Sixteen-year-old Ian is a dedicated, hard-working student athlete – and his game is tennis. His mother, Karen, proudly boasts about his commitment to tennis. “He has given up a lot to pursue his sport,” she says. Ian attends a private cyber-school program that affords Ian and his family, who live in Montgomery County, Pa, more flexibility to manage his demanding tennis training schedule.
When Ian’s dominant hand, arm and shoulder began to ache last winter, Karen and Ian sought treatment for what they thought was tennis elbow — a common orthopedic issue.
The pain continued and he was suffering, Karen recalls. “Ian had little use of his hand for weeks, it kept him up during the night, and he couldn’t even write nor do his schoolwork. We needed to find out how to treat his condition,” she shares.
When one of Ian’s doctors discovered a lump in his neck, Ian was sent for further tests and was then referred to Temple University Hospital. “We all felt it was an emergency, and I knew Temple has an excellent vascular program,” Karen says. “We learned after tests at Temple that not only did Ian have an aneurysm—a bulging blood vessel—but he had debilitating blood clots in his arm and hand. None of those showed on the MRIs.”
What had baffled the other physicians, Karen says, is that it wasn’t an orthopedic issue facing Ian, it was a vascular condition: thoracic outlet syndrome. The disorder arises from compression of the arteries, veins and nerves in the thoracic outlet, a small space underneath the clavicle (breastbone). According to Scott Golarz, MD, FACS, a vascular surgeon in the Temple Heart & Vascular Institute, “The majority of thoracic outlet patients we care for have severe compression of the nerves. These tend to be young or working-age people who use their arms and shoulders in the course of their jobs. But occasionally we see the arterial variety, which can be very dangerous.”
Dr. Golarz explains that in some instances hereditary issues lead to the condition. In Ian’s case it was an extra rib, Dr. Golarz affirms. “Over time and especially with repetitive use (as with sports) this can progressively damage the artery, nerves and veins as they pass through the shoulder. In its most dangerous form, the artery is so badly damaged that it grows and can even throw off clots,” says Dr. Golarz. “It’s these clots that can damage and even destroy the arm and hand.”
Dr. Golarz diagnosed Ian’s thoracic outlet syndrome and corrected the problem through decompression surgery, a complex procedure that involved removing a rib and part of a muscle and then cleaning up nerve damage and scar tissue around the nerves.