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<BIG>2016 OLYMPIC HOPEFUL HAS CAREER-SAVING SURGERY AT STONY BROOK</BIG>

Boxer Travels from Greece to Be Treated by Our Doctors to Get Back in the Ring

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<a href="http://medicine.stonybrookmedicine.edu/sdmpubfiles/pita-web.jpg" title="Boxer Nikoleta Pita (center) with her parents, post-op." class="colorbox colorbox-insert-image" rel="gallery-all"><img src="/sdmpubfiles/styles/240/public/pita-web.jpg?itok=v5TymMih" width="240" height="190" alt="Boxer Nikoleta Pita with her parents post-op" title="Boxer Nikoleta Pita (center) with her parents, post-op." class="image-240" /></a>
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Nikoleta Pita (center) with her parents, post-op. (Click on photo to enlarge.)
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STONY BROOK, NY, September 15, 2014 — For the past five years, 17-year-old Nikoleta Pita of <a href="http://www.piraeus-greece.org/piraeus-history.html" target="_blank">Piraeus, Greece</a>, has dreamed of making her country's Olympic boxing team. As a two-year national team member with a strong won-lost record, her dream was getting close to becoming a reality.

But almost a year ago, after a period of intense weight training, her right arm and shoulder suddenly swelled up and became very painful. And she developed numbness in her fingers.

Doctors in Greece told her she had clotted her right subclavian and axillary veins, the main veins draining the arm, and to stop everything — making her dream to become an Olympian come to a sudden halt.

Ms. Pita was diagnosed with thoracic outlet syndrome (TOS), a disorder that occurs when the blood vessels or nerves of the arm become compressed in the space between the collarbone and the first rib (thoracic outlet).

She was offered only conservative treatment with blood thinners by her doctors in Greece, who strongly suggested that she should completely abandon boxing or any other sport that involves intense weight training of the arms.

The boxer in Ms. Pita was hit hard by all this, but she wasn't going to give up.

With the support of her family she found out that a surgical treatment could help her keep her boxing career alive, but she would have to travel abroad to get the treatment she needed.

Through a family friend who had visited Stony Brook Medicine as an observing physician, Ms. Pita and her parents — Archilleas and Agapi Pita — learned of a doctor that could take care of her problem in the United States.

<a href="/surgery/people/faculty/dr-apostolos-k-tassiopoulos">Apostolos K. Tassiopoulos, MD</a>, professor of surgery and chief of vascular surgery, who was in Athens for a scientific meeting, met with Ms. Pita and her family, and he discussed the surgical treatment that could get their daughter back in the ring.

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Drs. Thomas Bilfinger (left) and Apostolos Tassiopoulos, who operated on Ms. Pita.
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Ms. Pita arrived in New York on August 31. The next day, Dr. Tassiopoulos and his colleague <a href="/surgery/people/faculty/dr-thomas-v-bilfinger">Thomas V. Bilfinger, MD, ScD</a>, professor of surgery and director of thoracic surgery, performed the surgery together to remove the first rib and free the attached muscles in order to free the compressed vein.

The surgeons made an incision in the armpit, and then removed the rib and the muscle attached to it, which allowed for more space around the vein. Patients usually need physical therapy after surgery to get their strength back.

One day after surgery, Ms. Pita felt great and ready to get back to her dream. "I'm feeling really strong, physically and mentally," she said. "This has definitely changed my life — Stony Brook saved my career, saved my dream."

Just after one week in the United States, Ms. Pita and her parents flew back to Greece.

<div class="subhead">About Thoracic Outlet Syndrome</div>

Common causes of TOS can include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. However, often doctors cannot determine the exact cause of this syndrome.

TOS symptoms can vary, depending on which structures are compressed.

When nerves are compressed, signs and symptoms of TOS include wasting in the fleshy base of the thumb (Gilliatt-Sumner hand); numbness or tingling in the arm or fingers; pain or aches in the neck, shoulder, or hand; and weakening grip.

The hallmark of venous compression is painful swelling of the forearm and back of the hand particularly, often accompanied by a bluish discoloration of the skin. Symptoms may include numbness, tingling, aching, swelling of the extremity and fingers, and weakness of the neck or arm.

<div class="callout">The purpose of thoracic outlet surgery is to release or remove the structures causing compression of the nerve or blood vessels.</div>

When arteries are compressed, the most prominent features are change in color and cold sensitivity in the hands and fingers, swelling, heaviness, paresthesias (tingling, tickling, or burning sensation of the skin), and poor blood circulation in the arms, hands, and fingers.

TOS is more common in women. The onset of symptoms usually occurs between the ages of 20 and 50. Doctors usually recommend nerve conduction studies, electromyography, or imaging studies to confirm or rule out a diagnosis of TOS.

Common treatment for TOS usually involves physical therapy and pain relief measures. Often, when only nerves are compressed but blood vessels are intact, patients will improve with these approaches.

However, when clots develop in the blood vessels or when pain from nerve compression is not improved with conservative measures, doctors usually recommend surgery.

The purpose of thoracic outlet surgery is to release or remove the structures causing compression of the nerve or blood vessels. TOS is known to affect athletes, particularly overhead athletes such as swimmers and baseball players. With appropriate care, these athletes can return to full activity within three to four months from surgery.

<a href="http://www.vascularweb.org/vascularhealth/Pages/thoracic-outlet-syndrom…; target="_blank">Click here</a> for more information about thoracic outlet syndrome. For consultations/appointments with our surgeons, call 631-444-4545.