Arterial Thoracic Outlet Syndrome in the Competitive Athlete

Major neurovascular conditions of the upper extremity are relatively rare and often difficult to recognize in competitive overhead athletes and those involved in frequent throwing or weight lifting regimens. Understanding these conditions is particularly important for vascular and thoracic surgeons caring for athletes, as well as orthopedic surgeons, emergency room physicians, and sports medicine specialists, because they can seriously limit athletic performance and may even have limb-threatening consequences. Some of the most significant upper extremity neurovascular disorders are related to compression of the brachial plexus nerves or the axillary and subclavian vessels, and are therefore considered different forms of thoracic outlet syndrome (TOS). In this chapter, current strategies for the diagnosis and treatment of arterial TOS are highlighted, both to avoid serious complications and to promote successful treatment outcomes, including arterial TOS involving the subclavian artery, compressive lesions of the axillary artery and its branches, and some forms of the quadrilateral space syndrome. Although the treatment options to be considered for arterial TOS are similar for all patients, competitive athletes often present special circumstances that need to be taken into account in the decision-making process. With early recognition, proper initial treatment, and definitive surgical care, most competitive athletes affected by arterial TOS can return to previous levels of performance.