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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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Bach K, Miller MA, Allgier A, Al Muhtaseb T, Little KJ, Schwentker AR. Thoracic Outlet Syndrome in the Pediatric and Young Adult Population. J Hand Surg Am 2024; 49:337-345. [PMID: 38310509 DOI: 10.1016/j.jhsa.2023.12.013] [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] [Received: 04/07/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE This study aimed to assess both nonsurgical and operative treatment outcomes of pediatric and young adult patients with thoracic outlet syndrome (TOS) at a tertiary care pediatric hospital. METHODS A retrospective chart review of patients diagnosed with TOS, who were seen between January 2010 and August 2022 at a tertiary care pediatric hospital, was conducted. Collected pre- and postoperative data included symptoms, provocative testing (ie, Roo's, Wright's, and Adson's tests), participation in sports or upper-extremity activities, additional operations, and surgical complications. Assessment of operative treatment efficacy was based on pre- and post-provocative testing, pain, venogram results, alleviation of symptoms, and return to previous activity level 6 months after surgery. RESULTS Ninety-six patients, (70 females and 26 males) with an average age at onset of 15 ± 4 (4-25) years, met the inclusion criteria for TOS. Among them, 27 had neurogenic TOS, 29 had neurogenic and vasculogenic TOS, 20 had vasculogenic TOS, 19 had Paget-Schroetter Syndrome, and one was asymptomatic. Twenty-six patients were excluded because of less than 6 months of follow-up. Of the remaining 70, 6 (8.6%) patients (4 bilateral and 2 unilateral) underwent nonoperative management with activity modification and physical therapy only, and one was fully discharged because of complete relief of symptoms. Sixty-four (90.1%) patients (45 bilateral and 19 unilateral) underwent surgery. A total of 102 operations were performed. Substantial improvements were observed in provocative maneuvers after surgery. Before surgery, 79.7% were involved in sports or playing musical instruments with repetitive overhead activity, and after surgery, 86.2% of these patients returned to their previous activity level. CONCLUSIONS Few patients were successfully managed with nonoperative activity modification and physical therapy. In those requiring surgical intervention, first or cervical rib resection with scalenectomy using a supraclavicular approach provided resolution of symptoms with 86.2% of patients being able to return to presymptom sport or activity level. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Karen Bach
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Melissa A Miller
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Allison Allgier
- Department of Occupational and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Tamara Al Muhtaseb
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Kevin J Little
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Ann R Schwentker
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Grigoriță L, Vaida MA, Jianu A. An Aberrant Subclavius Posticus Muscle: A Case Report. Med Princ Pract 2018; 27:579-581. [PMID: 29986338 PMCID: PMC6422154 DOI: 10.1159/000491931] [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] [Received: 02/05/2018] [Accepted: 07/09/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE An aberrant subclavius posticus muscle was found during routine dissection of the left infraclavicular fossa of a 60-year-old male cadaver. PRESENTATION This aberrant muscle arises antero-medially, from the costoclavicular ligament, runs postero-laterally, over the trunks of the brachial plexus, and postero-lateral has a common insertion with the omohyoid muscle. CONCLUSION The presence of such an aberrant muscle may cause a dynamic compression of the subclavian artery and brachial plexus.
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Affiliation(s)
| | - Monica-Adriana Vaida
- *Monica-Adriana Vaida, Department of Anatomy and Embryology, “Victor Babeş” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO–300041 Timisoara (Romania), E-Mail
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Hong J, Pisapia JM, Ali ZS, Heuer AJ, Alexander E, Heuer GG, Zager EL. Long-term outcomes after surgical treatment of pediatric neurogenic thoracic outlet syndrome. J Neurosurg Pediatr 2018; 21:54-64. [PMID: 29125442 DOI: 10.3171/2017.7.peds17257] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurogenic thoracic outlet syndrome (nTOS) is an uncommon compression syndrome of the brachial plexus that presents with pain, sensory changes, and motor weakness in the affected limb. The authors reviewed the clinical presentations and outcomes in their series of pediatric patients with surgically treated nTOS over a 6-year period. METHODS Cases of nTOS in patients age 18 years or younger were extracted for analysis from a prospective database of peripheral nerve operations. Baseline patient characteristics, imaging and neurophysiological data, operative findings, and outcomes and complications were assessed. RESULTS Twelve patients with 14 cases of nTOS surgically treated between April 2010 and December 2016 were identified. One-third of the patients were male, and 2 male patients underwent staged, bilateral procedures. Disabling pain (both local and radiating) was the most common presenting symptom (100%), followed by numbness (35.7%), then tingling (28.6%). The mean duration of symptoms prior to surgery was 15.8 ± 6.6 months (mean ± SD). Sports-related onset of symptoms was seen in 78.6% of cases. Imaging revealed cervical ribs in 4 cases, prominent C-7 transverse processes in 4 cases, abnormal first thoracic ribs in 2 cases, and absence of bony anomalies in 4 cases. Neurophysiological testing results were normal in 85.7% of cases. Conservative management failed in all patients, with 5 patients reporting minimal improvement in symptoms with physical therapy. With a mean follow-up after surgery of 22 ± 18.3 months (mean ± SD), pain relief was excellent (> 90%) in 8 cases (57.1%), and good (improved > 50%) in 6 cases (42.9%). On univariate analysis, patients who reported excellent pain resolution following surgery at long-term follow-up were found to be significantly younger, and to have suffered a shorter duration of preoperative symptoms than patients who had worse outcomes. Lack of significant trauma or previous surgery to the affected arm was also associated with excellent outcomes. There were 4 minor complications in 3 patients within 30 days of surgery: 1 patient developed a small pneumothorax that resolved spontaneously; 1 patient suffered a transient increase in pain requiring consultation, followed by hiccups for a period of 3 hours that resolved spontaneously; and 1 patient fell at home, with transient increased pain in the surgically treated extremity. There were no new neurological deficits, wound infections, deep vein thromboses, or readmissions. CONCLUSION Pediatric nTOS commonly presents with disabling pain and is more frequently associated with bony anomalies compared with adult nTOS. In carefully selected patients, surgical decompression of the brachial plexus results in excellent pain relief, which is more likely to be seen in younger patients who present for early surgical evaluation.
