Evolution of Diagnostic and Surgical Standards for Thoracic Outlet Syndrome in Elite Athletes: From Case Report Insights to Modern Vascular Surgery Algorithms
DOI:
https://doi.org/10.12775/QS.2026.75.75722Keywords
Keywords: Thoracic Outlet Syndrome; Paget-Schroetter syndrome; cross-country skiing; robotic first rib resection; vascular surgery; sports medicine; Quality in Sport.Abstract
Background. Thoracic Outlet Syndrome (TOS), particularly venous TOS (vTOS), is a career-threatening neurovascular condition in elite athletes. A historical case of an elite Polish skier highlighted how incomplete decompression led to premature career termination.
Aim. To review the evolution of diagnostic, endovascular, and surgical strategies for athletic TOS over the past decade and propose a modernized Return-to-Play (RTP) algorithm based on SVS guidelines.
Material and methods. A systematic review of PubMed, Scopus, Google Scholar, and APCZ UMK databases (2015–2026) was performed, focusing on vTOS management, robotic resections, and ultrasound-guided blocks.
Results. Published athletic cohorts demonstrate high rates of return to competitive sport following appropriate surgical decompression, although reported outcomes vary according to TOS subtype, athletic population, surgical technique, and the definition of return to play. In professional baseball players, 79% returned to the same or a higher level of competition following surgery (Chauhan et al., 2024). Minimally invasive approaches, including robotic first rib resection and VATS, may reduce surgical morbidity while providing adequate decompression in appropriately selected patients.
Conclusions. Early complete surgical decompression is the current gold standard for athletes with vTOS. Incorporating robotic techniques and dynamic vascular imaging optimizes clinical outcomes and preserves athletic careers.
References
1. Chauhan, A., Chalmers, P. N., Erickson, B. J., Thompson, R., Pearl, G. J., Romeo, A. A., Hoenecke, H. R., Ma, K., Tenner, Z., & Fronek, J. (2024). Performance and Return to Play After Surgery for Thoracic Outlet Syndrome in Professional Baseball Players: A Matched Cohort Analysis. The American Journal of Sports Medicine, 52(7), 1692–1699. https://doi.org/10.1177/03635465241243244
2. Colbert, L., Michener, L. A., & Basic, D. (2022). Rehabilitation in Overhead Athletes With Thoracic Outlet Syndrome: An Evidence-Based Framework. Journal of Sport Rehabilitation, 31(3), 340–349. https://doi.org/10.1123/jsr.2021-0201
3. Garamond, A., Lapeyre, M., Balla, L., & Feugier, P. (2021). Management of Venous Thoracic Outlet Syndrome in Elite Athletes: A Systematic Review and Meta-Analysis. Annals of Vascular Surgery, 73, 412–422. https://doi.org/10.1016/j.avsg.2020.12.018
4. Gharagozloo, F., Meyer, M., Tempesta, B. J., & Margolis, M. (2021). Robotic first rib resection for thoracic outlet syndrome. Journal of Thoracic Disease, 13(10), 6141–6154. https://doi.org/10.21037/jtd-21-1056
5. Illig, K. A., Donahue, D., Duncan, A., Freischlag, J., Gelabert, H., Johansen, K., Jordan, S., Sanders, R., & Thompson, R. (2016). Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. Journal of Vascular Surgery, 64(1), e23–e35. https://doi.org/10.1016/j.jvs.2016.04.039
6. Jones, M. R., Prabhakar, A., Viswanath, O., Urits, I., Green, J. B., Kendrick, J. B., Brunk, A. J., Eng, M. R., Orhurhu, V., Cornett, E. M., & Kaye, A. D. (2019). Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment. Pain and Therapy, 8(1), 5–18. https://doi.org/10.1007/s40122-019-0124-2
7. Kuhn, J. E., Lebus, G. F., & Bible, J. E. (2015). Thoracic outlet syndrome. Journal of the American Academy of Orthopaedic Surgeons, 23(4), 222–232. https://doi.org/10.5435/JAAOS-D-13-00215
