American Association for Hand Surgery
Theme: Beyond Innovation

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Outcomes Following Treatment in Pediatric Thoracic Outlet Syndrome
Kevin Little, MD; Ann R Schwentker, MD; Elizabeth A Lax, MD; Alex Balboa, BS; Kendra Eckstein, BS
Cincinnati Children's Hospital/University of Cincinnati, Cincinnati, OH

INTRODUCTION
The presence of Thoracic Outlet Syndrome (TOS) in the pediatric population has only recently been recognized. An algorithmic approach to these patients has yet to be formalized. The management and outcomes from both operative and non-operative treatment of pediatric patients are reported.
METHODS
For pediatric patients with symptoms of TOS, medical records were reviewed including demographic information, hospital records, operative reports, therapy reports and imaging reports. Patients were divided into operative vs non-operative treatment groups. Outcomes were reported including presence of symptoms, pre- and post-treatment activity level, and provocative testing (i.e. Roo's, Wright's, and Adson's tests).
RESULTS
Twenty-three children were seen between January 2010-June 2018 with signs and symptoms of TOS. Paget-Schroetter Syndrome (subclavian vein thrombosis) was diagnosed in 4 patients. 11 patients (48%) were active in competitive athletics—most commonly swimming (4) and softball (3). All patients received diagnostic advanced imaging (Chest MR Angiogram or CT scan), revealing narrowing of thoracic outlet vasculature in 19 patients (83%). Operative treatment was indicated in 19 patients (83%) with persistent symptoms despite conservative treatment, while 4 patients were managed non-operatively with activity modification and physical therapy. The mean follow-up was 16.89 months (0.5-47.1 months). Long-term resolution of symptoms was achieved in 86% of operative patients with half returning to pre-symptom activity level.
CONCLUSIONS
TOS is most likely to affect young athletes and individuals—especially females—who perform repetitive overhead movements (e.g., swimmers, softball players). In pediatric patients requiring intervention, first or cervical rib resection with scalenectomy via supraclavicular approach provided resolution of symptoms in 86% of patients with half the patients able to return to pre-symptom activity level.


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