Rapid Recovery After Thoracic Outlet Decompression in a Series of Adolescent Athletes With Chronic Atraumatic Shoulder-Girdle Pain, Scapular Winging/Dyskinesis, and Normal Electrodiagnostic Studies

Spontaneous shoulder-girdle pain and scapular winging/dyskinesis can be caused by several neuromuscular disorders identifiable electrodiagnostic studies (EDX). We describe a group of adolescent athletes with this clinical presentation but normal EDX, followed later development neurogenic thoracic outlet syndrome (NTOS). identified patients referred for the evaluation NTOS who had history chronic atraumatic pain, winging/dyskinesis, EDX. Each was refractory to conservative management underwent supraclavicular decompression brachial plexus neurolysis NTOS. Functional disability quantified Disability Arm, Shoulder, Hand (QuickDASH) scores. There were five female mean age at symptom onset 14.2 ± 0.4 years, including spontaneous severe in shoulder, scapula, arm, along prominent (Table). EDX normal, symptoms persisted 18.9 4.0 months before referral, pronounced upper extremity (mean QuickDASH, 54.6 6.9). By 3 after surgical treatment NTOS, all experienced near-complete resolution, markedly improved function 2.2 1.3) return activity (Fig). A subset may develop dynamic compression characteristic exhibiting an ischemic “Sunderland-zero” nerve conduction block which result rapid substantial improvement. The presence surgically treatable should considered selected longstanding fail management.TablePresenting characteristics, diagnostic findings, treatmentPatient No.12345Mean SEInitial Age, years131415131514.2 BMI, kg/m220.022.119.821.132.323.1 2.3 Sport(s)TennisBasketball/soccerSoftballBasketballBasketball/golf Dominant sideRightRightRightLeftRight Symptoms sideRightRightRightRightRight Initial painShoulder/scapula/armShoulder/scapulaShoulder/anterior chestShoulder/armShoulder Scapula wingingYesYesDyskinesisDyskinesisDyskinesis Steroid RxYesYesNoNoNo studyNormalNormalNormalNormalNormal Interval, monthsa12.34.07.811.86.78.5 1.6Diagnosis years141517161615.7 .0.5 Symptoms, months12.58.425.230.318.318.9 Pain VASb5/109/107/108/106/107.0 0.7 ParesthesiaYesYesYesYesYes MedicationsNoneNaproxen, GbNoneTylenol, IBPNone QuickDASH527348346654.6 6.9 SC tenderc2+/31+/31+/31+/32+/31.4 0.2 PM tenderc1+/31+/30/31+/32+/31.0 0.3 EAST, secondsd4030180180180122 36 # Dx criteriae11/1411/1410/149/1410/1410.2 0.4Surgical ASM Wt, g897787.8 MSM g7451176.8 1.2 Bone anomalyWide C7NoneNoneNoneNone PMT includedYesYesNoYesYes OP time, minutes174161141152163158 6 LOS, days433543.8 0.4ASM, Anterior scalene muscle; body mass index; CORE-TOS, Consortium Research Education on Thoracic Outlet Syndrome; Dx, diagnostic; 3-minute elevated arm stress test; electrodiagnostic; Gb, gabapentin; IBP, ibuprofen; length hospital stay; MSM, middle syndrome; OP, operation; PM, pectoralis minor; PMT, minor tenotomy; 18-item form survey; Rx, treatment; SC, supraclavicular; SE, standard error mean; VAS, visual analog scale; resected specimen weight.aInterval from study.bVAS scaled 1 10 patient-rated average intensity pain.cThe localized tenderness palpation 0 3+, as rated examining physician.dTime that patient able continue EAST.eThe number 14 possible CORE-TOS criteria present each patient. Open table new tab