shoulders and arms. Here, we report the case of a 24-year-old man who presented with left subclavian and axillary vein thrombosis after loading and unloading labor, who was diagnosed with PSS confirmed with Doppler ultrasound, and treated with anticoagulation. By comparing our case with 45 published case reports, we also aim to analyze patient characteristics, diagnostic methods, and treatment options for the disorder.
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Affiliation(s)
- Jaeyeong Heo
- Division of Environmental and Occupational Health Sciences University of Illinois at Chicago School of Public Health Chicago Illinois USA
| | - Khalid Medani
- Department of Occupational Medicine Concentra Urgent Care Inc. Moreno Valley California USA
| | - Haitham Juma
- Department of Occupational Medicine Loma Linda University Medical Center Loma Linda California USA
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3
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Chapman CL, Hess HW, Lucas RAI, Glaser J, Saran R, Bragg-Gresham J, Wegman DH, Hansson E, Minson CT, Schlader ZJ. Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States. Am J Physiol Regul Integr Comp Physiol 2021; 321:R141-R151. [PMID: 34161738 DOI: 10.1152/ajpregu.00103.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative review is to identify occupations that may place US workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in US workers supports the need for future investigations to understand this risk of CKDnt.
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Affiliation(s)
| | - Hayden W Hess
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jason Glaser
- La Isla Network, Washington, D.C.,Responsible Business Center at Birkbeck, University of London, London, United Kingdom
| | - Rajiv Saran
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Bragg-Gresham
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David H Wegman
- Department of Epidemiology, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Erik Hansson
- La Isla Network, Washington, D.C.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Zachary J Schlader
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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4
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Hilberg T, Ransmann P, Hagedorn T. Sport and Venous Thromboembolism. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:181-187. [PMID: 34024313 DOI: 10.3238/arztebl.m2021.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/13/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The occurrence of venous thromboembolisms (VTE) in association with sporting activity has been described but not yet systematically explored. The aim of this study was to determine the sites at which VTE occur in athletes, the accompanying features, and the special features of the symptoms and diagnosis, so that physicians can take the findings into consideration. METHODS A search of the literature in the databases PubMed, Web of Science, and Cochrane in accordance with the PRISMA criteria, together with a search of Google Scholar up to 29 February 2020. RESULTS No observational studies were identified. A total of 154 case descriptions were evaluated: 89 on upper-extremity deep vein thrombosis (DVT), 53 on lower-extremity DVT, and 12 on pulmonary embolisms with no evidence of thrombosis. Ninety-five percent of the upper-extremity DVT involved the region of the subclavian/axillary vein. Thoracic outlet syndrome (38%), hereditary thrombophilia/a family history of VTE (16%), intensive training (12%), and the use of oral contraceptives (7%) were identified as accompanying features. The upper-extremity DVT occurred mainly in male strength athletes and ball sports players. The lower-extremity DVT were located in the lower leg/knee (30%), the thigh (19 %), or occurred in combination in the lower leg-to-pelvis region (30 %). The features accompanying lower-extremity DVT were hereditary thrombophilia/a family history of VTE (30%), trauma (25%), immobilization (21%), and the use of oral contraceptives (11%). The lower-extremity DVT were found in endurance sports and ball sports. The symptoms may be obscured by sport-specific symptoms/trauma, and diagnosis is often delayed. Early D-dimer determination is useful and is complemented by diagnostic imaging. CONCLUSION VTE are found in association with sports. The background factors, the sites of VTE, the types of sports involved, and the accompanying features are all important to know. The symptoms may be obscured, and it may be difficult to reach the correct diagnosis. The possible presence of DVT must be borne in mind.
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Affiliation(s)
- Thomas Hilberg
- School of Human and Social Sciences, Department of Sports Medicine, University of Wuppertal
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Tanabe H, Miyamori D, Shigenobu Y, Ito Y, Kametani T, Kakimoto M, Kawahara A, Kikuchi Y, Kobayashi T, Otani Y, Kishikawa N, Kanno K, Ito M. Two Patients with Paget-Schroetter Syndrome That Were Successfully Diagnosed by Doppler Ultrasonography: Case Studies with a Literature Review. Intern Med 2020; 59:2623-2627. [PMID: 32581157 PMCID: PMC7662054 DOI: 10.2169/internalmedicine.4349-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
We herein report on two male patients (age, 22 and 44 years) who were referred to our department with swelling of the upper right arm after attending other hospitals. Right subclavian vein thrombosis was demonstrated by ultrasonography and they were then further evaluated by contrast-enhanced computed tomography (CT). Successful treatment involved venous thrombectomy in one patient and anticoagulant therapy in the other. Paget-Schhroetter syndrome was confirmed using standard vascular ultrasonography. Despite the accuracy of this method for diagnosing Paget-Schroetter syndrome, some cases are difficult to confirm. We reviewed 29 previously published case reports of Paget-Schroetter syndrome and analyzed the patient baseline characteristics, time to diagnosis, and the diagnostic methods used.
