McCarthy W J, Yao J S, Schafer M F, Nuber G, Flinn W R, Blackburn D, Suker J R
Department of Surgery, Northwestern University Medical School, Chicago, IL 60611.
J Vasc Surg. 1989 Feb;9(2):317-27.
Between 1983 and 1986, 23 athletes were evaluated for arm and hand complaints. Eleven players had symptoms of thoracic outlet compression. Severe arm fatigue (eight patients) and finger ischemia (three patients) were the presenting symptoms. In the remaining 12 athletes, symptoms of hand ischemia were predominant. Noninvasive testing with Doppler ultrasonography and duplex scanning (positional testing and finger systolic pressure recording) and cold immersion were used to aid in diagnosis. In the 11 athletes with thoracic outlet compression, arteriography confirmed the finding with compression of the subclavian artery in five, the axillary artery in one, both subclavian and axillary arteries in two, posterior humeral circumflex artery in one, and subclavian aneurysm in two. Compression of the suprascapular artery was identified in four, the subscapular artery in two, and the posterior humeral circumflex artery in one. Thrombosis of a first baseman's ulnar artery and occlusion of the palmar arch in a frisbee player were documented by arteriography. Decompression of the thoracic outlet consisted of anterior scalenectomy in five, pectoralis minor muscle division in one, and resection of both muscles in two. Removal of cervical rib with interposed vein graft was performed in the two players with arterial aneurysm. Hand ischemia in the remaining athletes was treated conservatively with Dextran-heparin infusion for acute ischemia. Repeat noninvasive study of all players demonstrated absence of compression in their playing position, and all have resumed their playing careers. Hand ischemia in athletes can be evaluated noninvasively and treated conservatively. Resection of hypertrophied muscles to decompress the thoracic outlet together with release of branch artery compression in selected athletes promotes perfusion to arm and shoulder muscles and helps to avoid the catastrophic complication of repetitive trauma leading to sudden arterial thrombosis.
1983年至1986年间，对23名有手臂和手部不适的运动员进行了评估。11名运动员有胸廓出口综合征的症状。主要症状为严重的手臂疲劳（8例）和手指缺血（3例）。其余12名运动员以手部缺血症状为主。采用多普勒超声和双功扫描（体位试验及手指收缩压记录）及冷浸试验等无创检查辅助诊断。在11例胸廓出口综合征的运动员中，动脉造影证实：5例为锁骨下动脉受压，1例为腋动脉受压，2例为锁骨下动脉和腋动脉均受压，1例为旋肱后动脉受压，2例为锁骨下动脉瘤。4例为肩胛上动脉受压，2例为肩胛下动脉受压，1例为旋肱后动脉受压。动脉造影证实一名一垒手尺动脉血栓形成及一名飞盘运动员掌弓闭塞。胸廓出口减压术包括5例行前斜角肌切除术，1例行胸小肌切断术，2例行双肌切除术。2例动脉动脉瘤患者行颈肋切除并植入静脉移植物。其余运动员的手部缺血采用右旋糖酐-肝素输注治疗急性缺血。对所有运动员重复进行无创检查，结果显示他们在比赛姿势时无压迫，所有运动员均已恢复职业生涯。运动员的手部缺血可通过无创检查进行评估并采用保守治疗。对部分运动员切除肥大肌肉以减压胸廓出口并解除分支动脉受压，可促进手臂和肩部肌肉的灌注，并有助于避免重复性创伤导致突然动脉血栓形成这一灾难性并发症。
