Thoracic Outlet Syndrome in Adolescents Is Real

Abstract

Thoracic Outlet Syndrome in Adolescents Is Real C hang and colleagues 1 from The Johns Hopkins Medical Institutions have provided us with a very helpful review of TOS occurring in adolescent patients. While a limited number of similar studies have previously been published, this is by far the largest series and large enough, I think, to provide meaningful data. Thoracic outlet syndrome is a “fuzzy” diagnosis; it is a real entity but one that is difficult to diagnose and that overlaps with multiple other problems. In adults, results are sometimes poor and the waters muddy. To a large extent, this is because adults often have numerous other factors in play, including liability and secondary gain issues, substance dependency and/or abuse, chronic regional pain syndrome, and underlying psychological disorders. The beauty of treating adolescents is that these factors are almost never in play; apart from the occasional case of Munchausen syndrome by proxy, adolescents with complaints of TOS have clear, unequivocal problems. Chang et al make 2 major points. First, adolescents present much more often with vascular (venous or arterial) TOS. This is most likely because they are more often athletes (venous TOS) and because congenital problems more frequently present early in life rather than in adulthood (arterial TOS). In turn, both entities are easier to treat and have better success rates than does neurogenic TOS. Second, all these patients have very good outcomes. I suspect that this is a result not only of the high percentage of vascular TOS but also of the factor cited in the previous paragraph—that these patients tend to have “clean” problems, without much of the baggage we are all used to dealing with in adults with TOS. Our experience in Rochester parallels this exactly: I am very happy to see a young patient walk through the door of our TOS clinic. The Hopkins experience provides a wealth of useful information. Most important, it lets us know that adolescents with TOS have excellent outcomes. Never make the mistake of denying a life-changing intervention to this group of patients just because of their age!