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Affiliation(s)
- Hiromasa Tanabe
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuya Shigenobu
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yayoiko Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Takahiro Kametani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masaki Kakimoto
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Akihiro Kawahara
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuka Kikuchi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Tomoki Kobayashi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuichiro Otani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Nobusuke Kishikawa
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Keishi Kanno
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
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Wollina U, Koch A, Langner D, Hansel G, Heinig B, Lotti T, Tchernev G. Acrocyanosis - A Symptom with Many Facettes. Open Access Maced J Med Sci 2018; 6:208-212. [PMID: 29484025 PMCID: PMC5816301 DOI: 10.3889/oamjms.2018.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 01/18/2023] Open
Abstract
Acrocyanosis is an uncommon complaint belonging to the acro-syndromes. It typically presents with coolness and bluish discolourations of hands, feet, ears, nose, lips and nipple. The most frequently affected parts of the body are the hands. This review discusses physical factors, vascular disorders, infectious diseases, haematological disorders, solid tumours genetic disorders, drugs, eating disorders, and spinal disease presenting as or leading to acrocyanosis.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - André Koch
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Dana Langner
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Gesina Hansel
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Birgit Heinig
- Städtisches Klinikum Dresden - Center of Physical and Rehabilitative Medicine, Dresden, Germany
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma, Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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7
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Ryan JW, Murphy A, Wrafter S, Ramiah V. Paget Schroetter syndrome imaged in multiple modalities and successfully treated with pharmacomechanical thrombectomy. BMJ Case Rep 2016; 2016:bcr-2016-218238. [PMID: 27927711 DOI: 10.1136/bcr-2016-218238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- James William Ryan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alexandra Murphy
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sarah Wrafter
- Emergency Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Vinny Ramiah
- Emergency Department, Mater Misericordiae University Hospital, Dublin, Ireland
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8
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Sanson H, Gautier V, Stansal A, Sfeir D, Franceschi C, Priollet P. [Deep venous thrombosis of the upper limb in a violin player: The "bow syndrome"]. ACTA ACUST UNITED AC 2016; 41:396-402. [PMID: 27823916 DOI: 10.1016/j.jmv.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exercise-induced thrombosis is a rare cause of deep venous thrombosis (DVT) of the upper limb and usually affects young subjects without comorbid conditions. The diagnosis may be challenging. CASE REPORT A 23-year-old female right-handed French teacher and amateur violin player presented with edema of the root of the right arm associated with erythrocyanosis of the extremity and collateral circulation of the shoulder. History taking revealed oral contraception and recent change in violin playing habits. D-dimers were negative. A second duplex-Doppler was required before visualization of a DVT in the right subclavian vein. The patient was given low-molecular-weight heparin alone, followed by rivaroxaban. The outcome was very favorable at 48h. The patient was seen at 4 months and had not had a recurrent episode. DISCUSSION The diagnosis of DVT of the upper limb is basically clinical. There is a clinical probability score for the introduction of anticoagulation even if the duplex-Doppler fails to visualize DVT, a situation that can occur due to the clavicular superposition in this region. Exercise-induced DVT should be suspected in patients with minimally intense but repeated exercise (hyper-abduction), e.g. as here playing the violin. Anticoagulation is the treatment of choice. The role for surgery and pharmacomechanical strategies remains to be defined. CONCLUSION Exercise-induced thrombosis (Paget-Schroetter syndrome) should be suspected in young patients free of any comorbidity who develop a thrombosis of the upper limb. Studies comparing different therapeutic options would be useful to achieve more homogeneous management practices despite the heterogeneous clinical presentations.
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Affiliation(s)
- H Sanson
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - V Gautier
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Stansal
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - D Sfeir
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - C Franceschi
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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