A Systematic Review of Pediatric Thoracic Outlet Syndrome

Introduction: Thoracic outlet syndrome (TOS) is a complex condition that affects the shoulder and neck region due to compression of the neurovascular bundle. This review focuses on TOS in pediatric patients, providing insights into its clinical presentation, etiology, treatment options, and outcomes compared to adult TOS.

Methods: To identify relevant studies, a comprehensive search for pediatric thoracic outlet syndrome was conducted in the PubMed database using PRISMA guidelines. Six studies published between 2008 and 2022, which included a total of 232 pediatric TOS cases, were analyzed. Data categories explored for TOS in pediatric patients included TOS type, laterality, bony abnormalities, delay to onset, symptoms, treatment modalities, initial surgical technique, surgical complications, percent lost to follow-up, mean follow-up period, cases of no relief, and cases of relief among others.

Results: The results of this review show a distinct pattern in pediatric TOS, with a higher prevalence in females (2:1 ratio), an average age of 15.49 years, and a lower prevalence of neurogenic TOS (66%) when compared to adults (95%). Venous and arterial TOS accounted for a higher proportion of cases in pediatric patients than in adults, challenging the traditional adult-oriented perspective. Right-sided presentations were more common, likely due to right-arm dominance in most individuals. Additionally, bony abnormalities were far less common in children (9.9%) when compared to adults (30%). The treatments for pediatric TOS involved mixed methods predominantly utilizing muscle resection (95.67%), neurolysis (78.35%), and bone resection (72.73%), with high rates of symptom relief (85.58%) following surgery. Complications were infrequent (5.12%), and most patients reported positive outcomes.

Conclusion : In conclusion, this systematic review highlights the unique characteristics of pediatric TOS and emphasizes the importance of recognizing these differences for accurate diagnosis and effective treatment in this patient population. Further research is needed to understand the predictive value of conservative treatments, especially in pediatric TOS cases.