VESS22 - Occurrence, Management, and Outcome of Thoracic Outlet Syndrome in National Collegiate Athletic Association Division I Conference

Objectives: Thoracic outlet syndrome (TOS, neurovascular compression at the thoracic outlet) is a disabling condition affecting the upper extremities. Athletes are at risk of developing TOS. Prior reports of TOS in athletes have been largely restricted to single center experiences, no National Athletic Conference level data has been reported. Our objective is to describe epidemiology of TOS in a National Collegiate Athletic Association Division I Conference (PAC-12).

Methods: Athletes with TOS were identified in the PAC-12 Health Analytics Program Database from 2016-2022. Data included demographics, sports, treatments, and outcome. TOS subcategories of neurogenic (NTOS) and venous (VTOS) were identified. Data were compared between NTOS and VTOS using chi square for categorical variables, and ANOVA for continuous variables, with significance established at p< 0.05.

Results: 15,609 athletes (6874 men and 8735 women) playing 21 sports were registered in the 7-year period. Average age was 23.0 years (men 23.2, women 22.8). TOS was identified in 76 (0.48%) athletes, 7 (9.2%) VTOS and 69 (90.8%) NTOS. These included 30 (39.5%) men and 46 (60.5%) women.

Sports played by athletes with TOS are presented in Table I. TOS was reported in 0.4% of all athletes, and was found at 2.6% of tennis players, 1.3% softball players, 1.3% rowers, and 0.8% of swimmers.

Most TOS patients (86%) were managed without surgery and 83% experience resolution of symptoms with physical therapy, testing and medication. Of the 14% of athletes who required surgery, 72% experienced resolution of their symptoms post-op. Overall symptom resolution was noted in 81.6% (79.7% NTOS and 100% VTOS, p=0.19).

Return to competition was noted in 95.4% (95% NTOS vs 100% VTOS, p=0.07) of patients managed without surgical decompression. Following surgery, 87.5% returned to competition (83.3% NTOS vs 100% VTOS, p=0.048). Overall, successful return to competition was noted 95.4% (100% VTOS, 95% NTOS, p=0.019). Table II. Four athletes (5.5%) graduated, not returning to competition. Return to competition data was unavailable for 7.

Conclusions: This is the first report of TOS in athletes based a National Collegiate Athletic Conference dataset. Injuries leading to TOS are rare in collegiate athletics. The risk of TOS is not equally distributed in all sports: most likely to be affected include tennis, softball, rowing, and swimming.

The majority of athletes with TOS were successfully managed non-operatively and surgical intervention was uncommon. With timely diagnosis and appropriate care, over 95% of athletes with TOS return to competition.