Predicting Return To Play In Ncaa Division 1 Athletes With Neurogenic Thoracic Outlet Syndrome

PURPOSE: Athletes who engage in repetitive upper extremity exercise are susceptible to neurogenic thoracic outlet syndrome (nTOS). Symptoms are often exacerbated by sport-specific activity and may result in missed practices and competitions. Treatment options include physical therapy (PT), anterior scalene botulinum toxin injection (BTI), or surgery. We sought to identify factors that predict return to play in elite athletes with nTOS regardless of treatment modality received. METHODS: Medical records of NCAA Division 1 athletes diagnosed with nTOS at a single university were retrospectively reviewed. Patient demographics, sport participation status, clinical presentation, physical examination, initial QuickDASH score, and treatment received were extracted from the charts (n = 36). Treatment modalities included PT, anterior scalene BTI, and first rib resection and anterior scalenectomy. RESULTS: 23 female and 13 male athletes were diagnosed with nTOS from 2000-2020. 53% of athletes had to limit athletic activity or stop competing due to nTOS-related symptoms. When considering all treatment modalities, 59% of previously restricted athletes were able to return to full competition (n = 10). The majority were able to return to full activity with conservative measures-either with PT alone, or in combination with BTI (n = 7). Three athletes required surgery before being able to return to full competition. Variables that were assessed as potential predictors of return to play included: presenting symptoms and symptom duration, gender, sport played, history of neck or shoulder injuries, mental health diagnosis, and initial QuickDASH score. On multivariate analysis, there were no statistically significant variables that predicted return to play regardless of treatment received. CONCLUSIONS: Many athletes with nTOS are unable to continue competing due to their symptoms. Over 50% of athletes with limited participation were able to return to full competition when considering all treatment modalities. In this cohort, no factors were identified which were predictive of return to play. The majority of athletes were able to return to full competition after non-invasive measures regardless of gender, symptom duration, severity of functional disability, sport played, or preexisting mental health diagnoses.