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Affiliation(s)
- Jennifer Hong
- 1Divison of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jared M Pisapia
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
| | - Zarina S Ali
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
| | - Austin J Heuer
- 3Division of Neurosurgery, The Children's Hospital of Philadelphia, Pennsylvania
| | - Erin Alexander
- 3Division of Neurosurgery, The Children's Hospital of Philadelphia, Pennsylvania
| | - Gregory G Heuer
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and.,3Division of Neurosurgery, The Children's Hospital of Philadelphia, Pennsylvania
| | - Eric L Zager
- 2Department of Neurosurgery, University of Pennsylvania, Philadelphia; and
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Abstract
The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery.
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Vu AT, Patel PA, Elhadi H, Schwentker AR, Yakuboff KP. Thoracic outlet syndrome in the pediatric population: case series. J Hand Surg Am 2014; 39:484-487.e2. [PMID: 24495625 DOI: 10.1016/j.jhsa.2013.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 02/02/2023]
Abstract
We present 4 patients, 4 months to 10 years of age, with thoracic outlet syndrome. All were referred to the brachial plexus clinic. Three patients were diagnosed with vascular thoracic outlet syndrome after clinical evaluation and diagnostic imaging. Three had a cervical rib and 1 had an anomalous first rib. All patients were treated surgically through a supraclavicular approach and had resolution of the symptoms. No postoperative complications were noted.
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Affiliation(s)
- Anthony T Vu
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Parit A Patel
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Haithem Elhadi
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Ann R Schwentker
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY
| | - Kevin P Yakuboff
- Division of Plastic, Reconstructive, and Hand Surgery, University of Cincinnati, Cincinnati, OH; Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Plastic Surgery, Institute of Reconstructive Surgery, New York University, New York, NY.
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Sabapathy SR, Venkatramani H, Bhardwaj P. Pseudarthrosis of cervical rib: an unusual cause of thoracic outlet syndrome. J Hand Surg Am 2010; 35:2018-21. [PMID: 21074954 DOI: 10.1016/j.jhsa.2010.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/11/2010] [Accepted: 08/16/2010] [Indexed: 02/02/2023]
Abstract
Thoracic outlet syndrome is uncommon in adolescence. Cervical rib fracture is an extremely rare cause of thoracic outlet syndrome in this age group. We report an unusual case of thoracic outlet syndrome in a 14-year-old girl caused by pseudarthrosis of the cervical rib. A magnetic resonance imaging scan showed significant compression of the brachial plexus by the pseudarthrosis mass. Excision of the cervical rib through a supraclavicular approach gave excellent results in this case.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, India.
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Maru S, Dosluoglu H, Dryjski M, Cherr G, Curl GR, Harris LM. Thoracic outlet syndrome in children and young adults. Eur J Vasc Endovasc Surg 2009; 38:560-4. [PMID: 19703780 DOI: 10.1016/j.ejvs.2009.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 06/20/2009] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Thoracic outlet syndrome has been well described in the population between 25 and 40 years of age, and is less frequently reported in those in the first two decades of life. The objective of this study was to review results with onset of TOS in the first two decades of life to determine type of presentation and outcomes from surgical intervention. METHODS AND MATERIALS Charts of all patients in the first two decades of life, operated on for TOS between 1994 and 2006 were reviewed with follow-up by clinic visit and phone survey to assess the patients' current level of activity and relief from symptoms. RESULTS Twelve patients were identified (13 operations), with a mean age of 16.8 years. Acute ischemic symptoms were the initial presentation for 38%, venous TOS in 24%, and neurogenic symptoms in 38%. All patients had symptom relief with surgery with a mean time to resolution of 10.9 weeks. All patients remained symptom free or improved at follow-up. CONCLUSIONS Vascular TOS is much more common in TOS presenting in the first two decades of life. Surgical intervention for TOS in this population results in long-lasting symptom relief and should be considered for all subtypes of patients.
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Affiliation(s)
- S Maru
- State University of New York at Buffalo, Department of Surgery, Buffalo, NY, USA
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