8. Markiewicz-Zahorski, M., & Gawroński, W. (2019). Thoracic Outlet Syndrome as a cause of career termination in an elite youth cross-country skier – case report. Quality in Sport, 5(4), 35–48. https://doi.org/10.12775/QS.2019.05.04.004
9. Napierała, M., Cieślicka, M., & Żukow, W. (2018). Assessment of physical fitness and health-related quality of life in athletes. Journal of Education, Health and Sport, 8(9), 112–124. https://doi.org/10.5281/zenodo.1418901
10. Pesser, N., Goetschen, L., van der Woude, P. C., van Sambeek, M. R. H. M., & Teijink, J. A. W. (2021). Feasibility and Diagnostic Accuracy of Ultrasound-Guided Anterior Scalene Muscle Block in Neurogenic Thoracic Outlet Syndrome. Journal of Vascular Surgery, 74(5), 1625–1632. https://doi.org/10.1016/j.jvs.2021.04.062
11. Shutze, W., Richardson, B., Shutze, R., Ditmars, M., & Briers, L. (2017). Midterm and long-term follow-up in competitive athletes undergoing thoracic outlet decompression for neurogenic thoracic outlet syndrome. Journal of Vascular Surgery, 66(6), 1798–1805. https://doi.org/10.1016/j.jvs.2017.04.061
12. StatPearls Publishing. (2025). Paget-Schroetter Syndrome. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK482416/
13. Thompson, J. F., Winterborn, R. J., Bays, S., White, H., & Johnston, A. (2011). Venous thoracic outlet compression and the Paget-Schroetter syndrome: a review and recommendations for management. Cardiovascular and Interventional Radiology, 34(5), 903–910. https://doi.org/10.1007/s00270-011-0148-0
14. Vemuri, C., Salehi, P., Benenati, J., & Thompson, R. W. (2020). Outcomes of early surgical intervention for venous thoracic outlet syndrome in competitive overhead athletes. Journal of Vascular Surgery, 72(1), 205–212. https://doi.org/10.1016/j.jvs.2019.09.052
15. Zeineddin, A., Alnuaimi, A., & El-Kersh, K. (2022). Robotic First Rib Resection for Thoracic Outlet Syndrome: Systemic Review and Surgical Outcomes. Journal of Surgical Research, 270, 312–320. https://doi.org/10.1016/j.jss.2021.09.028
16. Zheng, L., & Tan, X. (2022). Thoracic Outlet Syndrome in Sport: A Systematic Review. Frontiers in Physiology, 13, Article 838014. https://doi.org/10.3389/fphys.2022.838014
17. Chim, H., Hagan, R. R., et al. (2024). Consensus Recommendations for Neurogenic Thoracic Outlet Syndrome from the INTOS Workgroup. Plastic and Reconstructive Surgery – Global Open, 12(8), e6107. https://doi.org/10.1097/GOX.0000000000006107. Źródło potwierdza m.in. 17 rekomendacji konsensusowych oraz podejście do diagnostyki i leczenia nTOS.
18. Fisher, A. T., & Lee, J. T. (2024). Diagnosis and management of thoracic outlet syndrome in athletes. Seminars in Vascular Surgery, 37(1), 35–43. https://doi.org/10.1053/j.semvascsurg.2024.01.007. To bardzo dobre źródło do fragmentów o specyfice TOS u sportowców i diagnostyce.
19. Funakoshi, T., Furushima, K., Miyamoto, A., Kusano, H., Takahashi, T., Inoue, A., & Shimokobe, H. (2024). Thoracic outlet syndrome in overhead athletes. JSES International, 8(3), 620–629. https://doi.org/10.1016/j.jseint.2023.12.004. Badanie obejmowało 181 przypadków, w tym 79 sportowców overhead.
20. Jiang, D., Weiss, R., Lind, B., Morcos, O., & Lee, C. J. (2024). Predisposing Anatomy for Thoracic Outlet Syndrome and Functional Outcomes after Supraclavicular Thoracic Outlet Decompression in Athletes. Vascular Specialist International, 40, 19. https://doi.org/10.5758/vsi.240011. To źródło szczególnie dobrze pasuje do nowego fragmentu o anatomii predysponującej do TOS.
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Copyright (c) 2026 Aleksandra Markiewicz-Zahorski, Michał Markiewicz-Zahorski, Magdalena Markiewicz-Zahorski, Julia Jaszczyńska, Filip Kęska, Zoja Goti, Zofia Łubniewska, Jan Damian, Tomasz Kałużny, Maria Michalska
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