THORACIC OUTLET SYNDROME IN CHILDREN

Thoracic outlet syndrome, although uncommon in children, may be precip itated during rapid growth in adolescence, especially in association w ith a cervical rib. Four children exhibited the aching, tiredness in t he limb, and occasional paresthesia in adolescence. Two had a cervical rib requiring removal, after which the symptoms disappeared. The othe r two were treated nonoperatively with shoulder-strengthening exercise s and avoidance of posturing that elicited the symptoms. It is propose d that in a child, the anatomy of the thoracic outlet is constantly ch anging with growth and development of the structures that form the tho racic outlet, as well as those that traverse the outlet itseIf. A cons ervative approach to these symptoms is warranted in the first instance to allow further growth and remodeling of the thoracic outlet, which may be sufficient to accommodate the nerve roots and brachial plexus a nd alleviate the symptoms, Excision of the cervical rib in the presenc e of increasing and chronic Symptoms can be quite beneficial.