Diagnosis and Surgical Management of the Thoracic-Outlet Syndrome

Abstract

Peripheral neuropathies of the upper extremity are too often attributed to distally located nerve compressions. By contrast, little attention is paid to proximal sites of compression characterized by the manifestation of neural and/or vascular signs (Mumenthaler und Schliack 1982; Jaeger et al. 1986; Wilhelm and Wilhelm 1985). Among these, the thoracic outlet syndrome (TOS) is of particular practical relevance (Fig. 1; Mumenthaler and Schliack, 1982). In view of the specific anatomy involved, compression of the brachial plexus and/or brachial and subclavian vessels by the scalene muscles, the first rib, or the clavicle must be considered in the differential diagnosis of this syndrome. Abnormal structures, such as the presence of cervical ribs and hypertrophic ligamentous structures, may also play an important role in the pathogenesis of TOS. In this report we describe selected cases representing examples of each of the above anatomical conditions to demonstrate the direct relationship between clinical signs and underlying morphology in TOS.