Management of Thoracic Outlet Syndrome in Children

Introduction: Patients with Thoracic Outlet Syndrome (TOS) often present with symptoms including pain, dysesthesia/paresthesia, weakness and/or vascular compromise to the upper extremity when there is neurovascular compression. With failed conservative treatment, surgical intervention, specifically thoracic outlet decompression (TOD), should be considered. We report the safety and outcomes of pediatric patients treated with TOD.

Methods: We queried a clinical database for pediatric patients with a diagnosis of TOS who underwent surgery between 1/2014 and 5/2021. Information extracted included demographics, clinical presentation, diagnostic procedures, surgical treatment and follow up outcomes.

Results: Twenty-seven TOD were performed on 24 symptomatic patients, with equal distribution of neurogenic and vasogenic etiologies for the TOS. More than half of the patients were females (n=14), with a mean age of 15y (+2y). Pain (66%) and paresthesia (63%) were most commonly reported symptoms at presentation. Diagnostic procedures included imaging and physiologic assessments though no single modality proved to be significantly superior to the others. Predominantly, patients had right TOD (n=15), left TOD (n=5), and bilateral decompressions (n=4). Length of hospital stay was 1.4 days (SD 0.7), median 1day. Recovery was followed at 2 weeks, and at 3, 6, and 12 months. Significant improvement was reported for pain, paresthesia, and weakness at first follow up, but the sustainability of the improvement was variable over the follow up. TOD with or without 1st rib resection was achieved without complications or infection except in 1 patient who developed a pneumothorax and 1 patient anti-coagulated for Paget-Schroetter syndrome and had excessive bleeding from the surgical site. Two of 4 patients with bilateral TOD required a repeat decompression on one side.

Conclusion : Symptoms associated with TOS impact children’s quality of life. TOD is a safe and effective treatment for TOS and should be considered in children when conservative treatment fails to provide symptom relief.