Thoracic Outlet Syndrome in Athletes: A Narrative Review of Diagnostic Challenges, Management Strategies, and Return-to-Play Outcomes.
Kakamd FH, Abdulkarim MM, Asaad SK, Ghafour AK, Ahmed HH, Raoof SS et al. · Annals of vascular surgery · 2026
Introduction: Thoracic outlet syndrome (TOS) is a compression disorder involving the brachial plexus, subclavian artery, or subclavian vein within the thoracic outlet. Athletes represent a distinct population in whom delayed diagnosis may
Result: in career-threatening injuries.
Objectives: This review aimed to: (i) identify diagnostic pitfalls in athletes not captured by conventional provocative tests; (ii) evaluate conservative and operative management by TOS subtype; (iii) synthesize return-to-play (RTP) rates, timelines, and clearance criteria; and (iv) highlight methodological limitations and propose minimum reporting standards for future athlete-specific studies.
Methods: PubMed/MEDLINE, Scopus, and Google Scholar were searched from inception to July 2026 using controlled vocabulary and free-text terms for TOS, its subtypes, Paget-Schroetter syndrome, and athletic populations. Reference lists were hand-searched. Studies addressing TOS diagnosis, classification, pathophysiology, management, or RTP in athletes were eligible regardless of
Design: , reflecting limited randomized evidence. Journal legitimacy was screened using the Kscien's list.
Results: nTOS is the predominant form in athletes and usually improves with 4-6 months of rehabilitation, whereas refractory cases may require surgery. vTOS/Paget-Schroetter syndrome requires urgent thrombolysis and early first-rib resection; aTOS is rare but limb-threatening and requires prompt surgery. Mixed presentations occur in up to 23% of surgical cases.
Conclusions: Outcomes are favorable with subtype-specific diagnosis and
Objective: RTP criteria. However, evidence is limited by retrospective, single-center studies with pooled subtypes, inconsistent RTP definitions, and selective reporting. Prospective, sport-specific studies using standardized outcomes are needed.