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

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 have been reported. Our objective is to describe epidemiology of TOS in a National Collegiate Athletic Association Division I Conference (PAC-12). Athletes with TOS were identified in the PAC-12 Health Analytics Program Database from 2016 to 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 χ2 for categorical variables and analysis of variance for continuous variables, with significance established at P < .05. A total of 15,609 athletes (6874 men and 8735 women) playing 21 sports were registered in the 7-year period. The average age was 23.0 years (men 23.2 years, women 22.8 years). 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 patients with TOS (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 postoperatively. Overall symptom resolution was noted in 81.6% (79.7% NTOS and 100% VTOS, P = .19). Return to competition was noted in 95.4% (95% NTOS vs 100% VTOS, P = .07) of patients managed without surgical decompression. After surgery, 87.5% returned to competition (83.3% NTOS vs 100% VTOS, P = .048). Overall, successful return to competition was noted in 95.4% (100% VTOS, 95% NTOS, P = .019) (Table II). Four athletes (5.5%) graduated, not returning to competition. Return to competition data were unavailable for seven athletes. 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 nonoperatively, and surgical intervention was uncommon. With timely diagnosis and appropriate care, over 95% of athletes with TOS return to competition.Table IPercentage of PAC-12 athletes with thoracic outlet syndrome (TOS) by sportSport% With TOSTOS (N = 76)All PAC-12 Athletes (N = 15,609)Tennis2.612463Softball1.36454Rowing1.3181435Swimming0.87893Baseball0.781089Volleyball0.76867Water polo0.73438Gymnastics0.52364Wrestling0.41232Track and field0.241631Basketball0.22919Football0.263341Unique sports0.11680Cross country0.00443Diving0.0096Field hockey0.0083Golf0.00461Lacrosse0.00414Skiing0.00198Soccer0.001108 Open table in a new tab Table IIInjury details and performance outcomesTOS (N = 76), %NTOS (N = 69), %VTOS (N = 7), %P valueResolution of symptoms Overall81.679.7100.0.19 Nonsurgical care83.182.0100.0.22 Surgical care72.7762.5100.0.19Return to competition Overall95.495.0100.0.019 Nonsurgical care96.596.3100.0.07 Surgical care87.583.3100.0.048NTOS, Neurogenic thoracic outlet syndrome; TOS, thoracic outlet syndrome; VTOS, vascular thoracic outlet syndrome.Significance defined as P < .05 (boldface P values). Open table in a new tab